April 7, 2006

Staten Is. Chiropractic Assoc., P.C. v Long Is. Ins. Co. (2006 NY Slip Op 50588(U))

Headnote

The main issue in this case was whether the plaintiff, Staten Island Chiropractic Assoc., P.C., was entitled to recover $8,388.13 in first-party no-fault benefits for health care services provided to their assignor. Plaintiff had moved for summary judgment, but the court denied the motion. The court considered the fact that the defendant, Long Island Insurance Company, denied receiving the claims from the plaintiff. The plaintiff's only proof that it submitted its claims was a provider's statement that failed to prove a standard office practice or procedure designed to ensure that items are properly addressed and mailed. The court also considered that although plaintiff proved a claim denial form used by the defendant, the form admitted receipt of no specific claim and cannot be construed to concede that defendant received the specific claims at issue. In the end, the court affirmed the decision to deny plaintiff's motion for summary judgment.

Reported in New York Official Reports at Staten Is. Chiropractic Assoc., P.C. v Long Is. Ins. Co. (2006 NY Slip Op 50588(U))

Staten Is. Chiropractic Assoc., P.C. v Long Is. Ins. Co. (2006 NY Slip Op 50588(U)) [*1]

Staten Is. Chiropractic Assoc., P.C. v Long Is. Ins. Co.

2006 NY Slip Op 50588(U) [11 Misc 3d 140(A)]

Decided on April 7, 2006

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This opinion is uncorrected and will not be published in the printed Official Reports.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 April 7, 2006

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 9th and 10th JUDICIAL DISTRICTS

PRESENT: : RUDOLPH, P.J., TANENBAUM and LIPPMAN, JJ
2005-662 N C.

Staten Island Chiropractic Assoc., P.C., as Assignee of Regina Bellamy, Appellant,
against
Long Island Insurance Company, Respondent.

Appeal from an order of the District Court of Nassau County, First District (Erica L. Prager, J.), entered December 14, 2004. The order denied plaintiff’s motion for summary judgment.

Order affirmed without costs.

In this action to recover $8,388.13 in first-party no-fault benefits for health care services provided plaintiff’s assignor, plaintiff moved for summary judgment. The court below denied the motion and we affirm. Defendant denied receiving the instant claims and plaintiff’s only proof that it submitted its claims was the provider’s statement that “[e]ach of the claims for payment were [sic] timely submitted in the ordinary course of business to [defendant].” Such an assertion failed to prove a standard office practice or procedure designed to ensure that items are properly addressed and mailed (see Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679, 680 [2001]). Although plaintiff proved a claim denial form used by defendant which denied “all” of plaintiff’s claims, the form admitted receipt of no specific claim and cannot be construed to concede that defendant received the specific claims herein at issue.

Rudolph, P.J., Tanenbaum and Lippman, JJ., concur.
Decision Date: April 7, 2006