May 4, 2007

NY Arthroscopy & Sports Medicine PLLC v Motor Veh. Acc. Indem. Corp. (2007 NY Slip Op 27174)

Headnote

The provider's assignor received services on July 31, 2003, and MVAIC received the proof of claim in March 2004. The provider had earlier submitted the claim to another insurer whose policy had been cancelled, and MVAIC denied the claim as untimely while inviting a reasonable justification for the delay. The court held that MVAIC has the rights and obligations of an article 51 insurer, including the 45-day notice requirement. Even assuming the initial submission to the wrong insurer justified some delay, the provider gave no reasonable justification for the further delay of about three and a half months after learning there was no coverage. The order granting MVAIC summary judgment was affirmed.

Reported in New York Official Reports at NY Arthroscopy & Sports Medicine PLLC v Motor Veh. Acc. Indem. Corp. (2007 NY Slip Op 27174)

NY Arthroscopy & Sports Medicine PLLC v Motor Veh. Acc. Indem. Corp.
2007 NY Slip Op 27174 [15 Misc 3d 89]
Accepted for Miscellaneous Reports Publication
AT1
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
As corrected through Wednesday, June 20, 2007


[*1]
NY Arthroscopy & Sports Medicine PLLC, as Assignee of Madeline Gonzalez, Appellant,
v
Motor Vehicle Accident Indemnification Corporation, Respondent.

Supreme Court, Appellate Term, First Department, May 4, 2007

APPEARANCES OF COUNSEL

Israel, Israel & Purdy, LLP, Great Neck (William M. Purdy of counsel), for appellant. Marshall & Marshall, Jericho (Jeffrey D. Kadushin of counsel), for respondent.

{**15 Misc 3d at 90} OPINION OF THE COURT

Per Curiam.

Order, entered February 7, 2006, affirmed, with $10 costs.

Contrary to plaintiff’s contention, defendant Motor Vehicle Accident Indemnification Corporation (MVAIC) has the “rights and obligations” applicable to an insurer under article 51 of the Insurance Law (see Insurance Law § 5221 [b] [3]; New York Hosp. Med. Ctr. of Queens v Motor Veh. Acc. Indem. Corp., 12 AD3d 429, 430 [2004]) and is entitled to notice of claim within 45 days of the date services are rendered (see 11 NYCRR 65-1.1).

The record reveals that the health care services herein were rendered to plaintiff’s assignor on July 31, 2003. MVAIC received plaintiff’s proof of claim on March 30, 2004, eight months after the date the services were rendered. Attached to plaintiff’s proof of claim was correspondence indicating that plaintiff had made an “accidental submission” to State Farm Insurance Company in August 2003; a facsimile, dated September 23, 2003, transmitting State Farm’s cancellation notice of its policy effective January 3, 2003; and a December 18, 2003 letter to plaintiff from its attorney stating that the attorney was no longer looking to State Farm for payment of the bill because there was “no policy.” MVAIC ultimately denied the claim based on plaintiff’s untimely submission of proof of claim and afforded plaintiff the opportunity to provide a “reasonable justification” for the delay (see 11 NYCRR 65-3.3 [e]; Matter of Medical Socy. of State of N.Y. v Serio, 100 NY2d 854, 863 [2003]).

Defendant’s motion for summary judgment was properly granted. Even assuming, arguendo, that plaintiff’s inadvertent submission of the claim to State Farm initially justified its delay in submitting the claim to MVAIC (see 11 NYCRR 65-3.5 [1]), plaintiff failed to address, much less provide a “reasonable justification” for the 3½-month delay between [*2]December 18, 2003, when plaintiff’s counsel advised plaintiff that there was no coverage, and plaintiff’s submission of the claim to MVAIC on March 26, 2004.{**15 Misc 3d at 91}

We have considered plaintiff’s remaining argument and find it unavailing.

McKeon, J.P., McCooe and Schoenfeld, JJ., concur.