July 5, 2006

New York & Presbyt. Hosp. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 05336)

https://www.beynensonlaw.com/case-law/new-york-presbyt-hosp-v-new-york-cent-mut-fire-ins-co-2006-ny-slip-op-05336/

Court: Appellate Division, Second Department
Decided: July 5, 2006
Citation: 2006 NY Slip Op 05336 · 31 AD3d 403
Posture: Trial
Outcome: Insurer prevailed
Issues: Assignments and standing
Legal questions: Claimant's prima facie case at trial · Challenging the assignment of benefits (see the maps)

Cite as

New York & Presbyt. Hosp. v New York Cent. Mut. Fire Ins. Co., 31 AD3d 403 (2d Dept 2006)

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 providers lacked standing where the proof at trial included unsigned assignment-of-benefits forms. The Appellate Division, Second Department, reversed a judgment entered for the providers after a nonjury trial, granted the insurer's motion to dismiss for lack of standing, and dismissed the complaint. The trial court had denied that application. In rejecting the providers' standing, the appellate court relied on the unsigned forms and cited Leon v Martinez.

Reported in New York Official Reports at New York & Presbyt. Hosp. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 05336)

New York & Presbyt. Hosp. v New York Cent. Mut. Fire Ins. Co.

2006 NY Slip Op 05336 [31 AD3d 403]

July 5, 2006

Appellate Division, Second Department

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

As corrected through Wednesday, September 20, 2006

New York and Presbyterian Hospital et al., Respondents,
v
New York Central Mutual Fire Insurance Company, Appellant.

—[*1]

In an action to recover no-fault benefits under an insurance contract, the defendant appeals from a judgment of the Supreme Court, Nassau County (Mahon, J.), entered January 20, 2005, which, after a nonjury trial, and upon denying the defendant’s application to dismiss the complaint on the ground of lack of standing, is in favor of the plaintiffs and against it in the total sum of $33,452.77.

Ordered that the judgment is reversed, on the law, with costs, the motion is granted, and the complaint is dismissed.

The defendant correctly contends that the plaintiff hospitals lacked standing. The proof adduced at trial included unsigned assignment of benefit forms (see Leon v Martinez, 84 NY2d 83 [1994]). Schmidt, J.P., Adams, Luciano and Lifson, JJ., concur.

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.

Claimant's prima facie case at trial

Open the full map

What must a no-fault claimant prove at trial to make out its prima facie case for overdue benefits?

This decision: Insufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits)

Reversed a judgment after a nonjury trial and dismissed the complaint, holding the hospitals lacked standing because their trial proof included unsigned assignment-of-benefits forms.

Proof sufficientMailing/receipt not shownOverdue not shownBusiness-record foundation lackingOther element missingThis decision

Of the 103 decisions on this question in the Second Department courts and the Court of Appeals, 35 (this one included) are in the same category.

Challenging the assignment of benefits

Open the full map

Could the insurer contest the validity of the provider’s assignment of benefits, or had it waived that defense?

This decision: Claimant lacks a valid assignment, or failed to prove one where the issue was preserved; claim fails or is not yet due

Reversed the judgment after a nonjury trial and dismissed the complaint because the hospitals' trial proof included only unsigned assignment of benefit forms, so they lacked standing.

Defense waivedAssignment sufficientAssignment defense upheldIssue of factThis decision

Of the 96 decisions on this question in the Second Department courts and the Court of Appeals, 14 (this one included) are in the same category.

Similar decisions

New York Hosp. Med. Ctr. of Queens v New York Cent. Mut. Fire Ins. Co. (2004 NY Slip Op 05626)The insurer failed to establish mailing of assignment-verification requests and could not defeat the hospitals' summary judgment motion.
New York & Presbyt. Hosp. v Allstate Ins. Co. (2006 NY Slip Op 02731)The insurer proved exhaustion of policy limits before it became obligated to pay the provider's claim.
New York Hosp. Med. Ctr. of Queens v AIU Ins. Co. (2004 NY Slip Op 05217)The insurer waived objections to missing signatures by failing to challenge the hospital forms' completeness within 10 days of receipt.
New York & Presbyt. Hosp. v Selective Ins. Co. of Am. (2007 NY Slip Op 06848)The insurer's conclusory medical affidavit failed to raise a factual issue that the treated condition was unrelated to the automobile accident.
A.B. Med. Servs., PLLC v New York Cent. Mut. Fire Ins. Co. (2009 NY Slip Op 50331(U))The insurer's evidence established a founded belief that the assignors' injuries did not arise from an insured incident.