March 24, 2011

Omega Diagnostic Imaging, P.C. v MVAIC (2011 NY Slip Op 50432(U))

https://www.beynensonlaw.com/case-law/omega-diagnostic-imaging-p-c-v-mvaic-2011-ny-slip-op-50432u/

Court: Appellate Term, First Department
Decided: March 24, 2011
Citation: 2011 NY Slip Op 50432(U) · 30 Misc 3d 145(A)
Posture: Summary judgment
Outcome: Provider prevailed
Later treatment: Followed in 2 later decisions (see Cited by)
Issues: MVAIC Verification requests
Legal questions: MVAIC eligibility: qualified covered person · Outstanding verification and premature actions (see the maps)

Cite as

Omega Diagnostic Imaging, P.C. v MVAIC, 30 Misc 3d 145(A), 2011 NY Slip Op 50432(U) (App Term, 1st Dept 2011)

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.

MVAIC's summary judgment motion challenging the assignor's qualification for coverage was denied on appeal. The Appellate Term, First Department, affirmed, citing MVAIC v Interboro Med. Care & Diagnostic, PC and Englington Med., P.C. v Motor Veh. Acc. Indem. Corp. It also found no showing that exhaustion was required and rejected MVAIC's outstanding-verification argument, raised for the first time on appeal, as without merit.

Reported in New York Official Reports at Omega Diagnostic Imaging, P.C. v MVAIC (2011 NY Slip Op 50432(U))

[*1]

Omega Diagnostic Imaging, P.C. v MVAIC

2011 NY Slip Op 50432(U) [30 Misc 3d 145(A)]

Decided on March 24, 2011

Appellate Term, First Department

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

This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on March 24, 2011

APPELLATE TERM OF THE SUPREME COURT, FIRST DEPARTMENT

PRESENT: Lowe, III, P.J., Shulman, Hunter, Jr., JJ
570683/10.

Omega Diagnostic Imaging, P.C., a/a/o Derrick Brown, Plaintiff-Respondent, – –

against

MVAIC, Defendant-Appellant.

Defendant appeals from an order of the Civil Court of the City of New York, Bronx County (Fernando Tapia, J.), dated June 4, 2010, which denied its motion for summary judgment dismissing the complaint.

Per Curiam.

Order (Fernando Tapia, J.), dated June 4, 2010, affirmed, with $10 costs.

In this action by plaintiff-provider to recover assigned first-party no-fault benefits, defendant MVAIC’s motion for summary judgment dismissing the claim based on plaintiff’s failure to establish that its assignor qualified for MVAIC coverage, was properly denied (see Matter of MVAIC v Interboro Med. Care & Diagnostic, PC, 73 AD3d 667 [2010]; Englington Med., P.C. v Motor Veh. Acc. Indem. Corp. (___AD3d ___, 2011 NY Slip Op 00176 [2011]). Nor has defendant established that plaintiff was required to “exhaust its remedies” prior to commencing this action (see Omega Diagnostic Imaging, P.C. v MVAIC, 29 Misc 3d 129[A], 2010 NY Slip Op 51779[U] [2010]). Defendant’s argument, raised for the first time on appeal, that it is entitled to dismissal of the action as premature based on outstanding verification requests is without merit (id.).
THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.
I concurI concurI concur
Decision Date: March 24, 2011

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.

MVAIC eligibility: qualified covered person

Open the full map

Against MVAIC, was the claimant shown to be a qualified, covered person meeting article 52’s conditions?

This decision: MVAIC bore the burden on its eligibility / lack-of-coverage defense and did not meet it; claimant prevails on this point

Held MVAIC's motion based on the provider's failure to establish the assignor's qualification was properly denied, and MVAIC did not establish that the provider had to exhaust remedies before suing.

Found not eligibleClaimant's proof lackingMVAIC failed to proveUnresolved / for trialDefense precluded/waivedThis decisionCites it or cited by itCited or followed

Of the 43 decisions on this question in the First Department courts and the Court of Appeals, 20 (this one included) are in the same category. One decision in other departments that cites or is cited by this one is on the full map.

Outstanding verification and premature actions

Open the full map

Did unanswered verification requests make the provider’s claim premature, or justify denying it for nonresponse?

This decision: Defense rejected because the insurer's requests or proof were deficient (rules on the question, but another ground decided the case)

Rejected, by reference to the companion decision, MVAIC's argument raised first on appeal that the action was premature because verification requests were outstanding.

Premature: verification outstandingNonresponse denial upheldTriable issueInsurer's showing failsProvider compliedThis decisionCites it or cited by itCited or followed

Of the 38 decisions on this question in the First Department courts and the Court of Appeals, 7 (this one included) are in the same category.

Cited in this decision

A label shows how this decision treated the case it cites.

Matter of MVAIC v Interboro Med. Care & Diagnostic PC (2010 NY Slip Op 04522) FollowedMVAIC's lack-of-coverage defense is not precluded by failure to pay or deny a no-fault claim within 30 days.
Englington Med., P.C. v Motor Veh. Acc. Indem. Corp. (2011 NY Slip Op 00176) FollowedMVAIC failed to establish that the assignor's uninsured mini-bike disqualified the assignor from receiving no-fault benefits.
Omega Diagnostic Imaging, P.C. v MVAIC (2010 NY Slip Op 51779(U)) FollowedMVAIC's demand for a no-insurance affidavit from an uncontrolled nonparty driver was improper and did not render the action premature.

Cited by

A label shows how the later decision treated this one.

Pomona Med. Diagnostic, P.C. v MVAIC (2011 NY Slip Op 51891(U)) FollowedMVAIC's summary judgment motion was denied because it failed to show that the assignor was not a qualified person entitled to coverage.
JJ & R Chiropractic PC v MVAIC (2019 NY Slip Op 51559(U)) FollowedMVAIC's motion for summary judgment dismissing the provider's no-fault action was denied for failure to establish its asserted eligibility defenses.
Pomona Med. Diagnostic, P.C. v MVAIC (2011 NY Slip Op 51573(U))MVAIC's motion for summary judgment based on lack of qualified-person status or no-fault coverage was denied, and the order was affirmed.

Similar decisions

Omega Med. Diagnostic v MVAIC (2011 NY Slip Op 50275(U))The provider's summary judgment motion was granted and MVAIC's cross motion for summary judgment dismissing the complaint was denied.
Omega Diagnostic Imaging, PC v MVAIC (2017 NY Slip Op 50568(U))Trial documents established that the assignor failed to report the accident within 24 hours, defeating the provider's claim against MVAIC. The assignor alleged an unidentified vehicle struck the assignor's bicycle, but the notice of intention filed 12 days later stated that no police were called.
Central Radiology Servs., P.C. v MVAIC (2012 NY Slip Op 50875(U))MVAIC established the absence of a timely notice of claim or an application for leave to file a late notice, defeating coverage.
Socrates Med. Health, P.C. v MVAIC (2011 NY Slip Op 51961(U))The provider's summary judgment award was affirmed because MVAIC offered no competent proof that the assignor was unqualified for benefits.
Advanced Med. Diagnostics of Queens, P.C. v Mvaic (2015 NY Slip Op 51659(U))The provider failed at trial to show exhaustion of remedies against the known vehicle owner before seeking benefits from MVAIC. A prior order had limited the nonjury trial to whether MVAIC coverage existed.