February 20, 2007
New York & Presbyt. Hosp. v Travelers Prop. Cas. Ins. Co. (2007 NY Slip Op 01537)
https://www.beynensonlaw.com/case-law/new-york-presbyt-hosp-v-travelers-prop-cas-ins-co-2007-ny-slip-op-01537/
- Decided
- February 20, 2007
- Citation
- 2007 NY Slip Op 01537 · 37 AD3d 683
- Posture
- Summary judgment
- Outcome
- Provider prevailed
- Legal questions
- Claimant's prima facie case on motions · Proof of mailing (see the maps)
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.
Reported in New York Official Reports at New York & Presbyt. Hosp. v Travelers Prop. Cas. Ins. Co. (2007 NY Slip Op 01537)
| New York & Presbyt. Hosp. v Travelers Prop. Cas. Ins. Co. |
| 2007 NY Slip Op 01537 [37 AD3d 683] |
| February 20, 2007 |
| Appellate Division, Second Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| New York and Presbyterian Hospital et al., Plaintiffs, and Mount Sinai Hospital, as Assignee of Salvatore Gigante, Respondent, v Travelers Property Casualty Insurance Company, Appellant. |
—[*1] McDonnell & Adels, P.C., Garden City, N.Y. (Martha S. Henley of counsel), for appellant.
Joseph Henig, P.C., Bellmore, N.Y., for respondent.
In an action to recover no-fault medical payments under contracts of insurance, the defendant appeals from a judgment of the Supreme Court, Nassau County, entered March 29, 2006, which, upon an order of the same court (Brennan, J.) dated March 13, 2006, granting the motion of the plaintiff Mount Sinai Hospital, as assignee of Salvatore Gigante, for summary judgment on the third cause of action, is in favor of that plaintiff and against it in the principal sum of $30,092.49. The defendant’s notice of appeal from the order is deemed to be a notice of appeal from the judgment.
Ordered that the judgment is affirmed, with costs.
In support of its motion for summary judgment on the third cause of action, the plaintiff Mount Sinai Hospital, as assignee of Salvatore Gigante (hereinafter Mount Sinai), demonstrated its prima facie entitlement to judgment as a matter of law by submitting, inter alia, the requisite billing forms, a certified mail receipt, a signed return receipt card which referenced the patient and forms, and an affidavit of its third-party biller (see Hospital for Joint Diseases v Travelers Prop. Cas. Ins. Co., 34 AD3d 532 [2006]; New York & Presbyt. Hosp. v Allstate Ins. Co., 30 AD3d 492 [2006]). This evidence demonstrated that the defendant received the no-fault billing and failed to respond within the requisite 30-day period (see Insurance Law § 5106 [a]; 11 NYCRR 65-3.5). The defendant failed to raise a triable issue of fact in opposition to the motion. Accordingly, the Supreme Court properly [*2]granted the motion of Mount Sinai for summary judgment on the third cause of action.
The defendant’s remaining contention is improperly raised for the first time on appeal (see Rotundo v S & C Magnetic Resonance Imaging, 255 AD2d 573 [1998]) and, in any event, is without merit (see General Construction Law § 46; William Iselin & Co. v Fireman’s Fund Ins. Co., 117 AD2d 86, 90 [1986], mod 69 NY2d 908 [1987]). Mastro, J.P., Goldstein, Lifson and Carni, 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.
On summary judgment or another pretrial motion, what must a no-fault claimant show to establish its prima facie case?
This decision: Claimant's proof held to make out its prima facie case
Held the hospital established its prima facie case with the billing forms, a certified mail receipt, a signed return receipt card referencing the patient and forms, and its biller's affidavit, showing receipt and no response within 30 days.
Of the 1,063 decisions on this question in the Second Department courts and the Court of Appeals, 511 (this one included) are in the same category.
Did a party’s evidence establish that it mailed a no-fault claim, denial, verification request or examination notice?
This decision: The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response
Held the hospital's certified mail receipt, signed return receipt card referencing the patient and billing forms, and third-party biller's affidavit proved that the insurer received the bill.
Of the 1,384 decisions on this question in the Second Department courts and the Court of Appeals, 103 (this one included) are in the same category.
Cited in this decision
- Hospital for Joint Diseases v Travelers Prop. Cas. Ins. Co. (2006 NY Slip Op 08214)An insurer waives claim-form and assignment defenses by failing to timely object to form adequacy or seek assignment verification.
Cited by
- Hospital for Joint Diseases v New York Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 08038)The hospital's claim was premature because unrebutted proof showed that it ignored timely verification and follow-up requests.
- Kingsbrook Jewish Med. Ctr. v Allstate Ins. Co. (2009 NY Slip Op 00351)Judicially noticed diagnosis codes alone do not establish that treatment was wholly unrelated to an insured automobile accident.
- Westchester Med. Ctr. v Countrywide Ins. Co. (2007 NY Slip Op 09024)The insurer failed to prove mailing of verification requests and waived defenses based on incomplete assignment forms.
- Westchester Med. Ctr. v Progressive Cas. Ins. Co. (2008 NY Slip Op 04867)An insurer invoking the intoxication exclusion must establish that intoxication proximately caused the accident to obtain summary judgment.
- Westchester Med. Ctr. v Safeco Ins. Co. of Am. (2007 NY Slip Op 04484)The insurer waived claim-form and assignment defenses by failing to object timely to the forms or seek assignment verification.
- Westchester Med. Ctr. v Progressive Cas. Ins. Co. (2007 NY Slip Op 09770)The insurer's intoxication evidence defeated the hospital's summary judgment motion but did not establish entitlement to dismissal.
- Medalliance Med. Health Servs. v Allstate Ins. Co. (2013 NY Slip Op 23156)A provider may recover demanded interest on overdue no-fault payments even when the interest does not exceed five dollars.
Similar decisions
- Mount Sinai Hosp. v Government Empls. Ins. Co. (2011 NY Slip Op 05679)The insurer raised a triable issue as to whether it issued a denial of claim form to the hospital.
- 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.
- 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.
- Mount Sinai Hosp. v Allstate Ins. Co. (2006 NY Slip Op 00490)The insurer raised a triable issue about the provider's verification compliance but failed to establish entitlement to dismissal.
- New York & Presbyt. Hosp. v American Tr. Ins. Co. (2007 NY Slip Op 09376)The insurer raised a factual issue by showing a timely denial based on bills submitted more than 45 days after the last medical service.