May 3, 2019

Solution Bridge, Inc. v Nationwide Ins. (2019 NY Slip Op 50689(U))

https://www.beynensonlaw.com/case-law/solution-bridge-inc-v-nationwide-ins-2019-ny-slip-op-50689u/

Court: Appellate Term, Second Department
Decided: May 3, 2019
Citation: 2019 NY Slip Op 50689(U) · 63 Misc 3d 146(A)
Posture: Summary judgment
Outcome: Provider prevailed
Issues: Verification requests
Legal questions: Proof of mailing · Outstanding verification and premature actions (see the maps)

Cite as

Solution Bridge, Inc. v Nationwide Ins., 63 Misc 3d 146(A), 2019 NY Slip Op 50689(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2019)

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 affidavit raised a triable issue as to whether it had supplied the insurer's requested verification. The insurer obtained summary judgment dismissing the provider's assigned no-fault action on the ground that requested verification had not been provided. The provider's opposition affidavit was sufficient to raise a presumption that the verification had been mailed to and received by the insurer, leaving a factual dispute. The Appellate Term, Second Department, reversed the order and denied the insurer's motion for summary judgment dismissing the complaint.

Reported in New York Official Reports at Solution Bridge, Inc. v Nationwide Ins. (2019 NY Slip Op 50689(U))

[*1]

Solution Bridge, Inc. v Nationwide Ins.

2019 NY Slip Op 50689(U) [63 Misc 3d 146(A)]

Decided on May 3, 2019

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This opinion is uncorrected and will not be published in the printed Official Reports.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 May 3, 2019

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

PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, DAVID ELLIOT, JJ
2017-311 K C

Solution Bridge, Inc., as Assignee of Akosah, Stephanie, Appellant,
against
Nationwide Ins., Respondent.

The Rybak Firm, PLLC (Damin J. Toell of counsel), for appellant. Hollander Legal Group, P.C. (Allan S. Hollander of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Richard J. Montelione, J.), entered September 7, 2016. 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 on the ground that plaintiff had failed to provide requested verification.

Plaintiff correctly argues that the affidavit it submitted in opposition to defendant’s motion was sufficient to give rise to a presumption that the requested verification had been mailed to, and received by, defendant (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]) and thus that there is a triable issue of fact as to whether the verification had been provided.

Accordingly, the order is reversed and defendant’s motion for summary judgment dismissing the complaint is denied.

PESCE, P.J., ALIOTTA and ELLIOT, JJ., concur.

ENTER:
Paul Kenny
Chief Clerk
Decision Date: May 03, 2019

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.

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 mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or received

Held the provider's affidavit sufficient to raise a presumption that the requested verification was mailed to and received by the insurer, creating a triable issue whether it was provided.

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, 103 (this one included) are in the same category.

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

Held the insurer not entitled to dismissal because the provider's affidavit raised a presumption the verification was mailed and received, leaving a triable issue whether it was provided.

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.

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.

Similar decisions

Solution Bridge, Inc. v State Farm Mut. Auto. Ins. Co. (2019 NY Slip Op 50739(U))The provider's affidavit raised a triable issue as to whether it had supplied the insurer's requested verification.
Solution Bridge, Inc. v GEICO Ins. Co. (2021 NY Slip Op 50731(U))The provider's action was barred by res judicata because recovery would impair rights established in a declaratory judgment action.
New York Manual, P.T., P.C. v Nationwide Affinity Ins. Co. of Am. (2023 NY Slip Op 50281(U))The provider failed to raise a triable issue that it supplied requested verification or reasonably justified noncompliance.
Remedy Chiropractic, P.C. v Nationwide Ins. (2022 NY Slip Op 50935(U))The provider failed to raise a factual issue that it supplied outstanding verification or reasonably justified withholding it.
Blackman v Nationwide Ins. (2019 NY Slip Op 52038(U))Disputes over receipt of verification and the fee schedule barred summary judgment for either party.