December 22, 2017

MT Servs. P.T., P.C. v Country-Wide Ins. Co. (2017 NY Slip Op 51851(U))

https://www.beynensonlaw.com/case-law/mt-servs-p-t-p-c-v-country-wide-ins-co-2017-ny-slip-op-51851u/

Court: Appellate Term, Second Department
Decided: December 22, 2017
Citation: 2017 NY Slip Op 51851(U) · 58 Misc 3d 139(A)
Posture: Summary judgment
Outcome: Insurer prevailed
Issues: Verification requests Timeliness and preclusion
Legal questions: Proof of mailing · Outstanding verification and premature actions (see the maps)

Cite as

MT Servs. P.T., P.C. v Country-Wide Ins. Co., 58 Misc 3d 139(A), 2017 NY Slip Op 51851(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2017)

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.

The insurer's 30-day period to pay or deny had not begun because timely requested verification remained outstanding when the provider sued. The insurer established timely mailing of initial and follow-up written verification requests under 11 NYCRR 65-3.5 (b) and 11 NYCRR 65-3.8 (l), and demonstrated that it had not received the requested verification. The provider failed to show that it had supplied the material before commencing its assigned no-fault action. Under 11 NYCRR 65-3.5 (c) and 11 NYCRR 65-3.8 (a), the payment or denial period therefore had not begun. The Appellate Term, Second Department, affirmed denial of the provider's summary judgment motion and grant of the insurer's cross motion dismissing the complaint, rejecting the provider's remaining verification contentions.

Reported in New York Official Reports at MT Servs. P.T., P.C. v Country-Wide Ins. Co. (2017 NY Slip Op 51851(U))

[*1]

MT Servs. P.T., P.C. v Country-Wide Ins. Co.

2017 NY Slip Op 51851(U) [58 Misc 3d 139(A)]

Decided on December 22, 2017

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This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on December 22, 2017
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, MARTIN M. SOLOMON, JJ
2015-155 Q C

MT Services P.T., P.C., as Assignee of Richardson Steven, Appellant,
against
Country-Wide Ins. Co., Respondent.

Petre and Zabokritsky, P.C., (Zachary Rozenberg, Esq.), for appellant. Jaffe & Koumourdas, LLP (Jean H. Kang, Esq.), for respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Richard G. Latin, J.), entered December 3, 2014. The order denied plaintiff’s motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint.

ORDERED that the order is affirmed, with $25 costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment and defendant cross-moved for summary judgment dismissing the complaint. By order entered December 3, 2014, the Civil Court denied plaintiff’s motion and granted defendant’s cross motion.

Contrary to plaintiff’s contention, defendant established that it had timely mailed initial and follow-up requests for written verification (see 11 NYCRR 65-3.5 [b]; 65-3.8 [l]; St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). As defendant demonstrated that it had not received the requested verification, and plaintiff did not show that the verification had been provided to defendant prior to the commencement of the action, the 30-day period within which defendant was required to pay or deny the claims did not begin to run (see 11 NYCRR 65-3.5 [c]; 65-3.8 [a]; Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492 [2005]). As plaintiff’s remaining contentions regarding the [*2]verification requested by defendant lack merit, the order is affirmed.

PESCE, P.J., ALIOTTA and SOLOMON, JJ., concur.

ENTER:
Paul Kenny
Chief Clerk
Decision Date: December 22, 2017

Legal questions (2)

Questions 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.

Proof of mailing

Open the full map

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

Rejected the provider's challenge and held the insurer's proof established that it timely mailed its initial and follow-up verification requests.

Insurer proved mailingInsurer failed to proveProvider proved mailingProvider failed to proveTriable issue on mailingMixed rulingsThis decisionCites it or cited by itCited or followed

Of the 1,400 decisions on this question in the Second Department courts and the Court of Appeals, 809 (this one included) are in the same category.

Outstanding verification and premature actions

Open the full map

Did unanswered verification requests make the provider’s claim premature, or justify denying it for nonresponse?

This decision: Timely requests went unanswered; the claim is not overdue and the action is premature

Held the 30-day period never began to run because the insurer timely requested verification, showed it was not received, and the provider did not show it was supplied before suit.

Premature: verification outstandingNonresponse denial upheldTriable issueInsurer's showing failsProvider compliedThis decision

Of the 385 decisions on this question in the Second Department courts and the Court of Appeals, 153 (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.

Similar decisions

Active Chiropractic, P.C. v Country-Wide Ins. Co. (2017 NY Slip Op 51850(U))The insurer's 30-day period to pay or deny the appealed claim had not begun because timely requested verification remained outstanding.
Avenue I Med., P.C. v Country-Wide Ins. Co. (2017 NY Slip Op 51852(U))The provider's summary judgment motion was denied and the insurer's cross motion to dismiss the assigned no-fault claims was granted.
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.
Quality Health Prods. v Country-Wide Ins. Co. (2012 NY Slip Op 51641(U))The provider's action was premature because timely verification requests remained unanswered when the action began.
Exclusive Physical Therapy, P.C. v Country-Wide Ins. Co. (2017 NY Slip Op 51855(U))The insurer's cross motion for summary judgment dismissing the two no-fault claims at issue on appeal was granted.