June 20, 2005
Nyack Hosp. v State Farm Mut. Auto. Ins. Co. (2005 NY Slip Op 05278)
https://www.beynensonlaw.com/case-law/nyack-hosp-v-state-farm-mut-auto-ins-co-2005-ny-slip-op-05278/
- Decided
- June 20, 2005
- Citation
- 2005 NY Slip Op 05278 · 19 AD3d 569
- Posture
- Summary judgment
- Outcome
- Insurer prevailed
- Later treatment
- Contrasted (cf., but see) in 1 and followed in 6 later decisions (see Cited by)
- Issues
- Verification requests
- Legal questions
- Outstanding verification and premature actions (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 Nyack Hosp. v State Farm Mut. Auto. Ins. Co. (2005 NY Slip Op 05278)
| Nyack Hosp. v State Farm Mut. Auto. Ins. Co. |
| 2005 NY Slip Op 05278 [19 AD3d 569] |
| June 20, 2005 |
| Appellate Division, Second Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| Nyack Hospital, as Assignee of Ray Rodriguez, Appellant, v State Farm Mutual Automobile Insurance Company, Respondent. |
—[*1]
In an action to recover no-fault medical payments, the plaintiff appeals from an order of the Supreme Court, Nassau County (Brandveen, J.), dated September 22, 2004, which denied its motion for summary judgment and granted the defendant’s cross motion for summary judgment dismissing the complaint.
Ordered that the order is affirmed, with costs.
The Supreme Court properly denied the plaintiff’s motion for summary judgment and correctly granted the defendant’s cross motion for summary judgment dismissing the complaint. An insurer is not obligated to pay or deny a claim until it has received verification of all relevant information requested (see 11 NYCRR 65.15 [d], [g] [1], [7]; St. Vincent’s Hosp. of Richmond v American Tr. Ins. Co., 299 AD2d 338, 340 [2002]). It is undisputed that the plaintiff’s assignor and Good Samaritan Hospital failed to respond to the defendant’s verification requests for the record containing the assignor’s post-accident blood alcohol level. Accordingly, the period within which the defendant was required to respond to the plaintiff’s claim did not begin to run, and any claim for payment was premature (see Hospital for Joint Diseases v State Farm Mut. Auto. Ins. Co., 8 AD3d 533 [2004]; New York & Presbyt. Hosp. v Progressive Cas. Ins. Co., 5 AD3d 568 [2004]; cf. Presbyterian Hosp. in City of N.Y. v Aetna Cas. & Sur. Co., 233 AD2d 431 [1996]). Schmidt, J.P., S. Miller, Santucci and Mastro, JJ., concur.
Legal questions
A question 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.
Did unanswered verification requests make the provider’s claim premature, or justify denying it for nonresponse?
This decision: Timely requests went unanswered; the claim is not overdue and the action is premature
Held the complaint properly dismissed because the assignor and another hospital undisputedly never answered the insurer's requests for the blood alcohol record, so the time to pay or deny never began and the claim was premature.
Of the 374 decisions on this question in the Second Department courts and the Court of Appeals, 151 (this one included) are in the same category. 4 decisions in other departments that cite or are cited by this one are on the full map.
Cited in this decision
- Hospital for Joint Diseases v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 05413)The hospitals' first and fifth claims were dismissed because policy limits were exhausted and requested verification remained outstanding.
- New York & Presbyt. Hosp. v Progressive Cas. Ins. Co. (2004 NY Slip Op 01750)The insurer proved policy exhaustion on one hospital claim and absence of coverage on another, requiring dismissal of both.
Cited by
A label shows how the later decision treated this one.
- Westchester Med. Ctr. v One Beacon Ins. Co. (2008 NY Slip Op 52580(U)) Contrasted (cf., but see)The insurer's intoxication evidence raised factual questions but did not establish that intoxication caused the accident.
- Doshi Diagnostic Imaging Servs. v State Farm Ins. Co. (2007 NY Slip Op 27193) FollowedAn insurer may request medical-necessity verification from a prescribing physician if it properly notifies the applicant of outstanding requests.
- Westchester Med. Ctr. v State Farm Mut. Auto. Ins. Co. (2007 NY Slip Op 07690) FollowedThe insurer failed to establish intoxication or causation as a matter of law, but raised factual issues defeating the provider's motion.
- Elite Chiropractic Servs., PC v Travelers Ins. Co. (2005 NY Slip Op 51735(U)) FollowedAn insurer is not obligated to pay or deny a no-fault claim until requested verification has been provided.
- Darlington Med. Diagnostics, P.C. v Praetorian Ins. Co. (2011 NY Slip Op 51634(U)) FollowedUnder 11 NYCRR 65-3.8 (b) (3), an insurer need not pay or deny a no-fault claim until it receives the requested verification.
- Triangle R Inc. v Praetorian Ins. Co. (2010 NY Slip Op 52041(U)) FollowedAn insurer need not pay or deny a no-fault claim until it receives all relevant requested verification.
- St. Barnabas Hosp. v Government Empls. Ins. Co. (2017 NY Slip Op 27056) FollowedA hospital's claim was premature because it failed to verify which charges covered necessary emergency health services.
- Mount Sinai Hosp. v Auto One Ins. Co. (2014 NYSlipOp 06954)The insurer failed to establish prematurity because the hospital responded to verification and the requests' propriety remained disputed.
- Ocean Diagnostic Imaging, P.C. v Nationwide Mut. Ins. Co. (2006 NY Slip Op 50477(U))The provider's action was premature because the provider and assignor failed to respond to timely EUO verification requests.
- Beta Supply, Inc. v Government Employees Insurance Co. (2008 NY Slip Op 51406(U))The provider's claim was premature because it undisputedly failed to respond to verification requests presumed timely mailed and received.
Similar decisions
- Nyack Hosp. v Metropolitan Prop. & Cas. Ins. Co. (2005 NY Slip Op 02235)The insurer failed to prove mailing of its denial, and the denial was incomplete even if timely.
- Nyack Hosp. v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 52184(U))An insurer must accept a completed hospital facility form in place of an application for motor vehicle no-fault benefits.
- Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co. (2005 NYSlipOp 09484)An insurer need not pay or deny a no-fault claim until it receives all relevant verification requested.
- New York & Presbyt. Hosp. v Eagle Ins. Co. (2005 NY Slip Op 03210)An insurer was precluded from asserting delayed verification as a defense after failing to pay or deny upon receiving the requested material.
- Westchester Med. Ctr. v Progressive Cas. Ins. Co. (2007 NY Slip Op 06865)The provider's claim was premature because the insurer timely requested intoxication verification that it never received.