Reported in New York Official Reports at Health Value Med., P.C. v Country Wide Ins. (2022 NY Slip Op 51137(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
Country Wide Insurance, Respondent.
Glinkenhouse Queen, Esqs. (Alan Queen of counsel), for appellant. Thomas Torto, for respondent.
Appeal from an order of the Civil Court of the City of New York, Queens County (Terrence C. O’Connor, J.), entered April 5, 2018. The order, in effect, denied plaintiff’s motion to recalculate, from a simple rate to a compound rate, an award of statutory no-fault interest in a judgment of that court entered March 17, 2017.
ORDERED that the order is reversed, with $30 costs, and plaintiff’s motion to recalculate, from a simple rate to a compound rate, an award of statutory no-fault interest in a judgment entered March 17, 2017 is granted.
This action by a provider to recover assigned first-party no-fault benefits for a claim submitted to defendant on or about February 9, 1999, arising from an accident that occurred on September 24, 1998, was settled on July 31, 2008. Defendant did not pay the settlement amount, and a judgment was subsequently entered on March 17, 2017 (see CPLR 5003-a) awarding statutory no-fault interest at a simple 2% per month rate. Plaintiff moved, pursuant to CPLR 5019 (a), to have the interest recalculated pursuant to the pre-2002 regulations, which required no-fault interest to be calculated at a compound rate (see former 11 NYCRR 65.15 [h] [1]). Plaintiff appeals from an order of the Civil Court which, in effect, denied its motion.
Plaintiff correctly argues that the claim involved herein is governed by the former regulations providing for compound interest because the accident occurred prior to the effective date of the current regulations, which now provide for a simple rate of interest (see 11 NYCRR 65-3.9 [a], effective April 5, 2002; Matter of B.Z. Chiropractic, P.C. v Allstate Ins. Co., 197 AD3d 144, 155-156 [2021]). Consequently, plaintiff’s motion should have been granted. We note that, contrary to the statement of the Civil Court, postjudgment interest in a no-fault action [*2]is governed by Insurance Law § 5106 and its implementing regulations, not the CPLR (see Matter of B.Z. Chiropractic, P.C. v Allstate Ins. Co., 197 AD3d 144).
Accordingly, the order is reversed and plaintiff’s motion to recalculate, from a simple rate to a compound rate, an award of statutory no-fault interest in a judgment entered March 17, 2017 is granted.
ALIOTTA, P.J., GOLIA and BUGGS, JJ., concur.
ENTER:Paul Kenny
Chief Clerk
Decision Date: October 21, 2022
Reported in New York Official Reports at Good Samaritan Hosp. v MVAIC Ins. Co. (2022 NY Slip Op 51100(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 9th and 10th JUDICIAL DISTRICTS
against
MVAIC Insurance Company, Appellant.
Marshall & Marshall, PLLC (Frank D’Esposito and David Gierasch of counsel), for appellant. Dash Law Firm, P.C. (James Errera of counsel), for respondent.
Appeal from an order of the District Court of Suffolk County, Third District (C. Stephen Hackeling, J.), dated April 6, 2021. The order denied defendant’s motion for summary judgment dismissing the complaint and granted plaintiff’s cross motion for summary judgment.
ORDERED that the order is reversed, without costs, defendant’s motion for summary judgment dismissing the complaint is granted and plaintiff’s cross motion for summary judgment is denied.
In this action by a provider to recover assigned first-party no-fault benefits, defendant Motor Vehicle Accident Indemnification Corporation (sued herein as MVAIC Insurance Company) appeals from an order of the District Court dated July 1, 2021 denying defendant’s motion for summary judgment dismissing the complaint and granting plaintiff’s cross motion for summary judgment.
