May 13, 2010
Triangle R, Inc. v GEICO Ins. Co. (2010 NY Slip Op 50885(U))
https://www.beynensonlaw.com/case-law/triangle-r-inc-v-geico-ins-co-2010-ny-slip-op-50885u/
- Decided
- May 13, 2010
- Citation
- 2010 NY Slip Op 50885(U) · 27 Misc 3d 137(A)
- Posture
- Summary judgment
- Outcome
- Insurer prevailed
- Issues
- Verification requests
- Legal questions
- Outstanding verification and premature actions · Proof of mailing (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 GEICO Ins. Co. (2010 NY Slip Op 50885(U))
| Triangle R, Inc. v GEICO Ins. Co. |
| 2010 NY Slip Op 50885(U) [27 Misc 3d 137(A)] |
| Decided on May 13, 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| This opinion is uncorrected and will not be published in the printed Official Reports.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: : WESTON, J.P., RIOS and STEINHARDT, JJ
2009-806 Q C.
against
GEICO Insurance Company, Appellant.
Appeal from an order of the Civil Court of the City of New York, Queens County (Diane A. Lebedeff, J.), entered March 17, 2009, deemed from a judgment of the same court entered April 6, 2009 (see CPLR 5501 [c]). The judgment, entered pursuant to the March 17, 2009 order granting plaintiff’s motion for summary judgment and denying defendant’s cross motion for summary judgment, awarded plaintiff the principal sum of $479.50.
ORDERED that the judgment is reversed without costs, the order entered March 17, 2009 is vacated, plaintiff’s motion for summary judgment is denied, and defendant’s cross motion for summary judgment dismissing the complaint is granted without prejudice to plaintiff’s commencement of a new action.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment. Defendant opposed the motion and cross-moved for summary judgment dismissing the complaint on the ground that the action was premature because it was commenced before defendant had received responses to its outstanding verification requests. By order entered March 17, 2009, the Civil Court granted plaintiff’s motion and denied defendant’s cross motion. Defendant’s appeal from that order is deemed to be from the judgment which was [*2]subsequently entered (see CPLR 5501 [c]).
The affidavit of defendant’s claims representative established that defendant had timely mailed its request and follow-up request for verification to plaintiff (see Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [2001]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 18 [App Term, 2d & 11th Jud Dists 2007]) and that plaintiff had failed to provide the requested verification. In opposition to defendant’s cross motion, plaintiff did not demonstrate that it had provided defendant, prior to the commencement of the action, with the requested verification. Consequently, under the circumstances presented, the 30-day period within which defendant was required to pay or deny the claims did not commence to run (see Insurance Department Regulations [11 NYCRR] § 65-3.8 [a]; Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492 [2005]; Hospital for Joint Diseases v State Farm Mut. Auto. Ins. Co., 8 AD3d 533 [2004]; Vista Surgical Supplies, Inc. v General Assur. Co., 12 Misc 3d 129[A], 2006 NY Slip Op 51034[U] [App Term, 2d & 11th Jud Dists 2006]), and plaintiff’s action is premature (Hospital for Joint Diseases v New York Cent. Mut. Fire Ins. Co., 44 AD3d 903 [2007]). We do not reach any other issue.
Accordingly, the judgment is reversed, the order entered March 17, 2009 is vacated, plaintiff’s motion for summary judgment is denied, and defendant’s cross motion for summary judgment dismissing the complaint is granted without prejudice to plaintiff’s commencement of a new action.
Weston, J.P., Rios and Steinhardt, JJ., concur.
Decision Date: May 13, 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 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 insurer timely mailed its request and follow-up and the provider did not show it supplied the verification before suit, so the 30-day period never began; dismissed without prejudice.
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.
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 (rules on the question, but another ground decided the case)
Held the claims representative's affidavit established that the insurer timely mailed its initial and follow-up verification requests.
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.
Cited in this decision
A label shows how this decision treated the case it cites.
- Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co. (2005 NYSlipOp 09484) FollowedAn insurer need not pay or deny a no-fault claim until it receives all relevant verification requested.
- Hospital for Joint Diseases v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 05413) FollowedThe hospitals' first and fifth claims were dismissed because policy limits were exhausted and requested verification remained outstanding.
- Vista Surgical Supplies, Inc. v General Assur. Co. (2006 NY Slip Op 51034(U)) FollowedThe provider's action was premature because timely verification requests remained unanswered when the action began.
- Hospital for Joint Diseases v New York Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 08038) FollowedThe hospital's claim was premature because unrebutted proof showed that it ignored timely verification and follow-up requests.
Similar decisions
- 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.
- Triangle R, Inc. v Clarendon Ins. Co. (2010 NY Slip Op 52159(U))The provider's action was premature because timely verification requests remained unanswered when it sued.
- 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.
- Quality Rehab & P.T., P.C. v GEICO Ins. Co. (2010 NY Slip Op 50067(U))The provider's action was premature because it did not show that it supplied timely requested verification before commencing suit.
- EMC Health Prods., Inc. v Geico Ins. Co. (2014 NY Slip Op 51834(U))The provider's action was premature because requested verification remained outstanding when the action commenced.