May 11, 2012

W.H.O. Acupuncture, P.C. v GEICO Gen. Ins. Co. (2012 NY Slip Op 50884(U))

Headnote

The main issue of the case was whether the defendant's motion for summary judgment dismissing the complaint should have been granted as to the services rendered from August 2, 2007 to August 9, 2007. The court considered the fact that the defendant had demonstrated, prima facie, that it had timely denied the claims at issue, but the plaintiff's employee's affidavit created a triable issue of fact as to whether the claim had been timely denied. As a result, the court held that the defendant's motion for summary judgment dismissing the complaint should not have been granted as to that claim. The judgment was reversed, and the branch of defendant's cross motion seeking summary judgment dismissing the complaint as to the services was vacated and denied. Therefore, the plaintiff's appeal was successful in this aspect.

Reported in New York Official Reports at W.H.O. Acupuncture, P.C. v GEICO Gen. Ins. Co. (2012 NY Slip Op 50884(U))

W.H.O. Acupuncture, P.C. v GEICO Gen. Ins. Co. (2012 NY Slip Op 50884(U)) [*1]

W.H.O. Acupuncture, P.C. v GEICO Gen. Ins. Co.

2012 NY Slip Op 50884(U) [35 Misc 3d 141(A)]

Decided on May 11, 2012

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This opinion is uncorrected and will not be published in the printed Official Reports.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 May 11, 2012

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

PRESENT: : PESCE, P.J., RIOS and ALIOTTA, JJ
2011-244 Q C.

W.H.O. Acupuncture, P.C. as Assignee of NIHLAWI MOHAMAD, Appellant, —
against
GEICO General Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Genine D. Edwards, J.), entered December 17, 2010. The order, insofar as appealed from as limited by the brief, granted defendant’s cross motion for summary judgment dismissing the complaint. The appeal is deemed from a judgment of the same court entered January 18, 2011, pursuant to the December 17, 2010 order, dismissing the complaint (see CPLR 5501 [c]).

ORDERED that the judgment is reversed, without costs, so much of the order as granted the branch of defendant’s cross motion seeking summary judgment dismissing
the complaint as to services rendered from August 2, 2007 to August 9, 2007 is vacated, and that branch of defendant’s cross motion is denied.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals, as limited by its brief, from so much of an order as granted defendant’s cross motion for summary judgment dismissing the complaint. A judgment was subsequently entered, from which the appeal is deemed to have been taken (see CPLR 5501 [c]).

While defendant demonstrated, prima facie, that it had timely denied the claims at issue, by submitting an affidavit of an employee of its claims division setting forth defendant’s standard [*2]office practices and procedures for mailing 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]), plaintiff’s employee’s affidavit, submitted in support of plaintiff’s motion for summary judgment, created a triable issue of fact as to whether the claim for services rendered from August 2, 2007 to August 9, 2007 had been timely denied. As a result, defendant’s motion for summary judgment dismissing the complaint should not have been granted as to that claim.

Accordingly, the judgment is reversed, so much of the order as granted the branch of defendant’s cross motion seeking summary judgment dismissing the complaint as to the services rendered from August 2, 2007 to August 9, 2007 is vacated, and that branch of defendant’s cross motion is denied.

Pesce, P.J., Rios and Aliotta, JJ., concur.
Decision Date: May 11, 2012