October 11, 2016

Renelique v American Tr. Ins. Co. (2016 NY Slip Op 51546(U))

https://www.beynensonlaw.com/case-law/renelique-v-american-tr-ins-co-2016-ny-slip-op-51546u/

Court: Appellate Term, Second Department
Decided: October 11, 2016
Citation: 2016 NY Slip Op 51546(U) · 53 Misc 3d 143(A)
Posture: Summary judgment
Outcome: Provider prevailed
Issues: Verification requests
Legal questions: Outstanding verification and premature actions (see the maps)

Cite as

Renelique v American Tr. Ins. Co., 53 Misc 3d 143(A), 2016 NY Slip Op 51546(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 motion for summary judgment dismissing the provider's claims as premature for outstanding verification was denied on appeal. The Appellate Term, Second Department, reversed the order for the reasons stated in the companion appeal, Performance Plus Med., P.C. v Nationwide Ins., decided the same day, No. 2013-2766 Q C, without supplying independent reasoning.

Reported in New York Official Reports at Renelique v American Tr. Ins. Co. (2016 NY Slip Op 51546(U))

[*1]

Renelique v American Tr. Ins. Co.

2016 NY Slip Op 51546(U) [53 Misc 3d 143(A)]

Decided on October 11, 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This opinion is uncorrected and will not be published in the printed Official Reports.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 October 11, 2016

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

PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2014-1324 Q C

Pierre Jean Jacques Renelique, as Assignee of Susan Santiago, Appellant,
against
American Transit Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Ulysses Bernard Leverett, J.), entered May 23, 2014. The order granted defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order is reversed, with $30 costs, and defendant’s motion for summary judgment dismissing the complaint is denied.

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 as premature because plaintiff had failed to provide requested verification.

For the reasons stated in Performance Plus Med., P.C., as Assignee of Melanna Luckie v Nationwide Ins. (___ Misc 3d ___, 2016 NY Slip Op ______ [appeal No. 2013-2766 Q C], decided herewith), the order is reversed and defendant’s motion for summary judgment dismissing the complaint is denied.

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

Decision Date: October 11, 2016

Legal questions

A question 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: Fact issues remain on whether the verification defense applies

Reversed the dismissal of the action as premature and denied the insurer's verification-based summary judgment motion for the reasons in a companion decision, which found a triable issue whether the action was premature.

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

Of the 385 decisions on this question in the Second Department courts and the Court of Appeals, 114 (this one included) are in the same category.

Similar decisions

Renelique v Tri State Consumers Ins. Co. (2016 NY Slip Op 51536(U))The insurer's summary judgment motion based on outstanding verification was denied on appeal.
Renelique v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 50868(U))The insurer's affidavit established timely and proper mailing of the denial based on the assignor's IME nonappearance.
Renelique v Travelers Ins. Co. (2016 NY Slip Op 50911(U))The provider's affidavit raised a factual issue as to whether the insurer received requested verification and the action was premature.
Renelique v Allstate Ins. Co. (2016 NY Slip Op 51357(U))The insurer's affidavits failed to establish an office mailing procedure ensuring timely mailing of its denial of claim.
Renelique v National Liab. & Fire Ins. Co. (2016 NY Slip Op 51613(U))The insurer failed to prove mailing of the IME scheduling letters and therefore failed to establish that the assignor's IMEs were properly scheduled.