December 10, 2010
Triangle R, Inc. v Clarendon Ins. Co. (2010 NY Slip Op 52159(U))
https://www.beynensonlaw.com/case-law/triangle-r-inc-v-clarendon-ins-co-2010-ny-slip-op-52159u/
- Decided
- December 10, 2010
- Citation
- 2010 NY Slip Op 52159(U) · 29 Misc 3d 142(A)
- Posture
- Summary judgment
- Outcome
- Insurer prevailed
- Later treatment
- Followed in 1 later decision (see Cited by)
- Legal questions
- Proof of mailing · Outstanding verification and premature actions (see the maps)
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 Triangle R, Inc. v Clarendon Ins. Co. (2010 NY Slip Op 52159(U))
| Triangle R, Inc. v Clarendon Ins. Co. |
| 2010 NY Slip Op 52159(U) [29 Misc 3d 142(A)] |
| Decided on December 10, 2010 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports. |
SUPREME COURT OF THE STATE OF NEW YORK
APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., GOLIA and STEINHARDT, JJ
2009-2060 Q C.
against
Clarendon Insurance Company, Appellant.
Appeal from an order of the Civil Court of the City of New York, Queens County (Cheree A. Buggs, J.), entered May 11, 2009. The order denied defendant’s motion for summary judgment dismissing the complaint.
ORDERED that the order is reversed, without costs, and defendant’s motion for summary judgment dismissing the complaint is granted.
In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint on the ground that plaintiff had failed to provide requested verification. In opposition to the motion, plaintiff argued that defendant had failed to prove that it had timely mailed verification requests, and plaintiff asserted that it had never received verification requests. The Civil Court denied defendant’s motion. This appeal by defendant ensued.
The affidavit of defendant’s claims examiner established that defendant had timely mailed its request and follow-up request for verification to plaintiff in accordance with defendant’s standard office practices and procedures (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [2001]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]), and that plaintiff had failed to provide the requested verification. The mere denial by plaintiff’s billing manager of receipt of the verification requests did not overcome the presumption that proper mailing had occurred and that plaintiff had received the verification requests (see Schmiemann v State Farm Fire & Cas. Co., 13 AD3d 514 [2004]; Morales v Yaghoobian, 13 AD3d 424 [2004]). Contrary to plaintiff’s contention, the fact [*2]that copies of the verification requests, which were sent to plaintiff’s assignor, were sent to the wrong address does not render the verification requests a nullity since the requested verification was sought from plaintiff (see Insurance Department Regulations [11 NYCRR] § 65-3.5 [c]; § 65-3.6 [b]; cf. Doshi Diagnostic Imaging Servs. v State Farm Ins. Co., 16 Misc 3d 42 [App Term, 2d & 11th Jud Dists 2007]). Since plaintiff did not demonstrate that it had provided defendant, prior to the commencement of the action, with the requested verification, the 30-day period within which defendant was required to pay or deny the claims did not begin to run and plaintiff’s action is premature (see Insurance Department Regulations [11 NYCRR] § 65-3.8 [a]; Hospital for Joint Diseases v New York Cent. Mut. Fire Ins. Co., 44 AD3d 903 [2007]; Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492 [2005]).
Accordingly, defendant’s motion for summary judgment dismissing the complaint is granted.
Pesce, P.J., Golia and Steinhardt, JJ., concur.
Decision Date: December 10, 2010
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.
Did a party’s evidence establish that it mailed a no-fault claim, denial, verification request or examination notice?
This decision: The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice
Held the claims examiner's standard-practice affidavit established timely mailing of the verification requests, and the billing manager's mere denial of receipt did not overcome the presumption.
Of the 1,400 decisions on this question in the Second Department courts and the Court of Appeals, 809 (this one included) are in the same category.
Did unanswered verification requests make the provider’s claim premature, or justify denying it for nonresponse?
This decision: Timely requests went unanswered; the claim is not overdue and the action is premature
Held the action premature because the requests were properly mailed and unanswered; copies sent to the assignor's wrong address did not void requests that sought verification from the provider.
Of the 385 decisions on this question in the Second Department courts and the Court of Appeals, 153 (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)The insurer raised factual issues concerning a proper timely denial and its entitlement to deny the hospital's claim.
- Delta Diagnostic Radiology, P.C. v Chubb Group of Ins. (2007 NY Slip Op 27345)An insurer may prove mailing by describing its standard procedure for properly addressing and mailing items.
- Doshi Diagnostic Imaging Servs. v State Farm Ins. Co. (2007 NY Slip Op 27193) Contrasted (cf., but see)An insurer may request medical-necessity verification from a prescribing physician if it properly notifies the applicant of outstanding requests.
- Hospital for Joint Diseases v New York Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 08038)The hospital's claim was premature because unrebutted proof showed that it ignored timely verification and follow-up requests.
- Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co. (2005 NYSlipOp 09484)An insurer need not pay or deny a no-fault claim until it receives all relevant verification requested.
Cited by
A label shows how the later decision treated this one.
- Canon Chiropractic P.C. v MVAIC (2013 NY Slip Op 52044(U)) FollowedMVAIC proved lack of coverage despite mailing qualification letters to the assignor at the incorrect address supplied on the provider's bills.
- Triangle R, Inc. v Tri-State Consumer Ins. Co. (2013 NY Slip Op 50256(U))The provider's denial of receipt did not rebut proof of timely mailed verification requests, and its unanswered claims were premature.
Similar decisions
- Triangle R, Inc. v GEICO Ins. Co. (2010 NY Slip Op 50885(U))The provider's action was premature because it had not supplied requested verification before commencing suit.
- Triangle R Inc. v Praetorian Ins. Co. (2010 NY Slip Op 52294(U))The insurer retained its verification toll despite an early follow-up and a later follow-up outside the prescribed period.
- Triangle R, Inc. v Clarendon Natl. Ins. Co. (2011 NY Slip Op 51854(U))The insurer established the assignor's IME nonappearances and timely mailing of notices and the denial, warranting dismissal.
- Island Chiropractic Testing, P.C. v Praetorian Ins. Co. (2014 NY Slip Op 51795(U))The provider's verification responses presented a factual dispute that precluded summary judgment for either party.
- Skymed Med., P.C. v Tri-State Consumer Ins. (2014 NY Slip Op 51833(U))The provider's action was premature because the insurer proved timely verification requests and nonreceipt of the requested material.