June 10, 2022

Jamaica Wellness Med., P.C. v MVAIC (2022 NY Slip Op 50574(U))

https://www.beynensonlaw.com/case-law/jamaica-wellness-med-p-c-v-mvaic-2022-ny-slip-op-50574u/

Court: Appellate Term, Second Department
Decided: June 10, 2022
Citation: 2022 NY Slip Op 50574(U) · 75 Misc 3d 138(A)
Posture: Summary judgment
Outcome: Provider prevailed
Later treatment: Followed in 1 later decision (see Cited by)
Issues: Timeliness and preclusion MVAIC
Legal questions: MVAIC eligibility: qualified covered person (see the maps)

Cite as

Jamaica Wellness Med., P.C. v MVAIC, 75 Misc 3d 138(A), 2022 NY Slip Op 50574(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2022)

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.

MVAIC's 30-day period to deny a claim or request verification runs from receipt, regardless of whether covered-person status is determined. MVAIC sought summary judgment dismissing two service-date claims on lack-of-medical-necessity grounds. Its contention that the period depended on determining whether the assignor was a covered person under Insurance Law § 5221 (b) (2) was rejected. MVAIC therefore failed to establish that it was not precluded from asserting the defense. The Appellate Term, Second Department, affirmed the order, insofar as appealed from, leaving the denial of summary judgment on those two claims intact.

Reported in New York Official Reports at Jamaica Wellness Med., P.C. v MVAIC (2022 NY Slip Op 50574(U))

[*1]

Jamaica Wellness Med., P.C. v MVAIC

2022 NY Slip Op 50574(U) [75 Misc 3d 138(A)]

Decided on June 10, 2022

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This opinion is uncorrected and will not be published in the printed Official Reports.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 June 10, 2022

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

PRESENT: : THOMAS P. ALIOTTA, P.J., WAVNY TOUSSAINT, DONNA-MARIE E. GOLIA, JJ
2020-95 K C

Jamaica Wellness Medical, P.C., as Assignee of Vera Babukyants, Respondent,

against

MVAIC, Appellant.

Marshall & Marshall, PLLC (Frank D’Esposito of counsel), for appellant. Kopelevich & Feldsherova, P.C. (David Landfair of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Rosemarie Montalbano, J.), entered August 27, 2019. The order, insofar as appealed from, denied the branches of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims for dates of service December 10, 2015 and January 12, 2016.

ORDERED that the order, insofar as appealed from, is affirmed, without costs.

In this action by a provider to recover assigned first-party no-fault benefits, defendant Motor Vehicle Accident Indemnification Corporation (sued herein as MVAIC) appeals from so much of an order of the Civil Court as denied the branches of MVAIC’s motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims for dates of service December 10, 2015 and January 12, 2016.

Contrary to MVAIC’s contention, the 30-day period within which MVAIC may timely deny a claim or request verification begins to run upon receipt of the claim without regard to whether MVAIC has determined that plaintiff’s assignor is a covered person within the meaning of Insurance Law § 5221 (b) (2) (see New York Hosp. Med. Ctr. of Queens v Motor Veh. Acc. Indem. Corp., 12 AD3d 429 [2004]; Active Care Med. Supply Corp. v MVAIC, 66 Misc 3d 128[A], 2019 NY Slip Op 52045[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2019]). As a result, with respect to the branches of MVAIC’s motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims for dates of service December 10, 2015 and January 12, 2016, MVAIC failed to establish that it is not precluded from interposing its defense of lack of medical necessity (see Active Care Med. Supply Corp. v [*2]MVAIC, 2019 NY Slip Op 52045[U]).

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

ALIOTTA, P.J., TOUSSAINT and GOLIA, JJ., concur.

ENTER:
Paul Kenny
Chief Clerk
Decision Date: June 10, 2022

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.

MVAIC eligibility: qualified covered person

Open the full map

Against MVAIC, was the claimant shown to be a qualified, covered person meeting article 52’s conditions?

This decision: MVAIC may not rely on the eligibility objection because of untimely denial/verification or waiver (rules on the question, but another ground decided the case)

Held MVAIC's 30-day period to deny or request verification ran from receipt of the claim regardless of whether it had determined the assignor was a covered person, so it failed to show it was not precluded from its lack-of-medical-necessity defense.

Found not eligibleClaimant's proof lackingMVAIC failed to proveFound eligibleUnresolved / for trialDefense precluded/waivedThis decisionCites it or cited by itCited or followed

Of the 223 decisions on this question in the Second Department courts and the Court of Appeals, 16 (this one included) are in the same category.

Cited in this decision

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

New York Hosp. Med. Ctr. of Queens v Motor Veh. Acc. Indem. Corp. (2004 NY Slip Op 08087) FollowedMVAIC must comply with the 30-day deadline to pay or deny a no-fault claim before qualifying the injured claimant.
Active Care Med. Supply Corp. v MVAIC (2019 NY Slip Op 52045(U)) FollowedMVAIC's IME nonappearance and outstanding-verification defenses were precluded by its failure to timely deny or request verification.

Cited by

A label shows how the later decision treated this one.

Bronx Chiropractic Rehabilitation, P.C. v MVAIC (2024 NY Slip Op 50799(U)) FollowedMVAIC's time to deny or seek verification runs from claim receipt, regardless of whether it has determined covered-person status.

Similar decisions

Spine Care of N.J., P.C. v MVAIC (2021 NY Slip Op 51172(U))MVAIC's 30-day period to deny a claim or request verification begins on receipt, regardless of whether it has determined covered-person status.
First Am. Alliance, Inc. v MVAIC (2021 NY Slip Op 50447(U))MVAIC's 30-day period to deny a claim or request verification runs from receipt, regardless of whether it has determined covered-person status.
JFL Med. Care, P.C. v MVAIC (2024 NY Slip Op 50202(U))MVAIC failed to establish coverage exhaustion because it omitted the dates claims were received and fully verified.
NY Wellness Med., P.C. v MVAIC (2025 NY Slip Op 51165(U))MVAIC failed to establish other available insurance or timely denials preserving its defense of the assignor's EUO nonappearances.
Healthway Med. Care, P.C. v MVAIC (2026 NY Slip Op 50199(U))MVAIC failed to establish coverage exhaustion because its payment log omitted claim receipt and full-verification dates.