July 26, 2006
Vista Surgical Supplies, Inc. v Nationwide Mut. Ins. Co. (2006 NY Slip Op 51556(U))
https://www.beynensonlaw.com/case-law/vista-surgical-supplies-inc-v-nationwide-mut-ins-co-2006-ny-slip-op-51556u/
- Decided
- July 26, 2006
- Citation
- 2006 NY Slip Op 51556(U) · 12 Misc 3d 147(A)
- Posture
- Summary judgment
- Outcome
- Insurer prevailed
- Legal questions
- Claimant's prima facie case on motions · 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 Vista Surgical Supplies, Inc. v Nationwide Mut. Ins. Co. (2006 NY Slip Op 51556(U))
| Vista Surgical Supplies, Inc. v Nationwide Mut. Ins. Co. |
| 2006 NY Slip Op 51556(U) [12 Misc 3d 147(A)] |
| Decided on July 26, 2006 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports.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 and 11th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., GOLIA and RIOS, JJ
2005-1256 K C. NO. 2005-1256 K C
against
Nationwide Mutual Insurance Company, Respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Jack M. Battaglia, J.), entered July 6, 2005. The order granted defendant’s motion to dismiss the complaint to the extent of directing plaintiff to, inter alia, produce responses to defendant’s discovery demands, and denied plaintiff’s cross motion for summary judgment with leave to renew after completion of discovery.
Appeal from so much of the order as granted defendant’s motion to dismiss the complaint to the extent of directing plaintiff to, inter alia, provide responses to defendant’s discovery demands dismissed.
Order, insofar as reviewed, affirmed without costs.
Plaintiff commenced this action to recover assigned first-party no-fault benefits for medical supplies furnished to its assignor. Defendant moved to dismiss plaintiff’s complaint for plaintiff’s failure to comply with defendant’s discovery demands and plaintiff cross-moved for summary judgment. By order entered July 6, 2005, the court below granted defendant’s motion to the extent of ordering plaintiff to, inter alia, produce responses to defendant’s discovery demands and also denied plaintiff’s cross motion for summary judgment with leave to renew after completion of discovery. Plaintiff failed to submit written opposition to defendant’s motion, but [*2]instead cross-moved for summary judgment without addressing defendant’s argument that it was entitled to discovery. Since so much of the order as granted defendant’s motion to the extent of directing plaintiff to, inter alia, provide responses to defendant’s discovery requests was entered on default, the appeal therefrom by plaintiff, a defaulting party, must be dismissed (see CPLR 5511; Coneys v Johnson Controls, Inc., 11 AD3d 576 [2004]; see also Marino v Termini, 4 AD3d 342 [2004]; Adamson v Evans, 283 AD2d 527 [2001]).
A provider establishes a prima facie entitlement to summary judgment by proof that it submitted a claim, setting forth the fact and the amount of the loss sustained, and that payment of no-fault benefits was overdue (see Insurance Law § 5106 [a]; Mary Immaculate Hosp. v Allstate Ins. Co., 5 AD3d 742 [2004]; Amaze Med. Supply v Eagle Ins. Co., 2 Misc 3d 128[A], 2003 NY Slip Op 51701[U] [App Term, 2d & 11th Jud Dists]). A plaintiff ordinarily establishes the “submission” of the claim form by demonstrating proof of proper mailing, which gives rise to the presumption that the claim form was received by the addressee. The presumption may be created either by proof of actual mailing, or by proof of a standard office practice or procedure designed to ensure that items are properly addressed and mailed (see Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [2001]). Here, the affidavit of plaintiff’s corporate officer and the proof annexed thereto were insufficient to establish that plaintiff mailed the claims to defendant since “there is no evidence that th[e] claim[s] w[ere] mailed to [defendant] under that certified mail receipt number” (New York & Presbyt. Hosp. v Allstate Ins. Co., ___ AD3d ___, 2006 NY Slip Op 03558). Moreover, plaintiff’s attorney’s affirmation was not based on personal knowledge that the claim was actually mailed to defendant and, as such, is unsubstantiated hearsay and has no probative value (see e.g. Melbourne Med., P.C. v Utica Mut. Ins. Co., 4 Misc 3d 92 [App Term, 2d & 11th Jud Dists 2004]). Furthermore, the denial of claim form annexed to plaintiff’s moving papers was insufficient to establish that plaintiff sent, and that defendant received, the claims since items 23-32 on said denial of claim form, including the date on which defendant received the claims, were not filled out by defendant (cf. A.B. Med. Servs. v New York Cent. Mut. Fire Ins. Co., 3 Misc 3d 136[A], 2004 NY Slip Op 50507[U] [App Term, 2d & 11th Jud Dists]). Thus, plaintiff failed to establish its prima facie entitlement to summary judgment. Accordingly, the lower court properly denied plaintiff’s cross motion for summary judgment.
