Trial court, Second Department
Sep 24, 2026
2026 NY Slip Op 26164
Insurer prevailed
The provider failed to raise a factual issue concerning compliance with verification requests within 120 days. The Civil Court, Kings County, granted the insurer's summary judgment motion, dismissed the complaint with prejudice, and denied the provider's cross motion as moot. Under 11 NYCRR 65-3.5 (o), the insurer established nonreceipt of requested documents, while the provider supplied neither proof of compliance nor reasonable justification. Its owner's affidavit gave inconsistent mailing addresses and lacked corroborating documents. Government Employees Ins. Co. v Mayzenberg did not bar requests investigating licensing eligibility under 11 NYCRR 65-3.16 (a) (12): the denial rested on noncompliance with verification, without a conclusive finding of professional misconduct. The court declined to consider an amended cross motion served 18 months after the insurer's opposition and reply.
Trial court, Second Department
Sep 3, 2026
2026 NY Slip Op 51460(U)
Provider prevailed
The insurer failed to establish its intoxication exclusion or fee-schedule defense through competent, admissible evidence. The Civil Court, Kings County, denied its summary judgment motion in full. Under Westchester Med. Ctr. v Government Empls. Ins. Co., the insurer had to prove intoxication or impairment and that the injuries resulted from operating a vehicle in that condition. Unauthenticated medical records and a police report lacked an admissible foundation under CPLR 4518 or another evidentiary rule, and the assignor's EUO testimony disputed intoxication. The insurer also supplied no competent proof that the charges exceeded the applicable fee schedule. The court made no finding of intoxication or causation and left both defenses for proof at trial.
Trial court, First Department
Aug 24, 2026
2026 NY Slip Op 51435(U)
Insurer prevailed
The defendant insurer established that a separate company issued the assignor's policy and that it was not a proper party. The Civil Court, New York County, granted summary judgment under CPLR 3212 (b) and dismissed the provider's no-fault reimbursement complaint. The defendant's records search located no policy covering the assignor, while a claims representative for the separate issuing insurer identified the relevant policy and claim number. The provider's conclusory assertions concerning the issuer's identity and the companies' relationship raised no triable issue. Whether the defendant received the bills or issued a lack-of-coverage denial was immaterial to the jurisdictional issue presented.
Trial court, Second Department
Aug 20, 2026
2026 NY Slip Op 51339(U)
Insurer prevailed
Post-EUO verification requests continue tolling when the EUO fails to supply information necessary to verify the claim. The insurer submitted the EUO transcript and an SIU affidavit establishing that necessary information remained outstanding. Following Nationwide Affinity Ins. Co. of Am. v Gepp and 11 NYCRR 65-3.5 (c), the Civil Court, Kings County, rejected the provider's arguments that the completed EUO ended tolling and that the written request eight days later was untimely. The provider did not respond within 120 days; its later statement of intent to supply verification did not constitute a response. The insurer was entitled to deny the claim, and the court granted its CPLR 3212 summary judgment motion in its entirety and denied the provider's cross motion.
Trial court, First Department
Aug 19, 2026
2026 NY Slip Op 51329(U)
Provider prevailed
The insurer failed to establish timely, proper mailing of its initial verification request, defeating summary judgment for nonresponse. The Civil Court, Bronx County, denied the insurer's motion under CPLR 3212. The adjuster's affidavit described mailing procedures for the follow-up request but omitted the processing steps for the initial request; conflicting mailing dates also raised a factual issue. Although 11 NYCRR 65-3.5 (o) permits denial after 120 days without verification or reasonable justification, the insurer did not establish tolling. The court found requests for signed claim and assignment forms reasonable and rejected the provider's demand for separate copies to it and counsel under 11 NYCRR 65-3.6 (b). Timely, proper mailing remained for trial; if proven, the action was premature.
Trial court, Second Department
Aug 18, 2026
2026 NY Slip Op 51401(U)
Provider prevailed
MVAIC failed to establish nonreceipt of three bills, and the provider raised a medical-necessity issue on six others. The Civil Court, Kings County, described MVAIC's summary judgment motion as granted to an extent, but left all nine bills for trial and noted payments reducing five disputed balances. Although MVAIC was exempt from 11 NYCRR 65-3.5 (k), its mailing-only receipt affidavit omitted fax procedures or a policy rejecting fax submissions. The provider's affidavits describing transmission to MVAIC's conceded fax number defeated summary judgment, but did not establish timely submission without the bills themselves. A physician's rebuttal affidavit raised a factual issue concerning medical necessity for the other six bills.
