April 30, 2013
Leica Supply, Inc. v American Tr. Ins. Co. (2013 NY Slip Op 50711(U))
https://www.beynensonlaw.com/case-law/leica-supply-inc-v-american-tr-ins-co-2013-ny-slip-op50711u/
- Decided
- April 30, 2013
- Citation
- 2013 NY Slip Op 50711(U) · 39 Misc 3d 139(A)
- Posture
- Summary judgment
- Outcome
- Insurer prevailed
- Later treatment
- Followed in 1 later decision (see Cited by)
- Legal questions
- Proof of mailing (see the maps)
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 Leica Supply, Inc. v American Tr. Ins. Co. (2013 NY Slip Op 50711(U))
| Leica Supply, Inc. v American Tr. Ins. Co. |
| 2013 NY Slip Op 50711(U) [39 Misc 3d 139(A)] |
| Decided on April 30, 2013 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports.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, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : ALIOTTA, J.P., PESCE and RIOS, JJ
.
against
American Transit Insurance Co., Appellant.
Appeal from an order of the Civil Court of the City of New York, Queens County (Rudolph E. Greco, Jr., J.), entered September 8, 2011. The order, insofar as appealed from, denied defendant’s motion for summary judgment dismissing the complaint.
ORDERED that the order, insofar as appealed from, is reversed, with $30 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 so much of an order of the Civil Court as denied defendant’s motion for summary judgment dismissing the complaint.
In support of its motion, defendant proffered an affidavit by its claims examiner which was sufficient to establish that defendant’s denial of claim form had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]) and that plaintiff had submitted its claims to defendant more than 45 days after the date the services had been rendered to plaintiff’s assignor (see Insurance Department Regulations [11 NYCRR] § 65-1.1). Defendant’s denial of claim form adequately advised plaintiff of the basis for the denial, and it further advised plaintiff that the late submission of the claim would be excused if plaintiff provided a reasonable justification for the lateness (see Insurance Department Regulations [11 NYCRR] § 65-3.3 [e]). We find that the reason proffered by plaintiff was insufficient.
Accordingly, the order, insofar as appealed from, is reversed and defendant’s motion for summary judgment dismissing the complaint is granted.
Aliotta, J.P., Pesce and Rios, JJ., concur.
Decision Date: April 30, 2013
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.
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 (rules on the question, but another ground decided the case)
Held the claims examiner's affidavit sufficient to establish timely mailing of the denial, supporting dismissal because the claims were submitted beyond 45 days without adequate justification.
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.
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.
- Delta Diagnostic Radiology, P.C. v Chubb Group of Ins. (2007 NY Slip Op 27345) FollowedAn insurer may prove mailing by describing its standard procedure for properly addressing and mailing items.
Cited by
A label shows how the later decision treated this one.
- New York Med. & Diagnostic Ctr. v GEICO Ins. Co. (2021 NY Slip Op 51138(U)) FollowedThe insurer established untimely submission of five claims but failed to prove its fee-schedule defense to the remaining claim.
Similar decisions
- Leica Supply, Inc. v GEICO Indem. Co. (2013 NY Slip Op 50478(U))An insurer's delay letters that request no specific verification do not toll its time to pay or deny no-fault claims.
- Leica Supply, Inc. v Encompass Indem. Co. (2012 NY Slip Op 50890(U))The insurer proved timely mailing of EUO notices and the denial, and the assignor's failure to appear at either scheduled EUO. The provider challenged summary judgment dismissing its assigned no-fault claims.
- Lenox Hill Radiology & Mia, P.C. v American Mfrs. Mut. Ins. Co. (2013 NY Slip Op 51750(U))The provider submitted its claims more than 45 days after the services and offered no explanation for the delay.
- (2014 NY Slip Op 51267(U))The provider's unopposed summary judgment motion was denied for failure to prove overdue payment or a legally deficient denial.
- Greenway Med. Supply Corp. v ELRAC, Inc. (2016 NY Slip Op 51774(U))The defendant established that the provider submitted its claim more than five months after furnishing the supplies.