September 15, 2016

GL Acupuncture, P.C. v Allstate Ins. Co. (2016 NY Slip Op 51328(U))

Headnote

The main issue decided in this case was whether the defendant was entitled to summary judgment dismissing the complaint brought by the plaintiff, a provider seeking recovery of first-party no-fault benefits. The relevant facts considered by the court included the defendant's argument that it had fully paid the plaintiff for the services at issue in accordance with the workers' compensation fee schedule. On appeal, the plaintiff argued that the defendant had not sufficiently demonstrated that its denial of claim forms had been timely mailed. The court ultimately held that the defendant did not demonstrate its entitlement to summary judgment, reversed the lower court's order, and denied the defendant's motion for summary judgment dismissing the complaint.

Reported in New York Official Reports at GL Acupuncture, P.C. v Allstate Ins. Co. (2016 NY Slip Op 51328(U))

GL Acupuncture, P.C. v Allstate Ins. Co. (2016 NY Slip Op 51328(U)) [*1]

GL Acupuncture, P.C. v Allstate Ins. Co.

2016 NY Slip Op 51328(U) [53 Misc 3d 128(A)]

Decided on September 15, 2016

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This opinion is uncorrected and will not be published in the printed Official Reports.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 15, 2016

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

PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2014-529 Q C

GL Acupuncture, P.C., as Assignee of Richard Martinez, Appellant,
against
Allstate Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Cheree A. Buggs, J.), entered February 13, 2014. The order granted defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order is reversed, with $30 costs, and defendant’s motion for summary judgment dismissing the complaint is denied.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court which granted defendant’s motion for summary judgment dismissing the complaint. Defendant’s motion was based on the defense that it had fully paid plaintiff for the services at issue in accordance with the workers’ compensation fee schedule.

Plaintiff correctly argues on appeal that the affidavits submitted by defendant did not sufficiently set forth a standard office practice or procedure that would ensure that defendant’s denial of claim forms had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). Thus, defendant did not demonstrate its entitlement to summary judgment.

Accordingly, the order is reversed and defendant’s motion for summary judgment dismissing the complaint is denied.

Pesce, P.J., Aliotta and Solomon, JJ., concur.

Decision Date: September 15, 2016