December 17, 2014
True-Align Chiropractic Care, P.C. v Country Wide Ins. Co. (2014 NY Slip Op 51821(U))
https://www.beynensonlaw.com/case-law/true-align-chiropractic-care-p-c-v-country-wide-ins-co-2014-ny-slip-op51821u/
- Decided
- December 17, 2014
- Citation
- 2014 NY Slip Op 51821(U) · 46 Misc 3d 131(A)
- Posture
- Summary judgment
- Outcome
- Insurer prevailed
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 True-Align Chiropractic Care, P.C. v Country Wide Ins. Co. (2014 NY Slip Op 51821(U))
| True-Align Chiropractic Care, P.C. v Country Wide Ins. Co. |
| 2014 NY Slip Op 51821(U) [46 Misc 3d 131(A)] |
| Decided on December 17, 2014 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports.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 December 17, 2014
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2012-1596 K C
against
Country Wide Insurance Company, Respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Devin P. Cohen, J.), entered March 26, 2012. The order denied plaintiff’s motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint.
ORDERED that the order is affirmed, with $25 costs.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint on the grounds that plaintiff had failed to respond to defendant’s verification requests and that plaintiff’s assignor had failed to appear for duly scheduled independent medical examinations (IMEs). The Civil Court denied plaintiff’s motion and granted defendant’s cross motion.
Plaintiff’s arguments on appeal lack merit. The affidavit submitted by defendant sufficiently established the timely and proper mailing of the verification requests and the denial of claim forms (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]). Furthermore, contrary to plaintiff’s argument with respect to its first cause of action, defendant demonstrated that it had not received the verification requested, and plaintiff did not show that the requested verification had been provided to defendant. Finally, contrary to plaintiff’s argument with respect to the remaining causes of action, defendant established that plaintiff’s assignor had failed to appear for the scheduled IMEs (see Quality Psychological Servs., P.C. v Interboro Mut. Indem. Ins. Co., 36 Misc 3d 146[A], 2012 NY Slip Op 51628[U] [App Term, 2d, 11th & 13th Jud Dists 2012]).
Accordingly, the order is affirmed.
Pesce, P.J., Aliotta and Solomon, JJ., concur.
Decision Date: December 17, 2014
Legal questions (4)
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 insurer's affidavit sufficiently established the timely and proper mailing of its verification requests and denial of claim forms, rejecting the provider's arguments.
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 the insurer prove its IME/EUO no-show defense: mailed, compliant scheduling requests and the claimant’s nonappearance?
This decision: Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected
Held the insurer established that the assignor failed to appear for the scheduled IMEs, rejecting the provider's argument as to the remaining causes of action.
Of the 858 decisions on this question in the Second Department courts and the Court of Appeals, 527 (this one included) are in the same category.
Is an IME/EUO no-show defense precluded if the insurer did not timely deny the claim on that ground?
This decision: Timely denial required as part of the no-show defense, and the insurer showed it (rules on the question, but another ground decided the case)
Held the insurer's affidavit established timely and proper mailing of its denials, rejecting the provider's challenge, while the IME no-show defense defeated the remaining causes of action.
Of the 508 decisions on this question in the Second Department courts and the Court of Appeals, 338 (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 (rules on the question, but another ground decided the case)
Held the first cause of action properly dismissed because the insurer timely mailed its verification requests, had not received the verification, and the provider did not show it was provided.
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.
- Quality Psychological Servs., P.C. v Interboro Mut. Indem. Ins. Co. (2012 NY Slip Op 51628(U)) FollowedThe insurer's attorney affirmation established the assignor's EUO nonappearance through the law firm's appearance-recording procedures.
Similar decisions
- Pro-Align Chiropractic, P.C. v Integon Natl. Ins. Co. (2019 NY Slip Op 51967(U))The insurer proved timely mailing of the IME scheduling letters and denials and the assignor's failure to attend the scheduled IMEs. The provider appealed the grant of summary judgment dismissing its assigned no-fault benefits complaint and the denial of its cross-motion branch seeking discovery responses.
- Great Health Care Chiropractic, P.C. v Maya Assur. Co. (2014 NY Slip Op 51803(U))The insurer failed to prove mailing of IME scheduling letters, and the provider failed to establish entitlement to summary judgment.
- Active Chiropractic, P.C. v Country-Wide Ins. Co. (2017 NY Slip Op 51850(U))The insurer's 30-day period to pay or deny the appealed claim had not begun because timely requested verification remained outstanding.
- Restoration Chiropractic, P.C. v 21st Century Ins. Co. (2018 NY Slip Op 51656(U))The insurer's proof established proper mailing of EUO scheduling letters supporting its defense of the assignor's nonappearance.
- Actual Chiropractic, P.C. v A. Cent. Ins. Co. (2016 NY Slip Op 50397(U))The insurer failed to establish timely mailing of the IME scheduling letters underlying its nonappearance defense.