February 1, 2013

Quality Psychological Servs., P.C. v Utica Mut. Ins. Co. (2013 NY Slip Op 50148(U))

https://www.beynensonlaw.com/case-law/quality-psychological-servs-p-c-v-utica-mut-ins-co-2013-ny-slip-op50148u/

Court: Appellate Term, First Department
Decided: February 1, 2013
Citation: 2013 NY Slip Op 50148(U) · 38 Misc 3d 136(A)
Posture: Summary judgment
Outcome: Provider prevailed
Issues: Timeliness and preclusion Verification requests

Cite as

Quality Psychological Servs., P.C. v Utica Mut. Ins. Co., 38 Misc 3d 136(A), 2013 NY Slip Op 50148(U) (App Term, 1st Dept 2013)

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 provider EUO request was untimely and did not toll its time to pay or deny the claim. The insurer sought summary judgment dismissing the provider's first-party no-fault action. Its request for additional verification through a provider EUO was made well beyond the required 15-day period following the assignor's EUO. Applying 11 NYCRR 65-3.5 (b) and 11 NYCRR 65-3.8 (a) (1), the Appellate Term, First Department, affirmed the denial of the insurer's motion.

Reported in New York Official Reports at Quality Psychological Servs., P.C. v Utica Mut. Ins. Co. (2013 NY Slip Op 50148(U))

[*1]

Quality Psychological Servs., P.C. v Utica Mut. Ins. Co.

2013 NY Slip Op 50148(U) [38 Misc 3d 136(A)]

Decided on February 1, 2013

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This opinion is uncorrected and will not be published in the printed Official Reports.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 February 1, 2013

SUPREME COURT, APPELLATE TERM, FIRST DEPARTMENT

PRESENT: Lowe, III, P.J., Schoenfeld, Hunter, Jr., JJ
570808/12.

Quality Psychological Services, P.C., a/a/o Marlon McLeod, Plaintiff-Respondent, – –
against
Utica Mutual Insurance Company, Defendant-Appellant.

Defendant appeals from an order of the Civil Court of the City of New York, Bronx County (Robert R. Reed, J.), entered April 18, 2011, which denied its motion for summary judgment dismissing the complaint.

Per Curiam.

Order (Robert R. Reed, J.), entered April 18, 2011, affirmed, with $10 costs.

We sustain the denial of defendant’s motion for summary judgment dismissing this first-party no-fault action. Defendant’s June 26, 2008 request for additional verification in the form of an examination under oath (EUO) of the plaintiff medical provider was untimely and did not serve to toll defendant’s time to pay or deny the claim, since the request was made well beyond the requisite 15-day time period following the assignor’s EUO (see 11 NYCRR 65-3.5[b]; 65—3.8[a][1]; see Kingsbrook Jewish Med. Ctr. v Allstate Ins. Co., 61 AD3d 13, 17-18 [2009]).

THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.
Decision Date: February 01, 2013

Cited in this decision

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

Kingsbrook Jewish Med. Ctr. v Allstate Ins. Co. (2009 NY Slip Op 00351) FollowedJudicially noticed diagnosis codes alone do not establish that treatment was wholly unrelated to an insured automobile accident.

Similar decisions

Quality Psychological Servs., P.C. v Metropolitan Cas. Ins. Co. (2013 NY Slip Op 50250(U))The insurer failed to establish that EUO scheduling letters were mailed before the scheduled EUO dates, defeating summary judgment.
Five Boro Psychological Servs., P.C. v Utica Mut. Ins. Co. (2013 NY Slip Op 52005(U))An EUO rescheduled by mutual agreement before its scheduled date does not constitute a failure to appear.
Quality Psychological Servs., P.C. v New York Cent. Mut. Fire Ins. Co. (2013 NY Slip Op 50063(U))The insurer's psychologist's peer review was inadmissible, and the provider failed to establish entitlement to summary judgment.
All Boro Psychological Servs., P.C. v Hartford Ins. Co. (2012 NY Slip Op 51849(U))The insurer's affidavits established timely mailing of EUO notices and the denial, and the provider's failure to attend either EUO. In this action for assigned no-fault benefits, the provider challenged the insurer's proof supporting summary judgment dismissing the complaint.
New Quality Med., P.C. v Allstate Ins. Co. (2016 NY Slip Op 50871(U))The insurer failed to raise a triable issue as to timely denial of the provider's no-fault claim.