June 6, 2016

Ultimate Health Prods., Inc. v Allstate Ins. Co. (2016 NY Slip Op 50921(U))

https://www.beynensonlaw.com/case-law/ultimate-health-prods-inc-v-allstate-ins-co-2016-ny-slip-op50921u/

Court: Appellate Term, Second Department
Decided: June 6, 2016
Citation: 2016 NY Slip Op 50921(U) · 52 Misc 3d 128(A)
Posture: Summary judgment
Outcome: Split result
Issues: Verification requests
Legal questions: Outstanding verification and premature actions (see the maps)

Cite as

Ultimate Health Prods., Inc. v Allstate Ins. Co., 52 Misc 3d 128(A), 2016 NY Slip Op 50921(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2016)

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 insurer's summary judgment cross motion asserting outstanding verification was denied on appeal; the provider's motion remained denied. The Appellate Term, Second Department, modified the Civil Court's order and otherwise affirmed for the reasons stated in the companion appeal, Great Health Care Chiropractic, P.C. v Hereford Ins. Co., decided the same day, No. 2013-1720 Q C.

Reported in New York Official Reports at Ultimate Health Prods., Inc. v Allstate Ins. Co. (2016 NY Slip Op 50921(U))

[*1]

Ultimate Health Prods., Inc. v Allstate Ins. Co.

2016 NY Slip Op 50921(U) [52 Misc 3d 128(A)]

Decided on June 6, 2016

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This opinion is uncorrected and will not be published in the printed Official Reports.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 June 6, 2016

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

PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-2131 K C

Ultimate Health Products, Inc., as Assignee of KERWIN BOYEA, Appellant,
against
Allstate Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Katherine A. Levine, J.), entered March 4, 2013. 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 modified by providing that defendant’s cross motion for summary judgment dismissing the complaint is denied; as so modified, the order is affirmed, without 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 ground that the action was premature because plaintiff had failed to provide requested verification. By order entered March 4, 2013, the Civil Court denied plaintiff’s motion and granted defendant’s cross motion.

For the reasons stated in Great Health Care Chiropractic, P.C., as Assignee of Carlos Thomas v Hereford Ins. Co. (___ Misc 3d ___, 2016 NY Slip Op ___ [appeal No. 2013-1720 Q C], decided herewith), the order is modified by providing that defendant’s cross motion for summary judgment dismissing the complaint is denied.

Pesce, P.J., Aliotta and Solomon, JJ., concur.

Decision Date: June 06, 2016

Legal questions

A question 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.

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: Defense rejected because the insurer's requests or proof were deficient

Held the insurer was not entitled to summary judgment dismissing the complaint as premature for failure to provide requested verification, for reasons incorporated from a companion decision.

Premature: verification outstandingNonresponse denial upheldTriable issueInsurer's showing failsProvider compliedThis decision

Of the 385 decisions on this question in the Second Department courts and the Court of Appeals, 82 (this one included) are in the same category.

Similar decisions

Great Health Care Chiropractic, P.C. v Hereford Ins. Co. (2016 NY Slip Op 50910(U))The provider's owner's affidavit raised a factual issue as to receipt of requested verification and whether the action was premature.
Ultimate Health Prods., Inc. v Hereford Ins. Co. (2016 NY Slip Op 50367(U))A defense that no policy covers the claimed no-fault benefits is not precluded by defects in the insurer's denial or its timeliness.
Ultimate Care Chiropractic, P.C. v Merchants Mut. Ins. Co. (2017 NY Slip Op 51717(U))The provider's challenges to the insurer's summary judgment cross motion were unpreserved because they were first raised on appeal.
Great Health Care Chiropractic, P.C. v Unitrin Direct Ins. Co. (2016 NY Slip Op 50373(U))The insurer failed to prove a timely denial, and the provider failed to establish its prima facie entitlement to summary judgment.
Ultimate Health Prods., Inc. v American Tr. Ins. Co. (2015 NY Slip Op 51404(U))The insurer's summary judgment dismissal on the EUO nonappearance defense was affirmed upon a finding of timely mailing of the EUO letters.