Defendant established its prima facie entitlement to summary judgment by submitting evidence demonstrating that it timely denied plaintiff’s claim submitted in January 2018 for no-fault benefits, on the ground of untimeliness, as the claim was submitted more than 45 days after the date services were rendered (see 11 NYCRR 65-1.1) and that its denial informed plaintiff that it could excuse the delay if plaintiff provided “reasonable justification” for the late [*2]submission (see 11 NYCRR 65-3.3 [e]; Stand-Up MRI of the Bronx, P.C. v MVAIC Ins. Co., 76 Misc 3d 128[A], 2022 NY Slip Op 50789[U] [App Term, 2d Dept, 9th & 10th Jud Dists 2022]; Mount Sinai Hosp. of Queens v Country Wide Ins. Co., 43 Misc 3d 139[A], 2014 NY Slip Op 50780[U] [App Term, 2d Dept, 9th & 10th Jud Dists 2014]; see also Schottenstein Pain & Neuro, PLLC v MVAIC, 72 Misc 3d 131[A], 2021 NY Slip Op 50643[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2021]).
In opposition, plaintiff failed to raise a triable issue of fact as to whether it provided defendant with a reasonable justification for its untimely submission of the claim, as plaintiff failed to explain why, after learning that there was no insurance covering the accident, it first submitted the claim to the assignor’s personal health insurer instead of MVAIC, and why it took months before it first purportedly sent the claim to MVAIC (see Stand-Up MRI of the Bronx, P.C., 2022 NY Slip Op 50789[U]; Excel Surgery Ctr., LLC v MVAIC, 68 Misc 3d 134[A], 2020 NY Slip Op 51016[U] [App Term, 2d Dept, 9th & 10th Jud Dists 2020]; Mount Sinai Hosp. of Queens, 2014 NY Slip Op 50780[U]; see also Schottenstein Pain & Neuro, PLLC, 2021 NY Slip Op 50643[U]).
Plaintiff also failed to raise a triable issue of fact as to whether it actually first submitted the claim to MVAIC on October 17, 2017, the basis for plaintiff’s argument that defendant’s February 5, 2018 denial was untimely. To establish this mailing, plaintiff neither presented an affidavit by one with personal knowledge of the mailing nor provided sufficient practices and procedures of mailing, but rather relied on a certificate of mailing, which, under the circumstances presented, was insufficient to fill in the gaps in plaintiff’s proof of mailing.
Accordingly, the order is reversed, defendant’s motion for summary judgment dismissing the complaint is granted and plaintiff’s cross motion for summary judgment is denied.
GARGUILO, P.J., EMERSON and DRISCOLL, JJ., concur.
ENTER:Paul Kenny
Chief Clerk
Decision Date: October 14, 2022
Reported in New York Official Reports at Parisien v Travelers Ins. Co. (2022 NY Slip Op 51136(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
Travelers Insurance Company, Appellant.
Law Office of Aloy O. Ibuzor (Janice A. Robinson of counsel), for appellant. The Rybak Firm, PLLC (Damin J. Toell and Richard Rozhik of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Sandra E. Roper, J.), entered September 6, 2019. The order, insofar as appealed from as limited by the brief, denied the branch of defendant’s motion seeking summary judgment dismissing the complaint and granted plaintiff’s cross motion for summary judgment.
ORDERED that the order, insofar as appealed from, is modified by providing that plaintiff’s cross motion for summary judgment is denied; as so modified, the order, insofar as appealed from, is affirmed, without costs.
In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for, among other things, summary judgment dismissing the complaint on the ground that the action was premature as plaintiff had failed to respond to defendant’s timely requests for additional verification. Plaintiff opposed the motion and cross-moved for summary judgment. By order entered September 6, 2019, insofar as appealed from as limited by the brief, the Civil Court denied the branch of defendant’s motion seeking summary judgment dismissing the complaint and granted plaintiff’s cross motion.
Defendant demonstrated, prima facie, that it had timely mailed initial and follow-up requests for verification (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]), and that it had not received the requested verification. However, the affidavit submitted by plaintiff in opposition to defendant’s motion was sufficient to raise an issue of fact as to whether the requested verification had been mailed to, and received by, defendant (see Compas Med., P.C. v Praetorian Ins. Co., 49 Misc 3d 152[A], 2015 NY Slip Op 51776[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]). As a result, there is an issue of fact as to whether plaintiff’s action is premature.
Accordingly, the order, insofar as appealed from, is modified by providing that plaintiff’s cross motion for summary judgment is denied.
ALIOTTA, P.J., WESTON and TOUSSAINT, JJ., concur.
