June 28, 2011

Mount Sinai Hosp. v Government Empls. Ins. Co. (2011 NY Slip Op 05679)

https://www.beynensonlaw.com/case-law/mount-sinai-hosp-v-government-empls-ins-co-2011-ny-slip-op-05679/

Court
Appellate Division, Second Department
Decided
June 28, 2011
Citation
2011 NY Slip Op 05679 · 85 AD3d 1135
Posture
Summary judgment
Outcome
Insurer prevailed
Issues
Timeliness and preclusion Provider's prima facie case
Legal questions
Proof of mailing · Claimant's prima facie case on motions (see the maps)
Cite as
Mount Sinai Hosp. v Government Empls. Ins. Co., 85 AD3d 1135 (2d Dept 2011)

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Summary

Editorial summary by Beynenson Law, not part of the court’s decision.

The insurer raised a triable issue as to whether it issued a denial of claim form to the hospital. The hospital sought summary judgment on the fourth cause of action for no-fault medical payments. It established a prima facie case by demonstrating mailing and receipt of the billing forms and failure to pay or deny within 30 days under Insurance Law § 5106 (a) and 11 NYCRR 65-3.5. The Appellate Division, Second Department, reversed the order granting the hospital's motion and denied summary judgment because the insurer's opposition raised a factual dispute over issuance of the denial.

Reported in New York Official Reports at Mount Sinai Hosp. v Government Empls. Ins. Co. (2011 NY Slip Op 05679)

Mount Sinai Hosp. v Government Empls. Ins. Co.
2011 NY Slip Op 05679 [85 AD3d 1135]
June 28, 2011
Appellate Division, Second Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
As corrected through Wednesday, August 10, 2011
Mount Sinai Hospital, as Assignee of Meilun Chun, et al., Plaintiffs, and New York and Presbyterian Hospital, as Assignee of Gregory Berkley, Respondent,
v
Government Employees Insurance Company, Appellant.

—[*1] Teresa M. Spina, Woodbury, N.Y. (Jeanne M. Ortega and P. Stephanie Estevez of counsel), for appellant.

Joseph Henig, P.C., Bellmore, N.Y., for respondent.

In an action to recover no-fault medical payments under certain insurance policies, the defendant appeals from an order of the Supreme Court, Nassau County (Marber, J.), entered June 29, 2010, which granted the motion of the plaintiff New York and Presbyterian Hospital, as assignee of Gregory Berkley, for summary judgment on the fourth cause of action.

Ordered that the order is reversed, on the law, with costs, and the motion of the plaintiff New York and Presbyterian Hospital, as assignee of Gregory Berkley, for summary judgment on its fourth cause of action is denied.

The plaintiff New York and Presbyterian Hospital, as assignee of Gregory Berkley (hereinafter the hospital), made a prima facie showing of entitlement to judgment as a matter of law with respect to the fourth cause of action to recover no-fault medical payments by demonstrating that the necessary billing forms had been mailed to and received by the defendant and that the defendant had failed to either pay or deny the claim within the requisite 30-day period (see Insurance Law § 5106 [a]; 11 NYCRR 65-3.5; Hospital for Joint Diseases v Travelers Prop. Cas. Ins. Co., 9 NY3d 312, 317-318 [2007]; Westchester Med. Ctr. v New York Cent. Mut. Fire Ins. Co., 81 AD3d 929 [2011]; Westchester Med. Ctr. v Lincoln Gen. Ins. Co., 60 AD3d 1045, 1046 [2009]).

However, in opposition, the defendant raised a triable issue of fact as to whether it issued a denial of claim form dated April 2, 2008, to the hospital (see NYU-Hospital for Joint Diseases v Esurance Ins. Co., 84 AD3d 1190 [2011]; St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123, 1124 [2008]). Accordingly, the Supreme Court should have denied the hospital’s motion for summary judgment on its fourth cause of action. Rivera, J.P., Eng, Roman and Miller, JJ., concur.

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