Englinton Med., P.C. v MVAIC (2007 NY Slip Op 50164(U))

Reported in New York Official Reports at Englinton Med., P.C. v MVAIC (2007 NY Slip Op 50164(U))

Appeal from an order of the Civil Court of the City of New York, Kings County (George J. Silver, J.), entered October 18, 2005, deemed an appeal from a judgment of the same court entered November 9, 2005. The judgment, entered upon an order granting plaintiff’s motion for summary judgment and denying defendant’s cross motion for summary judgment, awarded plaintiff the principal sum of $2,172.18 plus statutory interest and attorney’s fees.

Judgment affirmed without costs.

We have deemed the appeal from the order entered October 18, 2005 to be an appeal from the judgment entered pursuant to that order (see CPLR 5520 [c]; Neuman v Otto, 114 AD2d 791 [1985]).

In this action to recover assigned first-party no-fault benefits, we do not pass on the propriety of the determination of the court below that plaintiff established its prima facie case, as defendant raises no issue with respect thereto, but instead argues that plaintiff was not entitled to recover no-fault benefits as an assignee since it failed to establish that its assignor was a “qualified person.”

Contrary to defendant’s contention, the 30-day requirement within which to pay or deny a claim (11 NYCRR 65-3.8 [c]), which applies to defendant Motor Vehicle Accident Indemnification Corporation (sued herein as MVAIC) as well as to other insurers (Insurance Law § 5221 [b] [3]), begins to run upon defendant’s receipt of the claim forms, and does not depend upon whether the eligible injured person has been deemed to be a “qualified person” (Insurance Law § 5202 [b]) by defendant (New York Hosp. Med. Ctr. of Queens v Motor Veh. [*2]Acc. Indem. Corp., 12 AD3d 429, 430 [2004]). Were the rule otherwise, defendant would be able to “obviate the 30-day time requirement [which] would frustrate the purpose and objective of the No-Fault Law” to ensure prompt payment of first party no-fault benefits without regard to fault, and of the 30-day requirement “to provide a tightly-timed process of claim disputation and payment” (New York Hosp. Med. Ctr. of Queens v Motor Veh. Acc. Indem. Corp., 12 AD3d at 430, quoting Presbyterian Hosp. in City of N.Y. v Maryland Cas. Co., 90 NY2d 274, 281 [1997]). Inasmuch as defendant admittedly neither denied the claims within 30 days after their receipt nor sought to extend that time by timely requesting verification, it was precluded from raising most defenses (see Presbyterian Hosp. in City of N.Y. v Maryland Cas. Co., 90 NY2d 274, supra).

It is noted that although defendant purportedly sent to plaintiff provider on July 9, 2003 and August 6, 2003, letters requesting information in order to determine whether plaintiff’s assignor was a “qualified person,” it failed to establish by competent evidence that it did so (see Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [2001]). Moreover, defendant’s letter of October 17, 2003, addressed to a law firm, and indicating that benefits were denied based upon plaintiff’s assignor’s failure to demonstrate that she was a “qualified person,” was not a valid request for verification since it did not demand or require a response (New York & Presbyt. Hosp. v Eagle Ins. Co., 17 AD3d 646 [2005]). Nor could it be considered a proper denial since it was not “on the prescribed denial of claim form” (Mount Sinai Hosp. v Triboro Coach, 263 AD2d 11, 16 [1999]) or on “a form or letter approved by the department” containing “substantially the same information as the prescribed form” (11 NYCRR 65-3.8 [c] [1]). Accordingly, plaintiff was entitled to summary judgment, as the court below properly determined.

Pesce, P.J., Rios and Belen, JJ., concur.
Decision Date: January 31, 2007