ENTER:Paul Kenny
Chief Clerk
Decision Date: September 30, 2022
Reported in New York Official Reports at Remedy Chiropractic, P.C. v Nationwide Ins. (2022 NY Slip Op 50935(U))
| Remedy Chiropractic, P.C. v Nationwide Ins. |
| 2022 NY Slip Op 50935(U) [76 Misc 3d 135(A)] |
| Decided on September 23, 2022 |
| 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 September 23, 2022
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : THOMAS P. ALIOTTA, P.J., MICHELLE WESTON, CHEREÉ A. BUGGS, JJ
2021-148 K C
against
Nationwide Ins., Respondent.
The Rybak Firm, PLLC (Damin J. Toell and Richard Rozhik of counsel), for appellant. Hollander Legal Group , P.C. (Allan S. Hollander and Christopher Volpe of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Carolyn Walker-Diallo, J.), dated October 9, 2020. The order granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross motion for summary judgment.
ORDERED that the order is affirmed, with $25 costs.
In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint on the ground that plaintiff had failed to provide requested verification. Plaintiff opposed the motion and cross-moved for summary judgment. By order dated October 9, 2020, the Civil Court granted defendant’s motion and dismissed the complaint on the ground that the action was premature due to plaintiff’s failure to provide requested verification, and denied plaintiff’s cross motion.
Defendant demonstrated, prima facie, that it had timely mailed initial and follow-up requests for verification (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]) and that it had not received all of the requested verification. In opposition, plaintiff’s owner merely stated that he had mailed the requested verification “to the extent such response was proper and in [his] possession.” In addition, the day after plaintiff’s owner purportedly mailed its response to defendant’s verification requests, an attorney representing plaintiff provided part of the requested verification, stating that plaintiff was not providing the [*2]remainder of defendant’s requested verification because plaintiff believed the remaining requests were objectionable. Thus, contrary to plaintiff’s contention on appeal, plaintiff failed to establish a triable issue of fact by demonstrating that it had provided the requested verification or had set forth a reasonable justification for the failure to comply with defendant’s verification requests (see 11 NYCRR 65-3.8 [b] [3]). Consequently, we find no basis to disturb the order (see Burke Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co., 75 Misc 3d 143[A], 2022 NY Slip Op 50623[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2022]; CPM Med Supply, Inc. v State Farm Fire & Cas. Ins. Co., 63 Misc 3d 140[A], 2019 NY Slip Op 50576[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2019]).
Accordingly, the order is affirmed.
ALIOTTA, P.J., WESTON and BUGGS, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: September 23, 2022
Reported in New York Official Reports at Wellness Plaza Acupuncture, P.C. v Nationwide Ins. (2022 NY Slip Op 50934(U))
| Wellness Plaza Acupuncture, P.C. v Nationwide Ins. |
| 2022 NY Slip Op 50934(U) [76 Misc 3d 135(A)] |
| Decided on September 23, 2022 |
| 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 September 23, 2022
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : MICHELLE WESTON, J.P., DONNA-MARIE E. GOLIA, CHEREÉ A. BUGGS, JJ
2021-131 K C
against
Nationwide Ins., Respondent.
The Rybak Firm, PLLC (Maksim Leyvi and Richard Rozhik of counsel), for appellant. Hollander Legal Group , P.C. (Allan S. Hollander and Christopher Volpe of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Nicholas W. Moyne, J.), entered February 26, 2021. The order granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross motion for summary judgment.
ORDERED that the order is affirmed, with $25 costs.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court granting defendant’s motion for summary judgment dismissing the complaint on the ground that plaintiff’s assignor had failed to appear for duly scheduled examinations under oath (EUOs), and denied plaintiff’s cross motion for summary judgment.
