June 17, 2022

New Millennium Med. Imaging, P.C. v 21st Century Ins. Co. (2022 NY Slip Op 50605(U))

Headnote

The relevant facts the court considered are that the plaintiff, New Millennium Medical Imaging, P.C., was seeking to recover first-party no-fault benefits from the defendant, 21st Century Insurance Company. The plaintiff failed to submit its claim form to the defendant within the required 45 days after the services were rendered and the defendant timely denied the claim. The plaintiff argued that it initially sent the claim form to a different insurance company and only sent it to the defendant after realizing the mistake. The main issue decided was whether the plaintiff provided a reasonable justification for its untimely submission of the claim form to the defendant, as required by the regulations. The court ultimately held that the plaintiff did not establish a reasonable justification for initially submitting the claim form to the wrong insurance company, as the form bore the defendant's name and address. Therefore, the court granted the defendant's motion for summary judgment dismissing the complaint and denied the plaintiff's cross motion for summary judgment.

Reported in New York Official Reports at New Millennium Med. Imaging, P.C. v 21st Century Ins. Co. (2022 NY Slip Op 50605(U))

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

New Millennium Medical Imaging, P.C., as Assignee of Li Zhu Bian, Respondent,
against
21st Century Insurance Company, Appellant.

Law Offices of Buratti, Rothenberg & Burns (Bianca Maynard Francois of counsel), for appellant. Law Office of Damin J. Toell, P.C. (Damin J. Toell of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Consuelo Mallafre Melendez, J.), entered January 8, 2020. The order denied defendant’s motion for summary judgment dismissing the complaint and granted plaintiff’s cross motion for summary judgment.

ORDERED that the order is reversed, with $30 costs, defendant’s motion for summary judgment dismissing the complaint is granted and plaintiff’s cross motion for summary judgment is denied.

In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from an order of the Civil Court entered January 8, 2020 denying defendant’s motion for summary judgment dismissing the complaint and granting plaintiff’s cross motion for summary judgment.

Plaintiff was required to submit its claim form to defendant within 45 days after the services were rendered (see 11 NYCRR 65-1.1; Synergy First Med., PLLC v MVAIC, 44 Misc 3d 127[A], 2014 NY Slip Op 50964[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2014]) and it is undisputed that plaintiff failed to do so. Defendant timely denied plaintiff’s claim seeking to recover for those services, based upon plaintiff’s untimely submission, and informed plaintiff that defendant would excuse the delay if plaintiff provided a “reasonable justification” therefor (see 11 NYCRR 65-3.3 [e]; see also Matter of Medical Socy. of State of NY v Serio, 100 NY2d 854, 862-863 [2003]; Synergy First Med., PLLC, 2014 NY Slip Op 50964[U]). In opposition to defendant’s motion, plaintiff demonstrated that it had initially sent the claim form at issue to a different insurance company, and that, after plaintiff learned, approximately one year later, that [*2]the information it had regarding the insurance company covering the accident was incorrect, it sent the claim form to defendant. However, plaintiff did not establish a reasonable justification for initially submitting the claim form to the wrong insurance company, given that the claim form which plaintiff alleged it submitted to the wrong insurance company bore defendant’s name and address. As a result, plaintiff did not establish that it had provided defendant with a reasonable justification for its untimely submission of the claim form to defendant.

Accordingly, the order is reversed, defendant’s motion for summary judgment dismissing the complaint is granted and plaintiff’s cross motion for summary judgment is denied.

ALIOTTA, P.J., GOLIA and BUGGS, JJ., concur.

ENTER:
Paul Kenny
Chief Clerk
Decision Date: June 17, 2022