Pesce, P.J., and Rios, J., concur.
Golia, J., concurs in a separate memorandum.
[*3]Golia, J., concurs with the result only, in the following memorandum:
While I agree with the ultimate disposition in the decision reached by the majority, I wish to emphasize that I disagree with certain propositions of law set forth in cases cited therein which are inconsistent with my prior expressed positions and generally contrary to my views.
Decision Date: July 26, 2006
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.
On summary judgment or another pretrial motion, what must a no-fault claimant show to establish its prima facie case?
This decision: Insufficient: claimant did not prove the claim was submitted (mailed to and received by the insurer)
Held the provider failed its prima facie burden because its officer's affidavit and certified mail proof did not show the claims were mailed, and the denial form left the receipt-date fields blank.
Of the 1,063 decisions on this question in the Second Department courts and the Court of Appeals, 78 (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 provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification response
Held the certified mail receipt was not tied to the claims, counsel's affirmation was hearsay, and a denial form with blank receipt fields did not establish that the insurer received the claims.
Of the 1,384 decisions on this question in the Second Department courts and the Court of Appeals, 64 (this one included) are in the same category.
Cited in this decision
A label shows how this decision treated the case it cites.
- Mary Immaculate Hosp. v Allstate Ins. Co. (2004 NY Slip Op 02359) FollowedThe hospitals established entitlement to summary judgment by proving that statutory billing forms were mailed and received and payment was overdue.
- Amaze Med. Supply v Eagle Ins. Co. (2003 NY Slip Op 51701(U)) FollowedA provider's completed claim forms establish its prima facie case without additional medical proof when the insurer is precluded.
- New York & Presbyt. Hosp. v Allstate Ins. Co. (2006 NY Slip Op 03558) FollowedThe providers failed to establish mailing and receipt of the hospital bill asserted in their second cause of action.
- Melbourne Med., P.C. v Utica Mut. Ins. Co. (2004 NY Slip Op 24221)EUO requests do not toll the claim determination period when the governing no-fault regulations do not authorize EUO verification.
- A.B. Med. Servs. v N. Y. Cent. Mut. Fire Ins. Co. (2004 NY Slip Op 50507(U)) Contrasted (cf., but see)An insurer opposing summary judgment on medical necessity must submit admissible proof even if unaffirmed reports supported a timely denial.
Cited by
- Vista Surgical Supplies, Inc. v Electric Ins. Co (2007 NY Slip Op 50150(U))The insurer failed to establish timely denial mailing, and affidavits first submitted in reply could not cure the deficiency.
Similar decisions
- Vista Surgical Supplies Inc. v Allstate Ins. Co. (2006 NY Slip Op 52520(U))The provider failed to prove mailing of its claim, while the insurer established that it had never received the claim.
- Vista Surgical Supplies, Inc. v Statewide Ins. Co. (2006 NY Slip Op 51118(U))The provider failed to establish claim submission because its mailing receipts and the insurer's verification letters were not linked to the claims.
- IVB Med. Supply, Inc. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 51660(U))The provider failed to prove submission of its claim, and its appeal from an unopposed discovery order was dismissed.
- Vista Surgical Supplies, Inc. v State Farm Mut. Ins. Co. (2006 NY Slip Op 51189(U))The insurer's denials dated more than 30 days after final verification precluded its medical necessity defense.
- Vista Surgical Supplies, Inc. v Allstate Ins. Co. (2006 NY Slip Op 51332(U))The provider's deficient mailing proof and ambiguous postal documentation left claim submission unresolved, defeating both summary judgment motions.