September 22, 2017

TAM Med. Supply Corp. v Tri State Consumers Ins. Co. (2017 NY Slip Op 51247(U))

https://www.beynensonlaw.com/case-law/tam-med-supply-corp-v-tri-state-consumers-ins-co-2017-ny-slip-op51247u/

Court: Appellate Term, Second Department
Decided: September 22, 2017
Citation: 2017 NY Slip Op 51247(U) · 57 Misc 3d 133(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

TAM Med. Supply Corp. v Tri State Consumers Ins. Co., 57 Misc 3d 133(A), 2017 NY Slip Op 51247(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2017)

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 supplied verification sought under the 120-day rule. The insurer obtained summary judgment based on a denial for failure to provide verification within 120 days of the initial request under 11 NYCRR 65-3.5 (o). Although the insurer demonstrated prima facie nonreceipt, the provider's opposing affidavit created a presumption that the verification had been mailed to and received by the insurer. The Appellate Term, Second Department, reversed the order and denied the insurer's motion because that proof raised a factual issue over whether the provider supplied the requested verification.

Reported in New York Official Reports at TAM Med. Supply Corp. v Tri State Consumers Ins. Co. (2017 NY Slip Op 51247(U))

[*1]

TAM Med. Supply Corp. v Tri State Consumers Ins. Co.

2017 NY Slip Op 51247(U) [57 Misc 3d 133(A)]

Decided on September 22, 2017

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This opinion is uncorrected and will not be published in the printed Official Reports.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 September 22, 2017

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

PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, MARTIN M. SOLOMON, JJ
2014-1850 Q C

TAM Medical Supply Corp., as Assignee of Budhram, Dhandai, Appellant,
against
Tri State Consumers Ins. Co., Respondent.

The Rybak Firm, PLLC (Damin J. Toell, Esq.), for appellant. Law Office of Laurie DiPreta (Rhonda H. Barry, Esq.), for respondent (no brief filed).

Appeal from an order of the Civil Court of the City of New York, Queens County (Sally E. Unger, J.), entered July 11, 2014. 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 defendant had timely and properly denied the claim at issue based upon plaintiff’s failure to provide requested verification within 120 days of the initial verification request (see 11 NYCRR 65-3.5 [o]). Contrary to plaintiff’s contention, defendant demonstrated, prima facie, that it had not received the requested verification. However, as plaintiff further argues, the affidavit submitted by plaintiff 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]). In light of the foregoing, there is a triable issue of fact as to whether plaintiff provided the requested verification.

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

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

ENTER:
Paul Kenny
Chief Clerk
Decision Date: September 22, 2017

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 raised a presumption that the requested verification was mailed to and received by the insurer, which against the insurer's non-receipt showing created a factual issue.

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 1,384 decisions on this question in the Second Department courts and the Court of Appeals, 99 (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

Reversed dismissal on the insurer's 120-day nonresponse denial because the provider's affidavit raised a presumption of mailing, creating a triable issue whether the requested verification was provided.

Premature: verification outstandingNonresponse denial upheldTriable issueInsurer's showing failsProvider compliedThis decisionCites it or cited by itCited or followed

Of the 374 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.

Cited by

Burke Physical Therapy, PC v State Farm Mut. Auto. Ins. Co. (2021 NY Slip Op 50624(U))The provider's detailed verification objections left factual issues about compliance with the insurer's requests.

Similar decisions

Tam Med. Supply Corp. v Hereford Ins. Co. (2017 NY Slip Op 51196(U))The provider's affidavit raised a factual issue over whether requested verification remained outstanding.
TAM Med. Supply Corp. v 21st Century Ins. Co. (2016 NY Slip Op 51319(U))The insurer established proper mailing of verification requests and nonreceipt of the requested verification, rendering the action premature.
TAM Med. Supply Corp. v Travelers Ins. Co. (2017 NY Slip Op 51251(U))The provider's affidavit raised a triable issue as to verification receipt and defeated the insurer's prematurity motion.
TAM Med. Supply Corp. v New York Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 51248(U))The provider's affidavit created a presumption of verification receipt and raised a triable issue concerning prematurity.
Tam Med. Supply Corp. v American Tr. Ins. Co. (2016 NY Slip Op 50369(U))The provider's owner's affidavit raised a triable issue as to receipt of requested verification, defeating summary judgment on prematurity.