September 8, 2017

Fema Med. Supply, Inc. v American Commerce Ins. Co. (2017 NY Slip Op 51160(U))

https://www.beynensonlaw.com/case-law/fema-med-supply-inc-v-american-commerce-ins-co-2017-ny-slip-op51160u/

Court: Appellate Term, Second Department
Decided: September 8, 2017
Citation: 2017 NY Slip Op 51160(U) · 57 Misc 3d 128(A)
Posture: Summary judgment
Outcome: Insurer prevailed
Issues: Provider's prima facie case
Legal questions: Claimant's prima facie case on motions (see the maps)

Cite as

Fema Med. Supply, Inc. v American Commerce Ins. Co., 57 Misc 3d 128(A), 2017 NY Slip Op 51160(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2017)

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.

The provider's summary judgment motion was denied because it failed to establish untimely or legally insufficient denials. The Appellate Term, Second Department, affirmed the order, insofar as appealed from, in the insurer's favor, finding no showing that the claims were not denied within 30 days or that timely denials were conclusory, vague or without merit as a matter of law.

Reported in New York Official Reports at Fema Med. Supply, Inc. v American Commerce Ins. Co. (2017 NY Slip Op 51160(U))

[*1]

Fema Med. Supply, Inc. v American Commerce Ins. Co.

2017 NY Slip Op 51160(U) [57 Misc 3d 128(A)]

Decided on September 8, 2017

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This opinion is uncorrected and will not be published in the printed Official Reports.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 September 8, 2017

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, MARTIN M. SOLOMON, JJ
2014-2754 Q C

Fema Medical Supply, Inc., as Assignee of Luc Evens, Appellant,
against
American Commerce Insurance Company, Respondent.

Amos Weinberg, Esq., for appellant. Bruno, Gerbino & Soriano, LLP (Mitchell L. Kaufman, Esq.), for respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Ulysses Bernard Leverett, J.), entered October 31, 2014. The order, insofar as appealed from, denied plaintiff’s motion for summary judgment.

ORDERED that the order, insofar as appealed from, is affirmed, with $25 costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from so much of an order of the Civil Court as denied plaintiff’s motion for summary judgment.

Plaintiff’s motion was properly denied, as plaintiff did not demonstrate either that defendant had failed to deny the claims at issue within the requisite 30-day period (see Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 25 NY3d 498 [2015]), or that defendant had issued timely denials of claim that were conclusory, vague or without merit as a matter of law (see Westchester Med. Ctr. v Nationwide Mut. Ins. Co., 78 AD3d 1168 [2010]; Ave T MPC Corp. v Auto One Ins. Co., 32 Misc 3d 128[A], 2011 NY Slip Op 51292[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2011]).

Accordingly, the order, insofar as appealed from, is affirmed.

PESCE, P.J., ALIOTTA and SOLOMON, JJ., concur.

Paul Kenny
Chief Clerk
Decision Date: September 08, 2017

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.

Claimant's prima facie case on motions

Open the full map

On summary judgment or another pretrial motion, what must a no-fault claimant show to establish its prima facie case?

This decision: Insufficient: claimant did not prove the claim was overdue (not paid or timely denied)

Held the provider's motion properly denied because it did not show the insurer failed to deny the claims within 30 days or that timely denials were conclusory, vague or without merit.

Proof sufficientMailing/receipt not shownOverdue not shownBusiness-record foundation lackingOther element missingThis decisionCites it or cited by itCited or followed

Of the 1,065 decisions on this question in the Second Department courts and the Court of Appeals, 247 (this one included) are in the same category.

Cited in this decision

A label shows how this decision treated the case it cites.

Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co. (2015 NY Slip Op 04787) FollowedA provider establishes entitlement to summary judgment on overdue no-fault claims with admissible proof of mailing and receipt of statutory claim forms.
Westchester Med. Ctr. v Nationwide Mut. Ins. Co. (2010 NY Slip Op 08933)The provider failed to establish entitlement to summary judgment because the insurer partially paid and denied the claim within 30 days.
Ave T MPC Corp. v Auto One Ins. Co. (2011 NY Slip Op 51292(U))The provider failed to establish summary judgment entitlement because nonpayment alone did not show an absent or legally insufficient denial.

Similar decisions

FEMA Med. Supply, Inc. v Country-Wide Ins. Co. (2018 NY Slip Op 50782(U))The provider failed to establish as a matter of law that it mailed its bills to the insurer.
Compas Med., P.C. v Fiduciary Ins. Co. of Am. (2015 NY Slip Op 51472(U))The provider's summary judgment motion was denied because it failed to establish prima facie entitlement on its no-fault claim.
(2014 NY Slip Op 51267(U))The provider's unopposed summary judgment motion was denied for failure to prove overdue payment or a legally deficient denial.
New Way Med. Supply Corp. v American Tr. Ins. Co. (2015 NY Slip Op 50422(U))The provider failed to establish an overdue claim or a timely denial that was conclusory, vague or legally without merit.
Daily Med. Equip. Distrib. Ctr., Inc. v American Tr. Ins. Co. (2016 NY Slip Op 51621(U))The insurer failed to prove IME nonappearance through a person with personal knowledge, while the provider failed to establish its prima facie case.