October 21, 2003

Y & T Supply Inc. v Aiu Ins. Co. (2003 NY Slip Op 51579(U))

Headnote

The court considered the fact that the plaintiff was seeking first-party no-fault benefits for health services provided to two individuals injured in an automobile accident, and that the defendant denied the claims for payment. The main issue decided was whether the defendant's denial of the claims was valid, as the plaintiff argued the claims were not timely denied as required by Insurance Law. The holding of the case was that the court affirmed the lower court's decision to deny the plaintiff's motion for summary judgment, as the defendant was able to rebut the plaintiff's prima facie case by showing that the plaintiff did not submit completed proof of claim and did not timely respond to requests for verification. The defendant also raised an additional issue of fact regarding fraud in the claim, further supporting the denial of the motion for summary judgment.

Reported in New York Official Reports at Y & T Supply Inc. v Aiu Ins. Co. (2003 NY Slip Op 51579(U))

Y & T Supply Inc. v Aiu Ins. Co. (2003 NY Slip Op 51579(U)) [*1]

Y & T Supply Inc. v AIU Ins. Co.

2003 NY Slip Op 51579(U)

Decided on October 21, 2003

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This opinion is uncorrected and will not be published in the Official Reports.

Decided on October 21, 2003

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM : 2nd and 11th JUDICIAL DISTRICTS

PRESENT:PESCE, P.J., ARONIN and PATTERSON, JJ.
NO. 2002-1537 K C

Y & T SUPPLY INC. a/a/o MARTHA DEJEAN JEAN SAMUEL EMMANUEL, Appellant, –
against
AIU INSURANCE COMPANY, Respondent.

Appeal by plaintiff from an order of the Civil Court, Kings County (J. Sullivan, J.), entered September 18, 2002, denying its motion for summary judgment.

Order unanimously affirmed without costs.

Plaintiff commenced this action, pursuant to Insurance Law § 5101 et seq. to recover first-party no-fault benefits for health services it provided to its assignors Martha DeJean and Jean Samuel Emmanuel for injuries they sustained in an automobile accident, and for statutory interest and attorneys fees. Thereafter, plaintiff moved for summary judgment on the ground that defendant did not pay or deny its claim within the 30-day period as provided by Insurance Law § 5106 (a). By order entered September 18, 2002, the court below denied plaintiff’s motion, from which this appeal ensues.

It is uncontroverted that defendant received plaintiff’s complete claim for $1,671.66 on July 18, 2000 ($759.33 for DeJean and $912.33 for Emmanuel). Defendant denied the part of the claim as to Emmanuel on December 13, 2000 and denied the part of the claim as to DeJean on December 15, 2000. Considering plaintiff’s failure to respond to defendant’s valid and timely requests for verification, defendant has rebutted plaintiff’s prima facie case, established through submission of its claim forms, by showing that plaintiff did not submit a completed proof of claim and that therefore plaintiff was no longer entitled to summary judgment by virtue of the fact that defendant did not timely pay or deny said claim (see Insurance Law Ы 5106 [a]; 11 NYCRR 65.15 [d], [g]; New York & Presbyt. Hosp. v American Tr. Ins. Co., 287 AD2d 699). To hold otherwise would allow plaintiff to obtain the benefits of the insurance regulations without having to abide by them. Consequently, defendant has shown a triable issue of fact, thereby [*2]defeating plaintiff’s motion for summary judgment (see Alvarez v Prospect Hosp., 68 NY2d 320, 324). Defendant’s papers in opposition raised an additional issue of fact by showing that fraud was committed as to the part of the claim concerning Emmanuel (see Metro Medical Diag. v Eagle Ins. Co., 293 AD2d 751; see also Central Gen. Hosp. v Chubb Group Ins. Cos., 90 NY2d 195).

Accordingly, we find that the court below properly denied plaintiff’s motion for summary judgment.
Decision Date: October 21, 2003