April 30, 2014

Mount Sinai Hosp. of Queens v Country Wide Ins. Co. (2014 NY Slip Op 50780(U))

Headnote

The court considered the timing of the denial of the claim form and the submission of the claim by the plaintiff. The main issue decided was whether the defendant's denial of claim form had been timely mailed and whether the plaintiff submitted the claim more than 45 days after the date the services had been rendered. The holding of the court was that the defendant's denial of claim form was timely mailed and the plaintiff had submitted its claim more than 45 days after the services had been rendered. As a result, the court affirmed the order granting the defendant's cross motion for summary judgment dismissing the complaint.

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))
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This opinion is uncorrected and will not be published in the printed Official Reports.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
Mount Sinai Hospital of Queens as Assignee of CHRISTOPHER NIX, Appellant,

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