May 22, 2007

Westchester Med. Ctr. v Safeco Ins. Co. of Am. (2007 NY Slip Op 04484)

https://www.beynensonlaw.com/case-law/westchester-med-ctr-v-safeco-ins-co-of-am-2007-ny-slip-op-04484/

Court: Appellate Division, Second Department
Decided: May 22, 2007
Citation: 2007 NY Slip Op 04484 · 40 AD3d 984
Posture: Summary judgment
Outcome: Provider prevailed
Issues: Assignments and standing Verification requests

Cite as

Westchester Med. Ctr. v Safeco Ins. Co. of Am., 40 AD3d 984 (2d Dept 2007)

Posture, outcome, issues and treatment by other decisions are Beynenson Law’s classification.

Summary

Editorial summary by Beynenson Law, not part of the court’s decision.

The insurer waived claim-form and assignment defenses by failing to object timely to the forms or seek assignment verification. The hospital established entitlement to summary judgment on the first cause of action through billing forms, a certified mail receipt, a signed return receipt referencing the assignor and forms, and its biller's affidavit of nonpayment and failure to deny. This proof showed receipt and no response within the 30-day period under Insurance Law § 5106 (a) and 11 NYCRR 65-3.5. The insurer raised no factual issue, and its waived defenses included the hospital's purported lack of standing. The Appellate Division, Second Department, affirmed the order, insofar as appealed from, granting the hospital's cross motion on that cause of action.

Reported in New York Official Reports at Westchester Med. Ctr. v Safeco Ins. Co. of Am. (2007 NY Slip Op 04484)

Westchester Med. Ctr. v Safeco Ins. Co. of Am.

2007 NY Slip Op 04484 [40 AD3d 984]

May 22, 2007

Appellate Division, Second Department

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

As corrected through Wednesday, July 11, 2007

Westchester Medical Center, as Assignee of Demetrio Recinos, Respondent,
v
Safeco Insurance Company of America, Appellant.

—[*1] Bruno, Gerbino & Soriano, LLP, Melville, N.Y. (Charles W. Benton of counsel), for appellant.

Joseph Henig, P.C., Bellmore, N.Y., for respondent.

In an action to recover no-fault insurance benefits under certain contracts of insurance, the defendant appeals, as limited by its brief, from so much of an order of the Supreme Court, Nassau County (Jaeger, J.), entered May 17, 2006, as granted that branch of the plaintiff’s cross motion which was for summary judgment on the first cause of action.

Ordered that the order is affirmed insofar as appealed from, with costs.

In support of that branch of its cross motion which was for summary judgment on the first cause of action, the plaintiff, Westchester Medical Center, as assignee of Demetrio Recinos (hereinafter WMC), demonstrated its prima facie entitlement to judgment as a matter of law by submitting, inter alia, the requisite billing forms, a certified mail receipt, a signed return receipt card which referenced Recinos and the forms, and an affidavit of its biller stating that the defendant failed either to pay or to deny the claim (see New York & Presbyt. Hosp. v Travelers Prop. Cas. Ins. Co., 37 AD3d 683 [2007]; Hospital for Joint Diseases v Travelers Prop. Cas. Ins. Co., 34 AD3d 532 [2006], lv granted 8 NY3d 807 [2007]; New York & Presbyt. Hosp. v Allstate Ins. Co., 30 AD3d 492 [2006]). This evidence demonstrated that the defendant received the no-fault billing and failed to respond within the requisite 30-day period (see Insurance Law § 5106 [a]; 11 NYCRR 65-3.5; New York & Presbyt. Hosp. v Travelers Prop. Cas. Ins. Co., supra). In opposition, the defendant failed to raise a triable issue of fact. There is no evidence that it timely objected to the completeness of the [*2]claim forms, or sought verification of Recinos’s assignment. Therefore, the defendant waived any defenses based thereon, including the plaintiff’s purported lack of standing to maintain the first cause of action (see Hospital for Joint Diseases v Travelers Prop. Cas. Ins. Co., supra; Nyack Hosp. v Encompass Ins. Co., 23 AD3d 535 [2005]; Hospital for Joint Diseases v Allstate Ins. Co., 21 AD3d 348 [2005]). Accordingly, the Supreme Court correctly granted that branch of the plaintiff’s cross motion which was for summary judgment on the first cause of action.

