July 27, 2011

Radiology Today, P.C. v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 52452(U))

Headnote

The main facts of the case involved an insurance dispute over first-party no-fault benefits that were assigned to Radiology Today, P.C. The issue before the court was whether New York Central Mutual Fire Insurance Company had failed to establish that Radiology Today did not comply with their requests for verification of the benefits. The court found that the insurance company had submitted evidence showing that they had timely mailed their requests for verification, and that Radiology Today had failed to provide the MRI films that had been requested. As a result, the court held that the 30-day period within which the insurance company was required to pay or deny the claims had not commenced, and therefore Radiology Today's action was premature. The court ultimately reversed the lower court's decision and granted the insurance company's motion for summary judgment dismissing the complaint.

Reported in New York Official Reports at Radiology Today, P.C. v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 52452(U))

Radiology Today, P.C. v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 52452(U)) [*1]

Radiology Today, P.C. v New York Cent. Mut. Fire Ins. Co.

2011 NY Slip Op 52452(U) [34 Misc 3d 139(A)]

Decided on July 27, 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This opinion is uncorrected and will not be published in the printed Official Reports.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 July 27, 2011

SUPREME COURT OF THE STATE OF NEW YORK

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

PRESENT: : PESCE, P.J., WESTON and STEINHARDT, JJ
2010-978 K C.

Radiology Today, P.C. as Assignee of SALMOND SADARIE, Respondent,
against
New York Central Mutual Fire Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Devin P. Cohen, J.), entered February 16, 2010. The order, insofar as appealed from, denied defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order, insofar as appealed from, is reversed, without costs, and defendant’s motion for summary judgment dismissing the complaint is granted.In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from so much of an order as denied its motion for summary judgment dismissing the complaint based on a finding that defendant had failed to establish that plaintiff did not comply with defendant’s requests for verification.

Contrary to plaintiff’s contention, the affidavit of defendant’s litigation examiner, submitted in support of defendant’s motion, established that defendant had timely mailed its requests and follow-up requests for verification (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Delta Diagnostic Radiology, P.C. v Chubb [*2]Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]), and that plaintiff had failed to provide the MRI films which, among other things, defendant’s requests for verification had sought. As plaintiff’s opposing papers failed to address defendant’s requests for the assignor’s MRI films, plaintiff did not demonstrate that it had provided defendant, prior to commencement of the action, with the verification requested. Consequently, the 30-day period within which defendant was required to pay or deny the claims did not commence to run and plaintiff’s action is premature (see Insurance Department Regulations [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, insofar as appealed from, is reversed, and defendant’s motion for summary judgment dismissing the complaint is granted.

Pesce, P.J., Weston and Steinhardt, JJ., concur.
Decision Date: July 27, 2011