December 23, 2009

Velen Med. Supply, Inc. v Country-Wide Ins. Co. (2009 NY Slip Op 52630(U))

https://www.beynensonlaw.com/case-law/velen-med-supply-inc-v-country-wide-ins-co-2009-ny-slip-op52630u/

Court: Appellate Term, Second Department
Decided: December 23, 2009
Citation: 2009 NY Slip Op 52630(U) · 26 Misc 3d 127(A)
Posture: Summary judgment
Outcome: Insurer prevailed
Issues: Verification requests
Legal questions: Outstanding verification and premature actions (see the maps)

Cite as

Velen Med. Supply, Inc. v Country-Wide Ins. Co., 26 Misc 3d 127(A), 2009 NY Slip Op 52630(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2009)

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 action was premature despite a follow-up verification request mailed on the 29th day after the initial request. The Appellate Term, Second Department, reversed the provider's judgment, vacated the underlying order, denied the provider's summary judgment motion, and granted the insurer's cross motion dismissing the complaint. Timely mailing of the initial verification request was undisputed, and the provider did not supply the information requested in either request. Following Infinity Health Prods., Ltd. v Eveready Ins. Co., the court concluded that the insurer's 30-day period to pay or deny had not begun, even though the follow-up preceded expiration of the full response period. The court reached no other issue.

Reported in New York Official Reports at Velen Med. Supply, Inc. v Country-Wide Ins. Co. (2009 NY Slip Op 52630(U))

[*1]

Velen Med. Supply, Inc. v Country-Wide Ins. Co.

2009 NY Slip Op 52630(U) [26 Misc 3d 127(A)]

Decided on December 23, 2009

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This opinion is uncorrected and will not be published in the printed Official Reports.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 23, 2009

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : GOLIA, J.P., PESCE and WESTON, JJ
2008-1847 Q C.

Velen Medical Supply, Inc. a/a/o Damien Dickenson, Respondent,
against
Country-Wide Insurance Company, Appellant.

Appeal from a judgment of the Civil Court of the City of New York, Queens County (Diane A. Lebedeff, J.), entered July 29, 2008. The judgment, entered upon an order of the same court entered May 8, 2008 granting plaintiff’s motion for summary judgment and denying defendant’s cross motion for summary judgment dismissing the complaint, awarded plaintiff the principal sum of $1,543.

ORDERED that the judgment is reversed without costs, the order entered May 8, 2008 is vacated, plaintiff’s motion for summary judgment is denied and defendant’s cross motion for summary judgment dismissing the complaint is granted.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment. Defendant opposed plaintiff’s motion and cross-
moved for summary judgment, arguing that plaintiff had failed to make a prima facie showing of its entitlement to judgment as a matter of law and that, in any event, the action was premature due to plaintiff’s failure to provide requested verification. The Civil Court granted plaintiff’s motion and denied defendant’s cross motion, finding, among other things, that defendant had failed to establish that its time to pay or deny plaintiff’s claims had been tolled since defendant’s follow-up verification request had been sent to plaintiff 29 days after the initial request for verification. A judgment was subsequently entered, and this appeal by defendant ensued.

It is undisputed that defendant timely mailed its initial request for verification and that plaintiff failed to provide the information requested. Plaintiff also did not provide the information requested in defendant’s follow-up verification request, which was mailed on the 29th day after the initial verification request, but prior to the expiration of the full 30-day period within which plaintiff was supposed to respond to defendant’s initial request for verification. As the foregoing facts are nearly identical to those in Infinity Health Prods., Ltd. v Eveready Ins. Co. (___ AD3d ___, 2009 NY Slip Op 08585 [2d Dept 2009]), “the 30-day period within which the defendant was required to pay or deny the claim did not commence to run . . . [and] plaintiff’s action is premature” (id. at *2 [citations omitted]). In view of the foregoing, we reach no other [*2]issue.

Accordingly, the judgment is reversed, the order entered May 8, 2008 is vacated, plaintiff’s motion for summary judgment is denied and defendant’s cross motion for summary judgment dismissing the complaint is granted on the ground that the action is premature.

Golia, J.P., Pesce and Weston, JJ., concur.
Decision Date: December 23, 2009

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: Timely requests went unanswered; the claim is not overdue and the action is premature

Held the action premature because the provider never answered the timely initial request or the follow-up mailed on the 29th day, which was effective, so the 30-day period never began to run.

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

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.

Infinity Health Prods., Ltd. v Eveready Ins. Co. (2009 NY Slip Op 08585) FollowedA provider that ignored two verification requests was estopped from invoking preclusion based on a follow-up sent three days early.

Similar decisions

D.S. Chiropractic, P.C. v Country-Wide Ins. Co. (2010 NY Slip Op 50649(U))The provider's action was premature because requested verification remained outstanding despite follow-up requests mailed on the 30th day.
St. Vincent Med. Care, P.C. v Country Wide Ins. Co. (2011 NY Slip Op 00214)The insurer's follow-up verification requests on the 30th day were effective, and the provider's incomplete compliance made the action premature.
Infinity Health Prods., Ltd. v Liberty Mut. Fire Ins. Co. (2012 NY Slip Op 52396(U))The provider's action was premature because timely verification requests remained unanswered.
Velen Med. Supply, Inc. v GEICO Ins. Co. (2009 NY Slip Op 50735(U))The insurer's affirmed peer review raised a medical-necessity issue, and the provider waived its objection to the stamped signature.
St. Vincent Med. Care, P.C. v Country-Wide Ins. Co. (2010 NY Slip Op 50444(U))Unanswered verification requests rendered seven claims premature, while separate-reimbursement denials raised factual issues on two others.