December 2, 2008

St. Barnabas Hosp. v American Tr. Ins. Co. (2008 NY Slip Op 09585)

Headnote

The case involved a dispute between St. Barnabas Hospital and American Transit Insurance Company over the payment of no-fault medical benefits under insurance contracts. St. Barnabas Hospital sought summary judgment on the first cause of action, claiming that it had made a prima facie showing of entitlement to judgment as a matter of law by demonstrating that the prescribed statutory billing forms were mailed to and received by the defendant and that payment was overdue. However, the defendant challenged this claim by arguing that the Hospital did not timely comply with the demand for verification, which raised a triable issue of fact. The court ultimately denied the defendant's cross motion for summary judgment dismissing the first cause of action and also denied the Hospital's motion for summary judgment on the first cause of action, finding that the defendant was not obligated to pay or deny the claim until all demanded verification was provided by the Hospital. Therefore, the court affirmed the order in part and modified it in part.

Reported in New York Official Reports at St. Barnabas Hosp. v American Tr. Ins. Co. (2008 NY Slip Op 09585)

St. Barnabas Hosp. v American Tr. Ins. Co.

2008 NY Slip Op 09585 [57 AD3d 517]

December 2, 2008

Appellate Division, Second Department

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

As corrected through Wednesday, February 11, 2009

St. Barnabas Hospital, as Assignee of Miguel Jimenez, et al., Respondents,
v
American Transit Insurance Company, Appellant.

—[*1] Stern & Montana, LLP, New York, N.Y. (Richard Montana of counsel), for appellant.

Joseph Henig, P.C., Bellmore, N.Y., for respondents.

In an action to recover no-fault medical payments under insurance contracts, the defendant appeals from so much of an order of the Supreme Court, Nassau County (Mahon, J.), dated January 28, 2008, as granted that branch of the motion of the plaintiff St. Barnabas Hospital, as assignee of Miguel Jimenez, which was for summary judgment on the first cause of action and denied that branch of its cross motion which was for summary judgment dismissing the first cause of action.

Ordered that the order is modified, on the law, by deleting the provision thereof granting that branch of the motion of the plaintiff St. Barnabas Hospital, as assignee of Miguel Jimenez, which was for summary judgment on the first cause of action and substituting therefor a provision denying that branch of the motion; as so modified, the order is affirmed insofar as appealed from, without costs or disbursements.

The plaintiff St. Barnabas Hospital, as assignee of Miguel Jimenez (hereinafter the Hospital), made a prima facie showing of entitlement to judgment as a matter of law on the first cause of action to recover no-fault benefits by demonstrating that the prescribed statutory billing forms were mailed to and received by the defendant and that payment was overdue (see Westchester Med. Ctr. v Allstate Ins. Co., 53 AD3d 481 [2008]; Hospital for Joint Diseases v New York Cent. Mut. Fire Ins. Co., 44 AD3d 903, 904 [2007]; New York & Presbyt. Hosp. v Countrywide Ins. Co., 44 AD3d 729, 730 [2007]). [*2]

However, in opposition, the defendant raised a triable issue of fact as to whether the Hospital timely complied with the demand for verification (see Mount Sinai Hosp. v Allstate Ins. Co., 25 AD3d 673, 674 [2006]). The defendant was not obligated to pay or deny the claim until all demanded verification was provided by the Hospital (see New York & Presbyt. Hosp. v Allstate Ins. Co., 31 AD3d 512, 513 [2006]; Nyack Hosp. v General Motors Acceptance Corp., 27 AD3d 96, 100-101 [2005], mod on other grounds 8 NY3d 294 [2007]; Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492, 493 [2005]).

Accordingly, the Supreme Court correctly denied that branch of the defendant’s cross motion which was for summary judgment dismissing the first cause of action, but should not have granted that branch of the Hospital’s motion which was for summary judgment on the first cause of action. Mastro, J.P., Rivera, Fisher and Eng, JJ., concur.