March 5, 2007

DSL Med. Practice, P.C. v American Tr. Ins. Co. (2007 NY Slip Op 50398(U))

Headnote

The court considered the fact that the defendant insurance company had issued timely initial and follow-up verification requests for the assignor's social security number in response to the plaintiff's claims for medical services. The main issue decided was whether the insurance company had properly denied payment based on the unsatisfied verification requests. The court held that the insurance company had established the basis for its knowledge of the preparation and issuance of the verification request letters, and therefore, the court affirmed the denial of the plaintiff's motion for summary judgment and granted the defendant partial summary judgment on its cross motion. The court also dismissed those claims for which the insurance company had issued verification requests as premature, and found that there was a triable issue for the remaining claim.

Reported in New York Official Reports at DSL Med. Practice, P.C. v American Tr. Ins. Co. (2007 NY Slip Op 50398(U))

DSL Med. Practice, P.C. v American Tr. Ins. Co. (2007 NY Slip Op 50398(U)) [*1]

DSL Med. Practice, P.C. v American Tr. Ins. Co.

2007 NY Slip Op 50398(U) [14 Misc 3d 145(A)]

Decided on March 5, 2007

Appellate Term, Second Department

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on March 5, 2007

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 2nd and 11th JUDICIAL DISTRICTS

PRESENT: : PESCE, P.J., WESTON PATTERSON and GOLIA, JJ
2005-1850 K C.

DSL Medical Practice, P.C. a/a/o Marcos Marinez, Appellant,
against
American Transit Insurance Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Eileen Nadelson, J.), entered September 26, 2005. The order, insofar as appealed from, denied plaintiff’s motion for summary judgment and granted defendant partial summary judgment on its cross motion.

Order, insofar as appealed from, affirmed without costs.

In this action to recover first-party no-fault benefits for medical services provided its assignor, defendant established that in response to plaintiff’s claims for $627.50, $540.80, $612.39, and $338, it issued timely initial and follow-up verification requests, for assignor’s social security number, all of which remain unsatisfied. Defendant’s affidavits set forth the basis of the affiants’ knowledge of the preparation and issuance of the verification request letters and a sufficiently detailed description of standard office mailing procedure so as to give rise to the presumption of mailing (see New York & Presbyt. Hosp. v Allstate Ins. Co., 29 AD3d 574 [2006]). As an assignor’s social security number is a proper subject of verification (Olympic Chiropractic, P.C. v American Tr. Ins. Co., 14 Misc 3d 129[A], 2007 NY Slip Op 50011[U] [App Term, 2d & 11th Jud Dists]; see generally Cassano v Carb, 436 F3d 74 [2d Cir 2006]), the court below properly denied plaintiff’s motion for summary judgment, granted defendant’s cross motion for summary judgment as to those claims under which it cross-moved for relief, and dismissed those claims as premature (Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492, 493 [2005]; New York & Presbyt. Hosp. v Progressive Cas. Ins. Co., 5 AD3d 568, 570 [2004]; A.B. Med. Servs. PLLC v Utica Mut. Ins. Co., 10 Misc 3d 50, 54 [App Term, 2d & 11th Jud Dists 2005]). With respect to the remaining [*2]claim, for $311.53, a triable issue exists as to whether defendant paid for said treatment as part of a prior claim submitted by plaintiff.

Pesce, P.J., Weston Patterson and Golia, JJ., concur.
Decision Date: March 5, 2007