January 18, 2008

East Coast Med. Care, P.C. v State Farm Mut. Auto Ins.Co. (2008 NY Slip Op 50118(U))

Headnote

The court considered the pretrial motion to preclude defendant's denial of claim forms and directed judgment in favor of the plaintiff in the principal sum of $8,715.82 in an action to recover first-party no-fault benefits. The main issue decided was whether defendant's NF-10 forms, which stated that each claim was denied based on an independent consultant's review, sufficiently apprised the plaintiff of the factual basis for the denials, in accordance with 11 NYCRR 65-3.8 (b)(4). The holding of the court was that defendant's NF-10 forms did sufficiently apprise the plaintiff of the factual basis for the denials, and therefore the motion to preclude defendant's NF-10 denial of claim forms should have been denied. The court reversed the order, denied the motion, and remanded the matter for further proceedings.

Reported in New York Official Reports at East Coast Med. Care, P.C. v State Farm Mut. Auto Ins.Co. (2008 NY Slip Op 50118(U))

East Coast Med. Care, P.C. v State Farm Mut. Auto Ins.Co. (2008 NY Slip Op 50118(U)) [*1]

East Coast Med. Care, P.C. v State Farm Mut. Auto Ins.Co.

2008 NY Slip Op 50118(U) [18 Misc 3d 133(A)]

Decided on January 18, 2008

Appellate Term, First 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This opinion is uncorrected and will not be published in the printed Official Reports.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 January 18, 2008

APPELLATE TERM OF THE SUPREME COURT, FIRST DEPARTMENT

PRESENT: McKEON, P.J., DAVIS, HEITLER, JJ
570161/07.

East Coast Medical Care, P.C. a/a/o Danielle Bobo, Francisco Hernandez, Silbert Clarke and Sarfraz Lallmahamd, Plaintiff-Respondent,
against
State Farm Mutual Auto Ins.Co., Defendant-Appellant.

Defendant appeals from an order of the Civil Court, Bronx County (Francis M. Alessandro, J.), dated February 4, 2005, which granted plaintiff’s pretrial motion to preclude defendant’s denial of claim forms and directed judgment in favor of plaintiff in the principal sum of $8,715.82.

Per Curiam.

Order (Francis M. Alessandro, J.), dated February 4, 2004, reversed, with $10 costs, motion denied and matter remanded for further proceedings.

In this action to recover first party no-fault benefits, plaintiff’s motion to preclude defendant’s NF-10 denial of claim forms should have been denied. Defendant’s NF-10 forms, which stated that each claim was denied based upon an independent consultant’s review, sufficiently apprised plaintiff of the factual basis for the denials (see 11 NYCRR 65-3.8 [b][4]; A.B. Med. Servs., PLLC v GEICO Cas. Ins. Co., 39 AD3d 778 [2007]).

THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.
Decision Date: January 18, 2008