Contrary to plaintiff’s contentions on appeal with respect to defendant’s motion, the proof submitted by defendant in support of its motion was sufficient to give rise to a presumption that the EUO scheduling letters and denial of claim forms had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]), and plaintiff failed to raise a triable issue of fact with respect to the timeliness of the mailings. Plaintiff’s contention that the initial EUO scheduling letter, which was mailed prior to the receipt of the claims at issue [*2]here, was required to be sent to plaintiff’s assignor within 15 business days of defendant’s receipt of either the NF-2 form or a claim received from another provider lacks merit (see 11 NYCRR 65-3.5 [b]; Appendix 13; UGP Acupuncture, P.C. v Metlife Auto & Home, 76 Misc 3d 129[A], 2022 NY Slip Op 50792[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2022]; Metropolitan Surgical Servs., P.C. v 21st Century Ins. Co., 75 Misc 3d 141[A], 2022 NY Slip Op 50606[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2022]; Columbus Imaging Ctr., LLC v Erie Ins. Co. of NY, 75 Misc 3d 137[A], 2022 NY Slip Op 50569[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2022]; City Anesthesia Healthcare, P.C. v Erie Ins. Co. of NY, 70 Misc 3d 141[A], 2021 NY Slip Op 50135[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2021]).
Accordingly, the order is affirmed.
WESTON, J.P., GOLIA and BUGGS, JJ., concur.
ENTER:Paul Kenny
Chief Clerk
Decision Date: September 23, 2022
Reported in New York Official Reports at Columbus Imaging Ctr., LLC v Erie Ins. Co. of N.Y. (2022 NY Slip Op 50929(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
Erie Insurance Company of New York, Appellant.
Robyn M. Brilliant, P.C. (Tori Y. Buttrum of counsel), for appellant. The Rybak Firm, PLLC (Damin J. Toell of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Ira R. Greenberg, J.), entered December 3, 2019. The order, insofar as appealed from, denied defendant’s motion for summary judgment dismissing the complaint and, upon denying plaintiff’s cross motion for summary judgment, found, in effect pursuant to CPLR 3212 (g), that the only issue remaining for trial was defendant’s defense that plaintiff’s assignor failed to appear for scheduled independent medical examinations.
ORDERED that the order, insofar as appealed from, is reversed, with $30 costs, and defendant’s motion for summary judgment dismissing the complaint is granted.
In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint on the ground that plaintiff’s assignor failed to appear for duly scheduled independent medical examinations (IMEs), and plaintiff cross-moved for summary judgment. Defendant appeals from so much of an order of the Civil Court as denied defendant’s motion for summary judgment dismissing the complaint and, upon denying plaintiff’s cross motion for summary judgment, found, in effect pursuant to CPLR 3212 (g), that the only issue remaining for trial was defendant’s defense that plaintiff’s assignor failed to appear for scheduled IMEs.
Contrary to the determination of the Civil Court, defendant demonstrated that, before it [*2]had received the claim at issue, it properly scheduled IMEs of plaintiff’s assignor, and that the assignor failed to appear for the duly scheduled IMEs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]). Defendant also demonstrated that it timely denied the claim (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]), based upon the assignor’s failure to appear for the IMEs. An assignor’s appearance at an IME “is a condition precedent to the insurer’s liability on the policy” (Stephen Fogel Psychological, P.C., 35 AD3d at 722).
Plaintiff’s remaining argument is not properly before this court as it is being raised for the first time on appeal, and we decline to consider it (see Joe v Upper Room Ministries, Inc., 88 AD3d 963 [2011]; Mind & Body Acupuncture, P.C. v Elrac, Inc., 48 Misc 3d 139[A], 2015 NY Slip Op 51219[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]).
Accordingly, the order, insofar as appealed from, is reversed and defendant’s motion for summary judgment dismissing the complaint is granted.
ALIOTTA, P.J., TOUSSAINT and GOLIA, JJ., concur.
ENTER:Paul Kenny
Chief Clerk
Decision Date: September 23, 2022
Reported in New York Official Reports at Arguelles M.D., P.C. v American Ind. Ins. Co. (2022 NY Slip Op 50926(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
American Independent Ins. Co., Omni Indemnity Company, American Independent Insurance Companies, Inc., and Good2Go Auto Insurance, Appellants.
Freiberg, Peck & Kang, LLP (Yilo J. Kang of counsel), for appellants. The Rybak Firm, PLLC (Oleg Rybak of counsel), for respondent (no brief filed).
Appeal from an order of the Civil Court of the City of New York, Kings County (Lorna J. McAllister, J.), entered January 25, 2019. The order, insofar as appealed from, denied defendants’ motion for summary judgment dismissing the complaint.