The defendant’s remaining contentions either are improperly raised for the first time in this Court or are without merit. Rivera, J.P., Florio, Dillon and Carni, JJ., concur.

Cited in this decision

New York & Presbyt. Hosp. v Travelers Prop. Cas. Ins. Co. (2007 NY Slip Op 01537)The hospital established receipt of its no-fault billing and the insurer's failure to respond within the required 30-day period.
Hospital for Joint Diseases v Travelers Prop. Cas. Ins. Co. (2006 NY Slip Op 08214)An insurer waives claim-form and assignment defenses by failing to timely object to form adequacy or seek assignment verification.
Nyack Hosp. v Encompass Ins. Co. (2005 NY Slip Op 08962)An insurer's letters delaying payment pending its investigation do not toll the 30-day period for paying or denying a no-fault claim.
Hospital for Joint Diseases v Allstate Ins. Co. (2005 NY Slip Op 06192)An insurer waived assignment objections by failing to timely object to hospital forms or seek verification of the assignments.

Cited by

Hospital for Joint Diseases v Travelers Prop. Cas. Ins. Co. (2007 NY Slip Op 09067)An insurer that fails to timely seek verification of an assignment cannot later contest its validity when the underlying claim is covered.
Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co. (2013 NY Slip Op 08430)A provider need not prove a claim's merits for summary judgment where the insurer failed to timely and properly deny the claim.
Hospital for Joint Diseases v New York Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 08038)The hospital's claim was premature because unrebutted proof showed that it ignored timely verification and follow-up requests.
Westchester Med. Ctr. v Progressive Cas. Ins. Co. (2008 NY Slip Op 04867)An insurer invoking the intoxication exclusion must establish that intoxication proximately caused the accident to obtain summary judgment.
NYU Hosp. for Joint Diseases v Country Wide Ins. Co. (2011 NY Slip Op 04219)The insurer's denial was fatally defective because it omitted required information and named the assignor as the benefits applicant.
Westchester Med. Ctr. v Allstate Ins. Co. (2007 NY Slip Op 08447)The hospital failed to establish that the insurer's timely NF-10 denial was too vague or deficient to constitute a proper response.
Westchester Med. Ctr. v Progressive Cas. Ins. Co. (2007 NY Slip Op 09770)The insurer's intoxication evidence defeated the hospital's summary judgment motion but did not establish entitlement to dismissal.
Nyack Hosp. v Allstate Ins. Co. (2014 NY Slip Op 00641)The insurer waived objections to deficient claim forms by failing to contest their adequacy timely at the claims stage.

Similar decisions

Westchester Med. Ctr. v Countrywide Ins. Co. (2007 NY Slip Op 09024)The insurer failed to prove mailing of verification requests and waived defenses based on incomplete assignment forms.
Westchester Med. Ctr. v Allstate Ins. Co. (2013 NY Slip Op 08616)The insurer failed to establish a verification toll because it offered no evidence of mailing a required follow-up request.
Westchester Med. Ctr. v Country Wide Ins. Co. (2011 NY Slip Op 03838)The insurer raised a triable issue as to whether the hospital fully complied with its verification demand.
Westchester Med. Ctr. v Government Empls. Ins. Co. (2014 NY Slip Op 00500)The insurer's contention that a complete absence of coverage survived its untimely denial was improperly raised for the first time on appeal.
Nyack Hosp. v Metropolitan Prop. & Cas. Ins. Co. (2005 NY Slip Op 02235)The insurer failed to prove mailing of its denial, and the denial was incomplete even if timely.