October 26, 2005
Elite Chiropractic Servs., PC v Travelers Ins. Co. (2005 NY Slip Op 51735(U))
https://www.beynensonlaw.com/case-law/elite-chiropractic-servs-pc-v-travelers-ins-co-2005-ny-slip-op-51735u/
- Decided
- October 26, 2005
- Citation
- 2005 NY Slip Op 51735(U) · 9 Misc 3d 137(A)
- Posture
- Summary judgment
- Outcome
- Insurer prevailed
- Issues
- Verification requests
- Legal questions
- Outstanding verification and premature actions (see the maps)
Posture, outcome, issues and treatment by other decisions are Beynenson Law’s classification. Treatment labels are assigned by a language model reading the citing decision; negative and appeal-history labels are checked by a second reader.
Summary
Editorial summary by Beynenson Law, not part of the court’s decision.
Reported in New York Official Reports at Elite Chiropractic Servs., PC v Travelers Ins. Co. (2005 NY Slip Op 51735(U))
| Elite Chiropractic Servs., PC v Travelers Ins. Co. |
| 2005 NY Slip Op 51735(U) [9 Misc 3d 137(A)] |
| Decided on October 26, 2005 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports. |
APPELLATE TERM OF THE SUPREME COURT, FIRST DEPARTMENT
PRESENT:
HON. LUCINDO SUAREZ, P.J.,
HON. WILLIAM P. McCOOE,
HON. PHYLLIS GANGEL-JACOB, , Justices.
against
Travelers Insurance Company,Calendar No. 05-229 Defendant-Appellant.
Defendant appeals from that portion an order of the Civil Court, Bronx County entered January 24, 2005 (Larry Schachner, J.) which denied its cross motion for summary judgment dismissing the complaint.
PER CURIAM
Order entered January 24, 2005 (Larry Schachner, J.), modified to the extent of granting summary judgment to defendant dismissing the complaint; as modified, affirmed, without costs.
Plaintiff provided medical services to its assignor and subsequently submitted claims to defendant insurer seeking first-party no-fault benefits. Defendant delayed payment on the ground that plaintiff’s assignor failed to respond to timely requests for additional verification.
Defendant established its entitlement to summary judgment dismissing the complaint. An insurer is not obligated to pay or deny a claim until requested verifications have been provided (see 11 NYCRR § 65-3.8[b][3]). The record reveals that plaintiff and its assignor failed to respond to defendant’s timely requests for additional verification. Accordingly, the period within which defendant was required to respond to plaintiff’s claims did not begin to run, and any claim for payment was premature (see Nyack Hospital v State Farm Mutual Automobile Insurance Company, 19 AD3d 569 [2005]).
This constitutes the decision and order of this court.
I concur
Decision Date: October 26, 2005
Legal questions
A question of no-fault law this decision rules on, from our Legal Questions pages. Bars count the decisions on the question by year and court, coloured by category; circles are this decision and the decisions on the question it cites or that cite it. Point at a bar or circle for details. The categories and summaries are Beynenson Law’s classification, made by a language model and checked by a second reading.
Did unanswered verification requests make the provider’s claim premature, or justify denying it for nonresponse?
This decision: Timely requests went unanswered; the claim is not overdue and the action is premature
Held the complaint should be dismissed because the provider and its assignor failed to respond to the insurer's timely additional verification requests, so the time to pay or deny never began and the claim was premature.
Of the 38 decisions on this question in the First Department courts and the Court of Appeals, 23 (this one included) are in the same category. 2 decisions in other departments that cite or are cited by this one are on the full map.
Cited in this decision
A label shows how this decision treated the case it cites.
- Nyack Hosp. v State Farm Mut. Auto. Ins. Co. (2005 NY Slip Op 05278) FollowedA hospital's no-fault claim was premature because requested verification of the assignor's post-accident blood alcohol level remained outstanding.
Cited by
- Ocean Diagnostic Imaging, P.C. v Nationwide Mut. Ins. Co. (2006 NY Slip Op 50477(U))The provider's action was premature because the provider and assignor failed to respond to timely EUO verification requests.
Similar decisions
- Doctor Goldshteyn Chiropractic, P.C. v Travelers Indem. Co. (2017 NY Slip Op 51816(U))The provider's action was premature because the insurer had not received the requested verification.
- Great Health Care Chiropractic, P.C. v Travelers Ins. Co. (2015 NY Slip Op 51665(U))The insurer failed to establish a proper EUO nonappearance denial because its first EUO notice was mailed about 50 days after claim receipt.
- Harbor Chiropractic, P.C. v Travelers Ins. Co. (2017 NY Slip Op 50959(U))The provider failed to show that requested verification was supplied before suit, leaving its action premature.
- Innovative Chiropractic, P.C. v Travelers Ins. Co. (2010 NY Slip Op 50994(U))The insurer's peer review established lack of medical necessity, and the provider raised no triable issue in response.
- Island Life Chiropractic, P.C. v Travelers Ins. Co. (2016 NY Slip Op 51413(U))The provider's mailing affidavit raised a factual issue whether the insurer received requested verification, precluding dismissal as premature.