January 26, 2010

St. Vincent’s Hosp. & Med. Ctr. v Allstate Ins. Co. (2010 NY Slip Op 00668)

https://www.beynensonlaw.com/case-law/st-vincents-hosp-med-ctr-v-allstate-ins-co-2010-ny-slip-op00668/

Court: Appellate Division, Second Department
Decided: January 26, 2010
Citation: 2010 NY Slip Op 00668 · 69 AD3d 923
Posture: Summary judgment
Outcome: Insurer prevailed
Later treatment: Followed in 1 later decision (see Cited by)
Issues: Staged accidents, lack of coverage Timeliness and preclusion

Cite as

St. Vincent's Hosp. & Med. Ctr. v Allstate Ins. Co., 69 AD3d 923 (2d Dept 2010)

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.

An insurer's failure to pay or deny a no-fault claim within 30 days does not preclude a defense that the accident was not an insured incident. The insurer established prima facie entitlement to summary judgment on that ground, and the provider failed to raise a triable factual issue. Following Central Gen. Hosp. v Chubb Group of Ins. Cos., the Appellate Division, Second Department, rejected the provider's preclusion argument. It reversed the order and judgment awarding benefits to the provider, denied the provider's summary judgment motion, granted the insurer's cross motion and dismissed the complaint.

Reported in New York Official Reports at St. Vincent’s Hosp. & Med. Ctr. v Allstate Ins. Co. (2010 NY Slip Op 00668)

St. Vincent’s Hosp. & Med. Ctr. v Allstate Ins. Co.

2010 NY Slip Op 00668 [69 AD3d 923]

January 26, 2010

Appellate Division, Second Department

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

As corrected through Wednesday, March 10, 2010

St. Vincent’s Hospital & Medical Center, as Assignee of Jane Fritz, Respondent,
v
Allstate Insurance Company, Appellant.

—[*1] McDonnell & Adels, PLLC, Garden City, N.Y. (Martha S. Henley of counsel), for appellant.

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

In an action to recover no-fault medical benefits under an insurance contract, the defendant appeals from an order and judgment (one paper) of the Supreme Court, Nassau County (Feinman, J.), entered January 14, 2009, which, upon a decision of the same court dated December 3, 2008, granted the plaintiff’s motion for summary judgment on the complaint, in effect, denied the defendant’s cross motion for summary judgment dismissing the complaint, and is in favor of the plaintiff and against it in the principal sum of $32,086.70.

Ordered that the order and judgment is reversed, on the law, with costs, the motion is denied, the cross motion is granted, and the complaint is dismissed.

In support of its cross motion, the defendant made a prima facie showing of entitlement to judgment as a matter of law by demonstrating that the accident in which the plaintiff’s assignor was injured was not an insured incident (see Central Gen. Hosp. v Chubb Group of Ins. Cos., 90 NY2d 195, 199 [1997]; see generally Alvarez v Prospect Hosp., 68 NY2d 320 [1986]). In opposition to the defendant’s prima facie showing, the plaintiff failed to raise a triable issue of fact. Contrary to the plaintiff’s contention, the defense of lack of coverage is not precluded by the defendant’s failure to pay or deny the subject no-fault claim within the requisite 30-day period (see Hospital for Joint Diseases v Travelers Prop. Cas. Ins. Co., 9 NY3d 312, 318 [2007]; Central Gen. Hosp. v Chubb Group of Ins. Co., 90 NY2d at 199).

Accordingly, the Supreme Court should have denied the plaintiff’s motion for summary judgment on the complaint, and granted the defendant’s cross motion for summary judgment dismissing the complaint.

The plaintiff’s remaining contentions are without merit. Rivera, J.P., Dillon, Miller and Roman, JJ., concur.

Cited in this decision

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

Hospital for Joint Diseases v Travelers Prop. Cas. Ins. Co. (2007 NY Slip Op 09067) FollowedAn insurer that fails to timely seek verification of an assignment cannot later contest its validity when the underlying claim is covered.

Cited by

A label shows how the later decision treated this one.

New York Hosp. Med. Ctr. of Queens v Utica Mut. Ins. Co. (2012 NY Slip Op 52388(U)) FollowedThe insurer established that the assignor's injuries did not arise from an insured incident, and the provider's records raised no triable issue.

Similar decisions

St. Vincent’s Hosp. & Med. Ctr. v County Wide Ins. Co. (2005 NY Slip Op 10114)A hospital's no-fault claim was dismissed because it was submitted more than 45 days after medical services were rendered.
New York Hosp. Med. Ctr. of Queens v Allstate Ins. Co. (2014 NY Slip Op 00640)The providers established receipt of their claim and nonpayment or improper denial within 30 days, warranting summary judgment.
St. Vincent Med. Care, P.C. v Country Wide Ins. Co. (2011 NY Slip Op 00214)The insurer's follow-up verification requests on the 30th day were effective, and the provider's incomplete compliance made the action premature.
Westchester Med. Ctr. v Allstate Ins. Co. (2014 NY Slip Op 00655)The provider obtained summary judgment because neither the insurer's asserted verification request nor its denial was sent within 30 days.
NYU-Hospital for Joint Diseases v Allstate Ins. Co. (2014 NY Slip Op 08613)The hospital failed to establish entitlement to summary judgment because its own papers included a timely and sufficient denial.