The Second Department reiterated that overdue-claim interest is 2% a month, pro rata on a 30-day month (11 NYCRR 65-3.9 (a)), and held that a court vacating a master arbitration award on finding the denial improper should award 65-4.6 (d) fees (Lam Quan). Following Marine Midland Bank, the Appellate Term, Second Department, rejected limitations and CPLR 3215 (c) challenges to a stipulation allowing judgment on any future default without time limit (Arguelles v AIG). It held that an insurer moving to vacate a CPLR 5003-a judgment must show improper tender (Medtech), and found late MVAIC submission unexcused where the provider never explained first billing another insurer (Queens Diagnostic Radiology).
Our summary of the month’s decisions, not the courts’ words.
Appellate Division, Second Department
Jun 4, 2025
2025 NY Slip Op 03328
Provider prevailed
Overdue no-fault benefits accrue interest at 2% per month, calculated pro rata using a 30-day month. After Supreme Court vacated a master arbitration award denying the provider's claim, it incorrectly calculated interest under Insurance Law § 5106 (a) and 11 NYCRR 65-3.9 (a). Having found the denial improper, it also should have awarded attorney's fees under 11 NYCRR 65-4.6 (d). The Appellate Division, Second Department, modified the judgment and otherwise affirmed it insofar as appealed from, remitting for recalculation of interest, determination of those fees, and additional appellate fees under 11 NYCRR 65-4.10 (j) (4). The provider's remaining challenges to the Supreme Court fee award and omission of a credit-card surcharge were not properly before the court.
Appellate Term, Second Department
Jun 20, 2025
2025 NY Slip Op 51150(U)
Provider prevailed
The insurer failed to support vacatur of a settlement judgment with evidence that the provider had not properly tendered settlement documents. The provider obtained judgment under CPLR 5003-a (e) based on the insurer's alleged failure to pay promptly. CPLR 5003-a (a) requires payment within 21 days after tender of an executed release and stipulation of discontinuance; CPLR 5003-a (g) defines tender as personal delivery or registered or certified mail, return receipt requested. On its motion to vacate, the insurer bore the burden of showing noncompliance, but submitted no evidence of improper tender. The Appellate Term, Second Department, affirmed the order, insofar as appealed from, denying the insurer's request to vacate the judgment.
Appellate Term, Second Department
Jun 20, 2025
2025 NY Slip Op 51151(U)
Provider prevailed
The provider's forgery affidavit raised a triable issue as to the insurer's defense that an endorsed check paid the claims. The insurer sought summary judgment dismissing an action for two assigned no-fault claims and submitted copies of the check's front and back. Its proof established prima facie that it mailed the check and that the check was endorsed and deposited or cashed. The provider denied receipt and submitted an affidavit of forgery bearing five signature samples. Apparent differences between those signatures and the endorsement raised a factual issue under CPLR 3212 (b) concerning forgery and nonpayment. The Appellate Term, Second Department, affirmed the order insofar as it denied the insurer's motion.
Appellate Term, Second Department
Jun 20, 2025
2025 NY Slip Op 51152(U)
Insurer prevailed
An insurer may request business records during claim verification to determine whether a provider meets licensing requirements. The provider challenged summary judgment dismissing its claims for failure to supply verification, including management agreements, W-2 forms, bank records, and leases. The Appellate Term, Second Department, found those requests proper under 11 NYCRR 65-3.16 (a) (1) and Mallela. An order denying the insurer summary judgment in a declaratory judgment action had no collateral estoppel effect because it was not a final merits determination. The court therefore did not reach whether the Civil Court properly rejected the provider's subsequent submission of that order as an improper surreply. It affirmed the order, insofar as appealed from, granting the insurer summary judgment.
Appellate Term, Second Department
Jun 6, 2025
2025 NY Slip Op 51142(U)
Provider prevailed
The provider's request for judgment under a settlement stipulation without an enforcement deadline was not time-barred. The stipulation permitted entry of judgment if the insurer failed to pay within 30 days. After the provider sought judgment years later, the Civil Court vacated the judgment and then dismissed the complaint under CPLR 213 (1). Following Marine Midland Bank v Worldwide Industrial Corp., the Appellate Term, Second Department, found that the stipulation expressly authorized judgment upon a future default without a time limit. CPLR 3215 (c) did not require an application within one year because CPLR 3215 (i) (1), governing settlement defaults, contains no such deadline. The order was reversed, dismissal denied, and the matter remitted for further proceedings.
Appellate Term, Second Department
Jun 6, 2025
2025 NY Slip Op 51147(U)
Insurer prevailed
The provider failed to justify submitting its claims to MVAIC more than 45 days after the services were rendered. The provider conceded that its submissions were untimely under 11 NYCRR 65-1.1. MVAIC established timely denials based on late submission and advised that reasonable justification could excuse the delay under 11 NYCRR 65-3.3 (e). The provider asserted that it initially sent the claims to an insurer and later submitted them to MVAIC after learning that the assignor qualified for MVAIC benefits. It did not explain why it initially submitted the claims to the insurer, and thus failed to establish reasonable justification. The Appellate Term, Second Department, reversed the order, insofar as appealed from, and granted MVAIC summary judgment dismissing the complaint.
