March 3, 2011

Quality Health Prods. v Country-Wide Ins. Co. (2011 NY Slip Op 50328(U))

Headnote

The court considered the fact that the plaintiff, Quality Health Products, was seeking to recover assigned first-party no-fault benefits from the defendant, Country-Wide Ins. Co. The main issue decided was whether the defendant timely denied the plaintiff's claims based on lack of medical necessity. The court held that the plaintiff failed to establish that the claim was not denied within 30 days and also failed to show that the basis for the denial was conclusory, vague, or had no merit as a matter of law. Therefore, the court affirmed the order denying the plaintiff's motion for summary judgment.

Reported in New York Official Reports at Quality Health Prods. v Country-Wide Ins. Co. (2011 NY Slip Op 50328(U))

Quality Health Prods. v Country-Wide Ins. Co. (2011 NY Slip Op 50328(U)) [*1]

Quality Health Prods. v Country-Wide Ins. Co.

2011 NY Slip Op 50328(U) [30 Misc 3d 143]

Decided on March 3, 2011

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This opinion is uncorrected and will not be published in the printed Official Reports.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 March 3, 2011

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : PESCE, P.J., GOLIA and STEINHARDT, JJ
2009-1770 K C.

Quality Health Products as Assignee of Darek Rudnik, Appellant,
against
COUNTRY-WIDE INS. CO., Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Noach Dear, J.), entered June 3, 2009. The order denied plaintiff’s motion for summary judgment.

ORDERED that the order is affirmed, without costs.

In this action by a provider to recover assigned first-party no-fault benefits, defendant opposed plaintiff’s motion for summary judgment, arguing that it had timely denied plaintiff’s claims on the ground of lack of medical necessity based upon a peer review report. The Civil Court denied plaintiff’s motion. This appeal by plaintiff ensued.

Plaintiff established that defendant did not pay plaintiff’s claim. However, plaintiff failed to establish that the claim was not denied within 30 days (see New York & Presbyt. Hosp. v Allstate Ins. Co., 31 AD3d 512 [2006]; see also Westchester Med. Ctr. v Nationwide Mut. Ins. Co., 78 AD3d 1168 [2010]). Plaintiff attached a copy of a portion of defendant’s denial of claim form to its motion papers, but this copy did not establish that defendant did not deny the claim within 30 days, since the date of the denial of claim form was not contained in the portion of the form annexed to plaintiff’s papers. Moreover, plaintiff’s affiant did not provide the date on which the denial of claim form was received by plaintiff. Furthermore, the reason for defendant’s denial of the claim was also not included in the annexed portion of the form. As plaintiff failed to show that the claim was not denied within 30 days or that the basis for the denial was conclusory, vague or had no merit as a matter of law, it failed to make a prima facie showing of its entitlement to judgment as a matter of law (see Westchester Med. Ctr., 78 AD3d 1168). As a result, we need not consider the sufficiency of defendant’s paper’s submitted in opposition to the motion (see Westchester Med. Ctr., 78 AD3d 1168). Accordingly, the [*2]
order denying plaintiff’s motion for summary judgment is affirmed, albeit on a different ground.

Pesce, P.J., Golia and Steinhardt, JJ., concur.
Decision Date: March 03, 2011