October 11, 2016

Laga v Hereford Ins. Co. (2016 NY Slip Op 51543(U))

https://www.beynensonlaw.com/case-law/laga-v-hereford-ins-co-2016-ny-slip-op-51543u/

Court: Appellate Term, Second Department
Decided: October 11, 2016
Citation: 2016 NY Slip Op 51543(U) · 53 Misc 3d 142(A)
Posture: Summary judgment
Outcome: Provider prevailed
Issues: Verification requests
Legal questions: Outstanding verification and premature actions (see the maps)

Cite as

Laga v Hereford Ins. Co., 53 Misc 3d 142(A), 2016 NY Slip Op 51543(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's motion for summary judgment dismissing the provider's claims as premature for outstanding verification was denied on appeal. The Appellate Term, Second Department, reversed the order for the reasons stated in the companion appeal, Performance Plus Med., P.C. v Nationwide Ins., decided the same day, No. 2013-2766 Q C, without supplying independent reasoning.

Reported in New York Official Reports at Laga v Hereford Ins. Co. (2016 NY Slip Op 51543(U))

[*1]

Laga v Hereford Ins. Co.

2016 NY Slip Op 51543(U) [53 Misc 3d 142(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This opinion is uncorrected and will not be published in the printed Official Reports.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.
2014-792 Q C

Adelaida M. Laga, PT, as Assignee of Junior Nervil, Appellant,
against
Hereford Insurance Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Richard G. Latin, J.), entered March 24, 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 on the ground that the action was premature because plaintiff had failed to provide requested verification.

For the reasons stated in Performance Plus Med., P.C., as Assignee of Melanna Luckie v Nationwide Ins. (__ Misc 3d ___, 2016 NY Slip Op ______ [appeal No. 2013-2766 Q C], decided herewith), 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: October 11, 2016

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.

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: Fact issues remain on whether the verification defense applies

Reversed dismissal of the action as premature and denied the insurer's summary judgment motion on its defense that the provider had failed to provide requested verification.

Premature: verification outstandingNonresponse denial upheldTriable issueInsurer's showing failsProvider compliedThis decision

Of the 374 decisions on this question in the Second Department courts and the Court of Appeals, 114 (this one included) are in the same category.

Similar decisions

Adelaida M. Laga, PT v Hereford Ins. Co. (2017 NY Slip Op 51462(U))The provider's affidavit raised a factual issue about receipt of requested verification, defeating the insurer's prematurity motion.
Laga v Lancer Ins. Co. (2017 NY Slip Op 51243(U))The insurer's summary judgment dismissing the provider's claims for failure to appear for EUOs was affirmed.
Performance Plus Med., P.C. v Nationwide Ins. (2016 NY Slip Op 51500(U))The provider's owner's affidavit raised a factual issue over receipt of requested verification and whether the action was premature.
Laga v Allstate Ins. Co. (2018 NY Slip Op 50416(U))The insurer failed to establish timely mailing of its denials and therefore did not show that its defenses escaped preclusion.
LMS Acupuncture, P.C. v Nationwide Ins. (2016 NY Slip Op 51542(U))The insurer's motion for summary judgment dismissing the provider's claims as premature for outstanding verification was denied on appeal.