December 23, 2011
Five Boro Psychological Servs., P.C. v Clarendon Natl. Ins. Co. (2011 NY Slip Op 52365(U))
https://www.beynensonlaw.com/case-law/five-boro-psychological-servs-p-c-v-clarendon-natl-ins-co-2011-ny-slip-op52365u/
- Decided
- December 23, 2011
- Citation
- 2011 NY Slip Op 52365(U) · 34 Misc 3d 133(A)
- Posture
- Summary judgment
- Outcome
- Insurer prevailed
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 Five Boro Psychological Servs., P.C. v Clarendon Natl. Ins. Co. (2011 NY Slip Op 52365(U))
| Five Boro Psychological Servs., P.C. v Clarendon Natl. Ins. Co. |
| 2011 NY Slip Op 52365(U) [34 Misc 3d 133(A)] |
| Decided on December 23, 2011 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports. |
SUPREME COURT OF THE STATE OF NEW YORK
APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., GOLIA and STEINHARDT, JJ
2010-1381 K C.
against
Clarendon National Insurance Company, Appellant.
Appeal from an order of the Civil Court of the City of New York, Kings County (Genine D. Edwards, J.), entered January 26, 2010. The order denied defendant’s motion for summary judgment dismissing the complaint without prejudice to renewal upon proof that plaintiff’s assignor “was given notice per HIPAA.”
ORDERED that the order is reversed, without costs, and defendant’s motion for summary judgment dismissing the complaint is granted.
In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from an order denying its motion for summary judgment dismissing the complaint without prejudice to renewal upon proof that plaintiff’s assignor “was given notice per HIPAA.”
On appeal, defendant contends, and plaintiff concedes, that no HIPAA authorization or notification was required. Defendant argues that it was entitled to summary judgment dismissing the complaint because it had not received written notice of the accident, which was a condition precedent to coverage.
Defendant established, through its submissions, that it had not received any written notice of the accident involving plaintiff’s assignor, that it had timely denied plaintiff’s claims on that basis, and that it had advised plaintiff in its denial that late notice might be excused if it was [*2]provided with “reasonable justification” for the failure to give timely notice (Insurance Department Regulations [11 NYCRR] §§ 65-1.1, 65-3.3 [e]). In opposition to defendant’s motion, plaintiff failed to demonstrate either that defendant had already been provided with timely written notice or that defendant had been provided with “reasonable justification” for the failure to comply with this requirement. Since compliance with the notice requirement of the policy is a condition precedent to coverage (see New York & Presbyt. Hosp. v Country Wide Ins. Co., 17 NY3d 586 [2011]) and since plaintiff failed to demonstrate the existence of a triable issue of fact (see Comfort Supply, Inc. v Clarendon Natl. Ins. Co., 33 Misc 3d 135[A], 2011 NY Slip Op 52018[U] [App Term, 2d, 11th & 13th Jud Dists 2011]), defendant was entitled to summary judgment dismissing the complaint.
Accordingly, the order is reversed and defendant’s motion is granted.
Pesce, P.J., Golia and Steinhardt, JJ., concur.
Decision Date: December 23, 2011
Cited in this decision
A label shows how this decision treated the case it cites.
- New York & Presbyt. Hosp. v Country-Wide Ins. Co. (2011 NY Slip Op 07149) FollowedA timely proof of claim does not satisfy the 30-day accident-notice requirement when submitted after that period expires.
- Comfort Supply, Inc. v Clarendon Natl. Ins. Co. (2011 NY Slip Op 52018(U))The insurer proved notice of the accident came more than 30 days afterward, and the provider offered no proof excusing the delay.
Similar decisions
- Five Boro Psychological Servs., P.C. v GEICO Gen. Ins. Co. (2012 NY Slip Op 51704(U))The insurer established timely mailing of its denial and lack of medical necessity through an unrebutted sworn peer review report.
- Five Boro Psychological Servs., P.C. v Progressive Northeastern Ins. Co. (2011 NY Slip Op 51528(U))A denial form offered to show that a claim was denied, rather than to prove its contents, needs no CPLR 4518 business-record foundation.
- Five Boro Psychological Servs., P.C. v Utica Mut. Ins. Co. (2011 NY Slip Op 51119(U))The insurer established that one claim was premature for unanswered verification and two others lacked medical necessity.
- All Boro Psychological Servs., P.C. v Allstate Ins. Co. (2013 NY Slip Op 50307(U))The insurer failed to prove timely mailing of IME scheduling letters and therefore failed to establish tolling of its claim deadline.
- Five S & A Rehab Pt, P.C. v Praetorian Ins. Co. (2012 NY Slip Op 51724(U))The insurer's affirmed IME report established lack of medical necessity, and the provider failed to rebut that showing.