October 15, 2013

Lenox Hill Radiology & Mia, P.C. v American Mfrs. Mut. Ins. Co. (2013 NY Slip Op 51750(U))

Headnote

The relevant facts the court considered in this case included the denial of a claim form by the defendants, who were insurance companies, and the late submission of the plaintiff's claims. The main issue decided was whether the defendants were justified in denying the claim and whether the plaintiff had provided a reasonable justification for the late submission. The holding of the case was that the defendants' denial of the claim form was timely and adequately advised the plaintiff of the basis for the denial, as well as the potential for excusing the late submission if a reasonable justification was provided. As the plaintiff failed to offer any explanation for the delay, the court reversed the original order and granted the defendants' motion for summary judgment dismissing the complaint.

Reported in New York Official Reports at Lenox Hill Radiology & Mia, P.C. v American Mfrs. Mut. Ins. Co. (2013 NY Slip Op 51750(U))

Lenox Hill Radiology & Mia, P.C. v American Mfrs. Mut. Ins. Co. (2013 NY Slip Op 51750(U)) [*1]

Lenox Hill Radiology & Mia, P.C. v American Mfrs. Mut. Ins. Co.

2013 NY Slip Op 51750(U) [41 Misc 3d 131(A)]

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This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on October 15, 2013

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

PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ
2011-2886 K C.

Lenox Hill Radiology and Mia, P.C. as Assignee of BERNARD MANU, Respondent, —
against
American Manufacturers Mutual Ins. Co., AMERICAN MOTORISTS INS. CO., AMERICAN PROTECTION INS. CO. and LUMBERMENS MUTUAL CASUALTY COMPANY All Doing Business as KEMPER INSURANCE COMPANIES, Appellants.

Appeal from an order of the Civil Court of the City of New York, Kings County (Reginald A. Boddie, J.), entered October 18, 2011. The order denied defendants’ motion for summary judgment dismissing the complaint.

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

In this action by a provider to recover assigned first-party no-fault benefits, defendants appeal from an order of the Civil Court which denied defendants’ motion for summary judgment dismissing the complaint.

In support of their motion, defendants proffered an affidavit by their claims examiner which was sufficient to establish that defendants’ 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 defendants 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). Defendants’ 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]). Plaintiff failed to offer any explanation for the delay.

Accordingly, the order is reversed and defendants’ motion for summary judgment dismissing the complaint is granted.
Pesce, P.J., Aliotta and Solomon, JJ., concur. [*2]
Decision Date: October 15, 2013