June 19, 2019
Orthoplus Prods., Inc. v Global Liberty Ins. Co. of N.Y. (2019 NY Slip Op 51003(U))
https://www.beynensonlaw.com/case-law/orthoplus-prods-inc-v-global-liberty-ins-co-of-n-y-2019-ny-slip-op51003u/
- Decided
- June 19, 2019
- Citation
- 2019 NY Slip Op 51003(U) · 64 Misc 3d 128(A)
- Posture
- Summary judgment
- Outcome
- Insurer prevailed
- Later treatment
- Followed in 1 later decision (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 Orthoplus Prods., Inc. v Global Liberty Ins. Co. of N.Y. (2019 NY Slip Op 51003(U))
| Orthoplus Prods., Inc. v Global Liberty Ins. Co. of N.Y. |
| 2019 NY Slip Op 51003(U) [64 Misc 3d 128(A)] |
| Decided on June 19, 2019 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports.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 June 19, 2019
PRESENT: Shulman, P.J., Cooper, Edmead, JJ.
570655/18
against
Global Liberty Insurance Company of New York, Defendant-Appellant.
Defendant appeals from an order of the Civil Court of the City of New York, New York County (Carolyn Walker-Diallo, J.), dated July 20, 2018, which denied its motion for summary judgment dismissing the complaint.
Per Curiam.
Order (Carolyn Walker-Diallo, J.), dated July 20, 2018, reversed, with $10 costs, motion granted and complaint dismissed. The Clerk is directed to enter judgment accordingly.
Defendant-insurer established its prima facie entitlement to summary judgment dismissing the underlying first-party no-fault claims as premature. Even accepting plaintiff’s assertion that it submitted certain verification documents to defendant, the record establishes that plaintiff did not fully respond to defendant’s requests for additional verification, which were properly mailed to plaintiff’s attorney as authorized by counsel’s prior correspondence to defendant (see St. Vincent’s Hosp. of Richmond v American Tr. Ins. Co., 299 AD2d 338 [2002]; GNK Med. Supply, Inc. v Tri-State Consumer Ins. Co., 37 Misc 3d 138[A], 2012 NY Slip Op 52195[U] [App Term, 1st Dept 2012]). Since verification remained outstanding, the then-applicable thirty-day period to pay or deny the claims did not begin to run, the claims were not overdue, and plaintiff’s action is premature (see St. Vincent Med. Care, P.C. v Country Wide Ins. Co., 80 AD3d 599, 600 [2011]; Westchester County Med. Ctr. v New York Cent. Mut. Fire Ins. Co., 262 AD2d 553 [1999]).
THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.
I concur I concur I concur
Decision Date: June 19, 2019
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 action premature because the provider did not fully respond to verification requests properly mailed to its attorney, so the 30-day period never began to run and the claims were not overdue.
Of the 38 decisions on this question in the First Department courts and the Court of Appeals, 23 (this one included) are in the same category. 2 decisions in other departments that cite or are cited by this one are on the full map.
Cited in this decision
- GNK Med. Supply, Inc. v Tri-State Consumer Ins. Co. (2012 NY Slip Op 52195(U))The insurer established that the provider's claim was premature because properly mailed verification requests went unanswered.
- St. Vincent Med. Care, P.C. v Country Wide Ins. Co. (2011 NY Slip Op 00214)The insurer's follow-up verification requests on the 30th day were effective, and the provider's incomplete compliance made the action premature.
Cited by
A label shows how the later decision treated this one.
- American Tr. Ins. Co. v PDA NY Chiropractic, P.C. (2023 NY Slip Op 50938(U)) FollowedA provider's substantial compliance with reasonable additional verification requests does not make its claims payable.
Similar decisions
- Lenox Hill Radiology & MIA, P.C. v Global Liberty Ins. Co. of N.Y. (2018 NY Slip Op 51810(U))The provider's action was premature because timely verification requests remained unanswered when the action was commenced.
- Infinity Health Prods. Ltd. v Liberty Mut. Fire Ins. Co. (2012 NY Slip Op 50774(U))The provider's action was premature because it failed to respond to timely verification requests and follow-up requests.
- Ortho Prods. & Equipments, Inc. v Eveready Ins. Co. (2013 NY Slip Op 50856(U))The provider's action was premature because its claim forms lacked substantially the same information as NF-3 forms requested in verification.
- Infinity Health Prods., Ltd. v Liberty Mut. Fire Ins. Co. (2012 NY Slip Op 52396(U))The provider's action was premature because timely verification requests remained unanswered.
- Quality Health Prods. v Country-Wide Ins. Co. (2012 NY Slip Op 51641(U))The provider's action was premature because timely verification requests remained unanswered when the action began.