April 30, 2014
Mount Sinai Hosp. of Queens v Country Wide Ins. Co. (2014 NY Slip Op 50780(U))
https://www.beynensonlaw.com/case-law/mount-sinai-hosp-of-queens-v-country-wide-ins-co-2014-ny-slip-op50780u/
- Decided
- April 30, 2014
- Citation
- 2014 NY Slip Op 50780(U) · 43 Misc 3d 139(A)
- Posture
- Summary judgment
- Outcome
- Insurer prevailed
- 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 Mount Sinai Hosp. of Queens v Country Wide Ins. Co. (2014 NY Slip Op 50780(U))
| Mount Sinai Hosp. of Queens v Country Wide Ins. Co. |
| 2014 NY Slip Op 50780(U) [43 Misc 3d 139(A)] |
| Decided on April 30, 2014 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports.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, 9th and 10th JUDICIAL DISTRICTS
PRESENT: : IANNACCI, J.P., MARANO and TOLBERT, JJ.
2012-2297 N C
against
Country Wide Insurance Company, Respondent.
[*1]
Appeal from an order of the District Court of Nassau County, First District (Andrea Phoenix, J.), dated June 4, 2012. The order granted defendant’s cross motion for summary judgment dismissing the complaint and implicitly denied plaintiff’s motion for summary judgment.
ORDERED that the order is affirmed, without costs.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the District Court which granted defendant’s cross motion for summary judgment dismissing the complaint and implicitly denied plaintiff’s motion for summary judgment.
In support of its cross motion, defendant proffered an affidavit by its no-fault litigation supervisor 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]) and that plaintiff had submitted its claim 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 informed 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 proffer a reason for the late submission. Consequently, the District Court properly determined that defendant was entitled to summary judgment dismissing the complaint.
Accordingly, the order is affirmed.
Iannacci, J.P., Marano and Tolbert, JJ., concur.
Decision Date: April 30, 2014
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 litigation supervisor's affidavit sufficient to establish timely mailing of the denial, which supported dismissal on the ground that the claim was submitted beyond 45 days without excuse.
Of the 1,384 decisions on this question in the Second Department courts and the Court of Appeals, 806 (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.
Cited by
- Stand-Up MRI of the Bronx, P.C. v MVAIC Ins. Co. (2022 NY Slip Op 50789(U))The provider failed to establish that it gave MVAIC reasonable justification for submitting its claims after the 45-day deadline.
- Good Samaritan Hosp. v MVAIC Ins. Co. (2022 NY Slip Op 51100(U))MVAIC established that the provider's claim was submitted late, and the provider failed to justify the delay or prove an earlier mailing.
Similar decisions
- Healthway Med. Care, P.C. v Country Wide Ins. Co. (2015 NY Slip Op 51654(U))The insurer established late notice of the accident, and the provider offered no proof of timely notice or a reasonable justification.
- Medical Careworks, P.C. v American Tr. Ins. Co. (2012 NY Slip Op 51281(U))The insurer established late notice of the accident, and the provider offered neither contrary proof nor a reasonable justification.
- Mount Sinai Hosp. v Country Wide Ins. Co. (2011 NY Slip Op 05680)The insurer raised factual issues about policy exhaustion during a verification toll and payment with overdue interest before suit.
- 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.
- New York Hosp. Med. Ctr. of Queens v Country Wide Ins. Co. (2011 NY Slip Op 01628)The hospital satisfied verification requests by supplying the precise version of the NF-5 and assignment forms the insurer requested.