October 26, 2005

Elite Chiropractic Servs., PC v Travelers Ins. Co. (2005 NY Slip Op 51735(U))

Headnote

The court considered the fact that plaintiff provided medical services to its assignor and submitted claims to the defendant insurer seeking first-party no-fault benefits. The main issue decided was whether the defendant insurer was obligated to pay or deny a claim when the plaintiff and its assignor failed to respond to timely requests for additional verification. The holding of the court was that the defendant insurer established its entitlement to summary judgment dismissing the complaint, as it was not obligated to pay or deny a claim until requested verifications were provided. The court found that the plaintiff and its assignor failed to respond to the defendant's timely requests for additional verification, making any claim for payment premature. Therefore, the defendant was not required to respond to the plaintiff's claims, and the claim for payment was not valid.

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)) [*1]

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This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on October 26, 2005

APPELLATE TERM OF THE SUPREME COURT, FIRST DEPARTMENT

PRESENT:
HON. LUCINDO SUAREZ, P.J.,
HON. WILLIAM P. McCOOE,
HON. PHYLLIS GANGEL-JACOB, , Justices.

Elite Chiropractic Services, PC as assignee of Josefine Adames, NY County Clerk’s Plaintiff-Respondent, No. 570354/05
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