November 1, 2016

Prime Diagnostic Med., P.C. v Liberty Mut. Fire Ins. Co. (2016 NY Slip Op 51612(U))

https://www.beynensonlaw.com/case-law/prime-diagnostic-med-p-c-v-liberty-mut-fire-ins-co-2016-ny-slip-op51612u/

Court: Appellate Term, Second Department
Decided: November 1, 2016
Citation: 2016 NY Slip Op 51612(U) · 53 Misc 3d 147(A)
Posture: Summary judgment
Outcome: Insurer prevailed
Issues: Verification requests Timeliness and preclusion
Legal questions: Proof of mailing · Outstanding verification and premature actions (see the maps)

Cite as

Prime Diagnostic Med., P.C. v Liberty Mut. Fire Ins. Co., 53 Misc 3d 147(A), 2016 NY Slip Op 51612(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2016)

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.

The insurer's claim specialist established timely mailing of verification requests and follow-up requests and the provider's failure to respond. The provider appealed an order granting the insurer summary judgment dismissing an action for assigned no-fault benefits. The Appellate Term, Second Department, rejected both challenges to the claim specialist's affidavit. Following St. Vincent's Hosp. of Richmond v Government Empls. Ins. Co., it found the affidavit sufficient to prove timely mailing; it also found sufficient proof that the requests remained unanswered. The order dismissing the complaint was affirmed.

Reported in New York Official Reports at Prime Diagnostic Med., P.C. v Liberty Mut. Fire Ins. Co. (2016 NY Slip Op 51612(U))

[*1]

Prime Diagnostic Med., P.C. v Liberty Mut. Fire Ins. Co.

2016 NY Slip Op 51612(U) [53 Misc 3d 147(A)]

Decided on November 1, 2016

Appellate Term, Second 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This opinion is uncorrected and will not be published in the printed Official Reports.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 November 1, 2016

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2014-11 Q C

Prime Diagnostic Medical, P.C., as Assignee of KHADINE ISAAC, Appellant,
against
Liberty Mutual Fire Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Ulysses Bernard Leverett, J.), entered December 9, 2013. The order granted defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order is affirmed, with $25 costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court which granted defendant’s motion for summary judgment dismissing the complaint.

Contrary to plaintiff’s first contention on appeal, the affidavit of defendant’s claim specialist established that defendant had timely mailed requests and follow-up requests for verification (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). Contrary to plaintiff’s remaining contention, the affidavit of defendant’s claim specialist was also sufficient to establish that plaintiff had failed to respond to those requests.

Accordingly, the order is affirmed.

Pesce, P.J., Aliotta and Solomon, JJ., concur.

Decision Date: November 01, 2016

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.

Proof of mailing

Open the full map

Did a party’s evidence establish that it mailed a no-fault claim, denial, verification request or examination notice?

This decision: The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice

Rejected the provider's contention and held the claim specialist's affidavit established that the insurer timely mailed its verification requests and follow-up requests.

Insurer proved mailingInsurer failed to proveProvider proved mailingProvider failed to proveTriable issue on mailingMixed rulingsThis decisionCites it or cited by itCited or followed

Of the 1,384 decisions on this question in the Second Department courts and the Court of Appeals, 806 (this one included) are in the same category.

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: Timely requests went unanswered; the claim is not overdue and the action is premature

Affirmed dismissal because the insurer's affidavit established timely verification requests and follow-ups and that the provider never responded to them.

Premature: verification outstandingNonresponse denial upheldTriable issueInsurer's showing failsProvider compliedThis decision

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.

Cited in this decision

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

St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co. (2008 NY Slip Op 04072) FollowedThe insurer raised factual issues concerning a proper timely denial and its entitlement to deny the hospital's claim.

Similar decisions

Prime Diagnostic Med., P.C. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 51363(U))The insurer's motion for summary judgment dismissing the provider's assigned no-fault claims was granted and affirmed on appeal.
Prime Diagnostic Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 51523(U))The insurer established proper mailing of IME notices and the denial form, as well as the assignor's failure to attend the IMEs. The provider appealed summary judgment dismissing its assigned no-fault claim.
Compas Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 51417(U))The insurer established proper mailing of verification requests and denials and timely denial after receipt of verification.
Clinton Place Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50960(U))The insurer's litigation examiner affidavit established timely mailing of the denials based on the assignor's IME nonappearance.
Compas Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51403(U))The insurer proved outstanding verification for the fifth claim and IME and EUO nonappearance for the first, third, and fourth claims.