January 8, 2009

Long Is. Multi-Medicine Group, P.c. v Travelers Ins. Co. (2009 NY Slip Op 50030(U))

Headnote

The relevant facts considered by the court were that Long Island Multi-Medicine Group, P.C. sought to recover assigned first-party no-fault benefits, and defendant Travelers Ins. Co. denied a number of the claims on the basis that they were not timely submitted. Plaintiff moved for summary judgment, which was granted, and defendant appealed, arguing that it had not waived its defense of untimeliness. The main issue decided was whether defendant waived its defense of untimeliness, and the court held that defendant had failed to establish that it timely denied the subject claims, and therefore failed to raise a triable issue of fact with respect to the claims at issue. The judgment was affirmed on other grounds.

Reported in New York Official Reports at Long Is. Multi-Medicine Group, P.c. v Travelers Ins. Co. (2009 NY Slip Op 50030(U))

Long Is. Multi-Medicine Group, P.c. v Travelers Ins. Co. (2009 NY Slip Op 50030(U)) [*1]

Long Is. Multi-Medicine Group, P.c. v Travelers Ins. Co.

2009 NY Slip Op 50030(U) [22 Misc 3d 127(A)]

Decided on January 8, 2009

Appellate Term, Second Department

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

As corrected in part through February 24, 2009; it will not be published in the printed Official Reports.

Decided on January 8, 2009

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : WESTON PATTERSON, J.P., RIOS and STEINHARDT, JJ
2007-717 Q C.

Long Island Multi-Medicine Group, P.C. a/a/o SUMIRA LUND, Respondent,
against
Travelers Ins. Co., Appellant.

Appeal from an order of the Civil Court of the City of New York, Queens County (Diane A. Lebedeff, J.), entered March 8, 2007, deemed from a judgment of the same court entered April 26, 2007 (see CPLR 5501 [c]). The judgment, entered pursuant to the March 8, 2007 order granting plaintiff’s motion for summary judgment, awarded plaintiff the principal sum of $2,948.88.

Judgment affirmed without costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment. Defendant opposed the motion, contending, inter alia, that issues of fact exist as to whether plaintiff timely submitted its claims to
defendant. The court granted plaintiff’s motion for summary judgment, finding that defendant waived its defense of untimeliness, since defendant failed to advise plaintiff that the claim would be reconsidered upon a showing of impossibility to timely submit the claims. This appeal by defendant ensued.

The affidavit of defendant’s claims representative submitted in opposition to plaintiff’s motion, and the denial of claim forms annexed thereto, demonstrate that defendant denied a number of plaintiff’s claims on the ground that they were not timely submitted (see generally Insurance Department Regulations [11 NYCRR] § 65.12). However, since none of the denial of claim forms correspond to the claim forms upon which plaintiff seeks summary judgment, defendant failed to establish that it timely denied the subject claims. As a result, defendant failed to raise a triable issue of fact with respect to the claims at issue (see Zuckerman v City of New York, 49 NY2d 557 [1980]). Accordingly, the judgment is affirmed, albeit on other grounds. [*2]

Weston Patterson, J.P., Rios and Steinhardt, JJ., concur.
Decision Date: January 08, 2009