September 15, 2008
Media Neurology, P.C. v Countrywide Ins. Co. (2008 NY Slip Op 51902(U))
https://www.beynensonlaw.com/case-law/media-neurology-p-c-v-countrywide-ins-co-2008-ny-slip-op-51902u/
- Judge
- Ash, J.
- Decided
- September 15, 2008
- Citation
- 2008 NY Slip Op 51902(U) · 21 Misc 3d 1101(A)
- Posture
- Other motion
- Outcome
- Provider prevailed
- Later treatment
- Followed in 1 later decision (see Cited by)
- Issues
- Verification requests
- Legal questions
- Outstanding verification and premature actions (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 Media Neurology, P.C. v Countrywide Ins. Co. (2008 NY Slip Op 51902(U))
| Media Neurology, P.C. v Countrywide Ins. Co. |
| 2008 NY Slip Op 51902(U) [21 Misc 3d 1101(A)] |
| Decided on September 15, 2008 |
| Civil Court Of The City Of New York, Kings County |
| Ash, J. |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports. |
Civil Court of the City of New York, Kings County
Media Neurology, P.C.
a/a/o JUSTIN HARRIS, Plaintiff,
against Countrywide Insurance Co., Defendant. |
143763/06
Sylvia G. Ash, J.
Plaintiff a health care service provider seeks to recover no-fault benefits for supplies furnished to its assignor. Defendant contends that Plaintiff’s claim is premature because Plaintiff failed to comply with an additional verification request. Plaintiff argues that it responded to Defendant’s verification request. Defendant argues that the response failed to fully comply with the request.
There is no dispute that Plaintiff responded to the additional verification request. There is also no dispute that upon receipt, Defendant did not request any further response from Plaintiff. The issue before the Court is whether Defendant was obligated to notify Plaintiff that its response to their additional verification request was insufficient and/or incomplete. In All Health Medical Care, P.C. v. Government Employees Insurance, 2 Misc 3d 907, the Court reasoned that while “… the regulations are silent as to what, if anything, the insurance company must do if it receives insufficient verification, that it is clear that the insurance company must affirmatively act once it receives a response to its verification request.” (see also Westchester County Medical Center v. NY Central Mutual Fire Ins Co., 262 AD2d 553).
In the case at Bar, once Plaintiff submitted its response to Defendant’s additional verification request, it was then incumbent on Defendant to inform Plaintiff that said response was insufficient and/or incomplete. Any confusion or disagreement on the part of the Defendant as to what was being sought should have been addressed by further communication, not inaction (see Westchester County Medical Center v. NY Central Mutual Fire Ins Co., supra). Neither party may ignore communications from the other without risking its chance to prevail in the matter (see All Health Medical Care, P.C. v. Government Employees Insurance Co., supra).
Accordingly, Plaintiff motion is hereby granted, judgment in favor of plaintiff for $2,118.33 plus interest , attorney’s fee, costs and disbursements. [*2]
This constitute the Decision and Order of the Court.
DATED: September 15, 2008______________________________
Sylvia G. Ash, J.C.C.
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 unanswered verification requests make the provider’s claim premature, or justify denying it for nonresponse?
This decision: Defense rejected because the insurer's requests or proof were deficient
Rejected the prematurity defense because the provider had responded to the verification request and the insurer, which considered the response incomplete, never told the provider so or requested anything further.
Of the 374 decisions on this question in the Second Department courts and the Court of Appeals, 78 (this one included) are in the same category.
Cited in this decision
A label shows how this decision treated the case it cites.
- All Health Med. Care v Government Empls. Ins. Co. (2004 NY Slip Op 24008) FollowedAn insurer must act within 30 days after receiving an arguably responsive verification response, even if it considers the response incomplete.
Cited by
A label shows how the later decision treated this one.
- Custom Orthotics, Ltd. v Government Empls. Ins. Co. (2009 NY Slip Op 29317) FollowedThe insurer's inaction on a physician-report response warranted payment, but an unresponsive invoice letter left the other claim premature.
Similar decisions
- North N.Y. Med. Care, P.C. v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 51557(U))The insurer's verification request, made two business days late, shortened its denial period to 28 days and rendered its denial untimely.
- St. Vincent Med. Care, P.C. v Country Wide Ins. Co. (2011 NY Slip Op 00214)The insurer's follow-up verification requests on the 30th day were effective, and the provider's incomplete compliance made the action premature.
- New York Diagnostic Med. Care, P.C. v Country-Wide Ins. Co. (2015 NY Slip Op 50814(U))The parties' summary judgment motions were denied because factual issues remained about the provider's response to verification requests.
- Westchester Med. Ctr. v Allstate Ins. Co. (2014 NY Slip Op 00655)The provider obtained summary judgment because neither the insurer's asserted verification request nor its denial was sent within 30 days.
- Northshore Chiropractic Diagnostics, P.C. v A. Cent. Ins. Co. (2014 NY Slip Op 51825(U))The insurer's verification requests were timely, but a factual issue remained as to whether the provider adequately responded.