August 23, 2012

Quality Health Prods. v Country-Wide Ins. Co. (2012 NY Slip Op 51641(U))

https://www.beynensonlaw.com/case-law/quality-health-prods-v-country-wide-ins-co-2012-ny-slip-op-51641u/

Court: Appellate Term, Second Department
Decided: August 23, 2012
Citation: 2012 NY Slip Op 51641(U) · 36 Misc 3d 148(A)
Posture: Summary judgment
Outcome: Insurer prevailed
Issues: Verification requests
Legal questions: Outstanding verification and premature actions · Proof of mailing (see the maps)

Cite as

Quality Health Prods. v Country-Wide Ins. Co., 36 Misc 3d 148(A), 2012 NY Slip Op 51641(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2012)

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 provider's action was premature because timely verification requests remained unanswered when the action began. The insurer's litigation supervisor established timely mailing of initial and follow-up requests under 11 NYCRR 65-3.5 (b) and 11 NYCRR 65-3.6 (b). The insurer showed that it had not received the requested verification, and the provider failed to show that it had supplied it before commencing suit. Accordingly, the 30-day period to pay or deny had not begun under 11 NYCRR 65-3.8 (a). The Appellate Term, Second Department, affirmed the order denying the provider's summary judgment motion and granting the insurer's cross motion dismissing the complaint.

Reported in New York Official Reports at Quality Health Prods. v Country-Wide Ins. Co. (2012 NY Slip Op 51641(U))

[*1]

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

2012 NY Slip Op 51641(U) [36 Misc 3d 148(A)]

Decided on August 23, 2012

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This opinion is uncorrected and will not be published in the printed Official Reports.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 August 23, 2012

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

PRESENT: : PESCE, P.J., WESTON and RIOS, JJ
2010-1784 K C.

Quality Health Products as Assignee of BETH McCULLOUGH, Appellant, —
against
Country-wide Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Kenneth P. Sherman, J.), entered November 23, 2009. The order denied plaintiff’s motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint.

ORDERED that the order is affirmed, without 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 denied plaintiff’s motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint.

The affidavit of defendant’s litigation supervisor established that defendant had timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]) its initial and follow-up requests for verification to plaintiff (see Insurance Department Regulations [11 NYCRR] §§ 65-3.5 [b]; 65-3.6 [b]). Defendant demonstrated that it had not received the requested verification, and plaintiff did not show that the verification had been provided to defendant prior to the commencement of the action. Consequently, the 30-day period within which defendant was required to pay or deny the claims did not begin to run and plaintiff’s action is premature (see Insurance Department Regulations [*2][11 NYCRR] § 65-3.8 [a]; Hospital for Joint Diseases v New York Cent. Mut. Fire Ins. Co., 44 AD3d 903 [2007]; Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492 [2005]).

Accordingly, the order is affirmed.

Pesce, P.J., Weston and Rios, JJ., concur.
Decision Date: August 23, 2012

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.

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

Held the action premature because the insurer timely mailed initial and follow-up verification requests and had not received the verification, and the provider did not show it was provided before suit.

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

Of the 385 decisions on this question in the Second Department courts and the Court of Appeals, 153 (this one included) are in the same category.

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 (rules on the question, but another ground decided the case)

Held the litigation supervisor's affidavit established timely mailing of the initial and follow-up verification requests to the provider.

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 1,400 decisions on this question in the Second Department courts and the Court of Appeals, 809 (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.
Delta Diagnostic Radiology, P.C. v Chubb Group of Ins. (2007 NY Slip Op 27345) FollowedAn insurer may prove mailing by describing its standard procedure for properly addressing and mailing items.
Hospital for Joint Diseases v New York Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 08038) FollowedThe hospital's claim was premature because unrebutted proof showed that it ignored timely verification and follow-up requests.
Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co. (2005 NYSlipOp 09484) FollowedAn insurer need not pay or deny a no-fault claim until it receives all relevant verification requested.

Similar decisions

Quality Rehab & P.T., P.C. v GEICO Ins. Co. (2010 NY Slip Op 50067(U))The provider's action was premature because it did not show that it supplied timely requested verification before commencing suit.
Quality Health Prods. v GEICO Gen. Ins. Co. (2012 NY Slip Op 51645(U))The provider's notice of trial was vacated because discovery remained outstanding, and its untimely discovery objections required production.
Favorite Health Prods., Inc. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50467(U))The provider's action was premature because the insurer had not received all requested verification before suit.
Quality Health Prods., Inc. v Auto One Ins. Co. (2008 NY Slip Op 51530(U))The insurer failed to establish continued EUO tolling after receiving verification, rendering its denial untimely and precluding fraudulent billing.
MT Servs. P.T., P.C. v Country-Wide Ins. Co. (2017 NY Slip Op 51851(U))The insurer's 30-day period to pay or deny had not begun because timely requested verification remained outstanding when the provider sued.