July 18, 2005

New York & Presbyt. Hosp. v AIU Ins. Co. (2005 NY Slip Op 06014)

https://www.beynensonlaw.com/case-law/new-york-presbyt-hosp-v-aiu-ins-co-2005-ny-slip-op-06014/

Court
Appellate Division, Second Department
Decided
July 18, 2005
Citation
2005 NY Slip Op 06014 · 20 AD3d 515
Posture
Summary judgment
Outcome
Insurer prevailed
Later treatment
Contrasted (cf., but see) in 1 and followed in 1 later decisions (see Cited by)
Issues
Timeliness and preclusion Policy issues
Legal questions
Claimant's prima facie case on motions (see the maps)
Cite as
New York & Presbyt. Hosp. v AIU Ins. Co., 20 AD3d 515 (2d Dept 2005)

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.

A resubmitted no-fault claim previously and timely denied is not subject to a new 30-day payment-or-denial period. The hospital established a prima facie case through proof of mailed and received billing forms and overdue benefits, but the insurer demonstrated a prior timely denial of the same claim. The Appellate Division, Second Department, reversed the order and judgment, insofar as appealed from, and denied the hospital summary judgment on the first cause of action. The insurer nevertheless failed to establish entitlement to dismissal based on the intoxication exclusion. The court dismissed the reargument appeal as nonappealable and the renewal appeal as academic, vacating the subsequent determinations.

Reported in New York Official Reports at New York & Presbyt. Hosp. v AIU Ins. Co. (2005 NY Slip Op 06014)

New York & Presbyt. Hosp. v AIU Ins. Co.
2005 NY Slip Op 06014 [20 AD3d 515]
July 18, 2005
Appellate Division, Second Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
As corrected through Wednesday, September 21, 2005
New York and Presbyterian Hospital, as Assignee of Luis Reyes, Respondent, et al., Plaintiff,
v
AIU Insurance Company, Appellant.

—[*1]

In an action to recover unpaid no-fault insurance medical benefits, the defendant appeals (1) from so much of an order and judgment (one paper) of the Supreme Court, Nassau County (McCarty, J.), entered April 1, 2004, as, upon a decision of the same court dated January 23, 2004, granted that branch of the plaintiffs’ motion which was for summary judgment on the first cause of action asserted by the plaintiff New York and Presbyterian Hospital, and, in effect, denied its cross motion for summary judgment dismissing the complaint, and is in favor of the plaintiff New York and Presbyterian Hospital and against it in the principal sum of $14,574, (2), as limited by its brief, from so much of an order of the same court entered June 30, 2004, as, in effect, upon reargument, adhered in part to the prior determination in the decision dated January 23, 2004, and (3) from so much of an order of the same court entered August 25, 2004, as denied its motion for leave to renew that branch of the plaintiff’s prior motion which was for summary judgment on the first cause of action.

Ordered that the appeal from the order entered June 30, 2004, is dismissed as no appeal lies from an order made upon reargument and adhering to the prior determination in a decision (see Matter of A & S Transp. Co. v County of Nassau, 154 AD2d 456 [1989]); and it is further,

Ordered that the appeal from the order entered August 25, 2004, is dismissed as [*2]academic in light of the determination of the appeal from the order and judgment; and it is further,

Ordered that the order and judgment is reversed insofar as appealed from, on the law, that branch of the motion which was for summary judgment on the first cause of action asserted by the plaintiff New York and Presbyterian Hospital is denied, and the decision entered June 30, 2004, and the order entered August 25, 2004, are vacated; and it is further,

Ordered that one bill of costs is awarded to the defendant.

The plaintiff made a prima facie showing of entitlement to judgment as a matter of law “by submitting evidentiary proof that the prescribed statutory billing forms had been mailed and received and that payment of no-fault benefits was overdue” (New York Hosp. Med. Ctr. of Queens v Motor Veh. Acc. Indem. Corp., 12 AD3d 429 [2004]). However, in opposition to the motion, the defendant established that it had previously and timely denied the same claim, and that the no-fault billing at issue was a resubmission of a claim to which the rule that a claim must be paid or denied within 30 days did not apply (see Hospital for Joint Diseases v Allstate Ins. Co., 5 AD3d 441, 442 [2004]).

Notwithstanding that the defendant established that its prior denial of the claim was timely, the defendant failed to establish its entitlement to summary judgment dismissing the complaint based on the intoxication exclusion (see Lynch v Progressive Ins. Co., 12 AD3d 570 [2004]; North v Travelers Ins. Co., 218 AD2d 901 [1995]). Adams, J.P., Santucci, Goldstein and Crane, JJ., concur.

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