December 27, 2005
St. Vincent’s Hosp. & Med. Ctr. v County Wide Ins. Co. (2005 NY Slip Op 10114)
https://www.beynensonlaw.com/case-law/st-vincents-hosp-med-ctr-v-county-wide-ins-co-2005-ny-slip-op-10114/
- Decided
- December 27, 2005
- Citation
- 2005 NY Slip Op 10114 · 24 AD3d 748
- Posture
- Summary judgment
- Outcome
- Split result
- Later treatment
- Contrasted (cf., but see) in 1 and followed in 1 later decisions (see Cited by)
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.
Reported in New York Official Reports at St. Vincent’s Hosp. & Med. Ctr. v County Wide Ins. Co. (2005 NY Slip Op 10114)
| St. Vincent’s Hosp. & Med. Ctr. v County Wide Ins. Co. |
| 2005 NY Slip Op 10114 [24 AD3d 748] |
| December 27, 2005 |
| Appellate Division, Second Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| St. Vincent’s Hospital & Medical Center et al., Appellants, v County Wide Insurance Company, Respondent. |
—[*1]
In an action to recover no-fault medical payments under an insurance contract, the plaintiffs appeal from so much of an order of the Supreme Court, Nassau County (Cozzens, J.), April 6, 2005, as denied those branches of their motion which were for summary judgment on the first and second causes of action and granted the defendant’s cross motion for summary judgment dismissing those causes of action.
Ordered that the order is modified, on the law, by deleting the provision thereof granting that branch of the cross motion which was for summary judgment dismissing the second cause of action, and substituting therefor a provision denying that branch of the cross motion; as so modified, the order is affirmed insofar as appealed from, without costs or disbursements, and the second cause of action is reinstated.
The Supreme Court correctly granted the branch of the defendant insurer’s cross motion which was for summary judgment dismissing the first cause of action, asserted on behalf of the plaintiff St. Vincent’s Hospital & Medical Center (hereinafter St. Vincent’s), as the defendant established that St. Vincent’s failed to submit its claim within 45 days after rendition of medical services (see 11 NYCRR 65-1.1). St. Vincent’s legal and factual arguments in opposition are without merit.
The court erred, however, in granting the branch of the defendant insurer’s cross [*2]motion which was for summary judgment dismissing the second cause of action, asserted on behalf of the plaintiff Brooklyn Hospital Center. Numerous questions of fact exist as to how this claim was processed in 2002 and again in 2004, whether it should be paid by a workers’ compensation carrier, and even the correct amount thereof. As such, neither party demonstrated its prima facie entitlement to judgment as a matter of law on the second cause of action.
The parties’ remaining contentions are without merit. Adams, J.P., S. Miller, Ritter and Lifson, JJ., concur.
Cited by
A label shows how the later decision treated this one.
- Wyckoff Hgts. Med. Ctr. v Country-Wide Ins. Co. (2010 NY Slip Op 02552) Contrasted (cf., but see)The hospital's completed NF-5 submitted within 45 days after services satisfied the policy's written notice requirement.
- Eagle Chiropractic, P.C. v Chubb Indem. Ins. Co. (2008 NY Slip Op 50525(U)) FollowedAn insurer need not prove a policy contains the mandatory 45-day claim deadline when an older endorsement could no longer apply.
- Sound Shore Med. Ctr. v Lumbermens Mut. Cas. Co. (2006 NY Slip Op 05939)The insurer justified vacating its default with an employee's affidavit describing a clerical error and a prima facie meritorious defense.
- New York & Presbyt. Hosp. v American Tr. Ins. Co. (2007 NY Slip Op 09376)The insurer raised a factual issue by showing a timely denial based on bills submitted more than 45 days after the last medical service.
- Prestige Med. & Surgical Supply, Inc. v Chubb Indem. Ins. Co. (2010 NY Slip Op 50449(U))The provider failed to justify its late claim submission because it did not explain why it first billed another insurer.
- PDG Psychological, P.C. v State Farm Ins. Co. (2006 NY Slip Op 51398(U))A notice to admit cannot establish a provider's prima facie case by admitting the contents of bills and an assignment.
- Community Med. Imaging P.C. v American Tr. Ins. Co. (2024 NY Slip Op 50301(U))A no-fault arbitrator may require a mailing affidavit when documentary proof of timely claim submission is inconclusive.
Similar decisions
- St. Vincent’s Hosp. & Med. Ctr. v Allstate Ins. Co. (2010 NY Slip Op 00668)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.
- 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 American Tr. Ins. Co. (2005 NY Slip Op 03046)An insurer's failure to timely deny a hospital claim precluded its defense that the hospital used the wrong DRG billing code.
- St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co. (2008 NY Slip Op 04072)The insurer raised factual issues concerning a proper timely denial and its entitlement to deny the hospital's claim.
- St. Vincent’s Hosp. & Med. Ctr. v Hanover Ins. Co. (2009 NY Slip Op 00674)The insurer's default judgment vacatur was affirmed, as was denial of the provider's contempt motion over an information subpoena.