October 11, 2016

Island Life Chiropractic, P.C. v Travelers Ins. Co. (2016 NY Slip Op 51511(U))

https://www.beynensonlaw.com/case-law/island-life-chiropractic-p-c-v-travelers-ins-co-2016-ny-slip-op51511u/

Court: Appellate Term, Second Department
Decided: October 11, 2016
Citation: 2016 NY Slip Op 51511(U) · 53 Misc 3d 140(A)
Posture: Summary judgment
Outcome: Insurer prevailed
Issues: Verification requests Timeliness and preclusion
Legal questions: Proof of mailing · Outstanding verification and premature actions (see the maps)

Cite as

Island Life Chiropractic, P.C. v Travelers Ins. Co., 53 Misc 3d 140(A), 2016 NY Slip Op 51511(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2016)

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 insurer established proper mailing of verification requests and nonreceipt of the requested verification, making the action premature. The provider appealed dismissal of its assigned first-party no-fault claims. The insurer's submissions supported a presumption that both the initial and follow-up requests had been properly mailed and demonstrated that the verification remained outstanding. Following Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co. on prematurity, the Appellate Term, Second Department, affirmed the order granting the insurer's motion for summary judgment dismissing the complaint.

Reported in New York Official Reports at Island Life Chiropractic, P.C. v Travelers Ins. Co. (2016 NY Slip Op 51511(U))

[*1]

Island Life Chiropractic, P.C. v Travelers Ins. Co.

2016 NY Slip Op 51511(U) [53 Misc 3d 140(A)]

Decided on October 11, 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This opinion is uncorrected and will not be published in the printed Official Reports.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 October 11, 2016

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

PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2014-277 Q C

Island Life Chiropractic, P.C., as Assignee of Karolane Jean Louis, Appellant,
against
Travelers Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Ulysses Bernard Leverett, J.), entered December 11, 2013. The order granted defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order is affirmed, with $25 costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order granting defendant’s motion for summary judgment dismissing the complaint on the ground that the action was premature because plaintiff had failed to provide requested verification.

Contrary to plaintiff’s contentions, the proof submitted by defendant in support of its motion was sufficient to give rise to a presumption that the initial and follow-up verification requests had been properly mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]), and to demonstrate that defendant had not received the requested verification and, thus, that plaintiff’s action is premature (see Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492 [2005]). Plaintiff’s remaining contention lacks merit (see Rogy Med., P.C. v Clarendon Natl. Ins. Co., 43 Misc 3d 133[A], 2014 NY Slip Op 50629[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2014]).

Accordingly, the order is affirmed.

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

Decision Date: October 11, 2016

Legal questions (2)

Questions 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.

Proof of mailing

Open the full map

Did a party’s evidence establish that it mailed a no-fault claim, denial, verification request or examination notice?

This decision: The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice

Held the insurer's proof sufficient to raise a presumption that its initial and follow-up verification requests were properly mailed, rejecting the provider's challenge to that proof.

Insurer proved mailingInsurer failed to proveProvider proved mailingProvider failed to proveTriable issue on mailingMixed rulingsThis decisionCites it or cited by itCited or followed

Of the 1,400 decisions on this question in the Second Department courts and the Court of Appeals, 809 (this one included) are in the same category.

Outstanding verification and premature actions

Open the full map

Did unanswered verification requests make the provider’s claim premature, or justify denying it for nonresponse?

This decision: Timely requests went unanswered; the claim is not overdue and the action is premature

Held the action premature because the insurer showed it properly mailed initial and follow-up verification requests and never received the requested verification, so dismissal was affirmed.

Premature: verification outstandingNonresponse denial upheldTriable issueInsurer's showing failsProvider compliedThis decisionCites it or cited by itCited or followed

Of the 385 decisions on this question in the Second Department courts and the Court of Appeals, 153 (this one included) are in the same category.

Cited in this decision

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

St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co. (2008 NY Slip Op 04072) FollowedThe insurer raised factual issues concerning a proper timely denial and its entitlement to deny the hospital's claim.
Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co. (2005 NYSlipOp 09484) FollowedAn insurer need not pay or deny a no-fault claim until it receives all relevant verification requested.
Rogy Med., P.C. v Clarendon Natl. Ins. Co. (2014 NY Slip Op 50629(U)) FollowedThe insurer established lack of medical necessity for three claims and outstanding verification for two, but failed on two others.

Similar decisions

Island Life Chiropractic, P.C. v American Tr. Ins. Co. (2016 NY Slip Op 51541(U))The insurer's cross motion for summary judgment dismissing the provider's claims as premature for outstanding verification was denied on appeal.
Island Chiropractic Testing, P.C. v Praetorian Ins. Co. (2014 NY Slip Op 51795(U))The provider's verification responses presented a factual dispute that precluded summary judgment for either party.
Island Life Chiropractic, P.C. v National Liab. & Fire Ins. Co. (2016 NY Slip Op 50927(U))The insurer's summary judgment cross motion asserting prematurity for failure to provide requested verification was denied on appeal.
Harbor Chiropractic, P.C. v Travelers Ins. Co. (2017 NY Slip Op 50959(U))The provider failed to show that requested verification was supplied before suit, leaving its action premature.
Island Life Chiropractic, P.C. v 21st Century Ins. Co. (2017 NY Slip Op 51824(U))The provider failed to establish that its claims were denied late or that timely denials were conclusory, vague or legally meritless.