ORDERED that the order, insofar as appealed from, is reversed, with $30 costs, and defendants’ motion for summary judgment dismissing the complaint is granted.
In this action by a provider to recover assigned first-party no-fault benefits, defendants appeal from so much of an order of the Civil Court as denied defendants’ motion which had sought summary judgment dismissing the complaint on the ground, among others, that the action was barred by the statute of limitations.
In support of a cross motion for summary judgment, plaintiff submitted an affidavit by plaintiff’s owner who asserted that the subject claim forms were submitted to defendants on or before October 20, 2007, that the claims had not been paid, and that statutory interest was to be computed as of 30 days after each claim’s submission. Consequently, the payment due date, as implicitly alleged by plaintiff in its complaint and in the affidavit by plaintiff’s owner, must be deemed to have been in November 2007, that is, 30 days after defendants’ receipt of the claims (see Insurance Law § 5106 [a]; 11 NYCRR 65-3.8; Shtarkman v MVAIC, 20 Misc 3d 132[A], [*2]2008 NY Slip Op 51447[U] [App Term, 2d Dept, 2d & 11th Jud Dists 2008]). Plaintiff did not commence this action until 2018, after the six-year statute of limitations for contract actions, which is applicable to this cause of action (see CPLR 213 [2]; Mandarino v Travelers Prop. Cas. Ins. Co., 37 AD3d 775 [2007]), had expired. As plaintiff raised no issue of fact as to the timeliness of the action, defendants’ motion to dismiss based on the statute of limitations should have been granted (see A.M. Med., P.C. v Continental Ins. Co., 47 Misc 3d 128[A], 2015 NY Slip Op 50389[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]; DJS Med. Supplies, Inc. v Clarendon Natl. Ins. Co., 32 Misc 3d 129[A], 2011 NY Slip Op 51304[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2011]).
Accordingly, the order, insofar as appealed from, is reversed and defendants’ motion for summary judgment dismissing the complaint is granted.
ALIOTTA, P.J., TOUSSAINT and GOLIA, JJ., concur.
ENTER:Paul Kenny
Chief Clerk
Decision Date: September 23, 2022
Reported in New York Official Reports at New Millennium Med. Imaging, P.C. v GEICO (2022 NY Slip Op 22300)
| New Millennium Med. Imaging, P.C. v GEICO |
| 2022 NY Slip Op 22300 [76 Misc 3d 31] |
| Accepted for Miscellaneous Reports Publication |
| Supreme Court, Appellate Term, Second Department, 2d, 11th and 13th Judicial Districts |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| As corrected through Wednesday, November 23, 2022 |
[*1]
| New Millennium Medical Imaging, P.C., as Assignee of Shomari Neysmith, Respondent, v GEICO, Appellant. |
Supreme Court, Appellate Term, Second Department, 2d, 11th and 13th Judicial Districts, September 23, 2022
Law Office of Goldstein, Flecker & Hopkins (Lawrence J. Chanice of counsel) for appellant.
Law Office of Damin J. Toell, P.C. (Damin J. Toell of counsel) for respondent.
Ordered that the order, insofar as appealed from, is affirmed, with $25 costs.
In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals, as limited by its notice of appeal, from so much of an order of the Civil Court as denied defendant’s motion which had sought to dismiss the complaint, pursuant to CPLR 3211 (a) (5), on the ground that the action is barred by the statute of limitations.
A defendant moving to dismiss a complaint on statute of limitations grounds bears the initial burden of establishing, prima facie, that the time in which to commence the action has expired (see 6D Farm Corp. v Carr, 63 AD3d 903 [2009]; Island ADC, Inc. v Baldassano Architectural Group, P.C., 49 AD3d 815 [2008]). It is well settled that the six-year statute of limitations applies to the claim involved herein (CPLR 213 [2]; see Mandarino v Travelers Prop. Cas. Ins. Co., 37 AD3d 775 [2007]; Cautious Care Med., P.C. v Omni Indem. Co., 69 Misc 3d 145[A], 2020 NY Slip Op 51384[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2020]). The time within which an action must be commenced is computed “from the time the cause of action accrued to the time the claim is interposed” (CPLR 203 [a]).
[*2]“[A]n insurance company must pay or deny [a no-fault] claim within 30 calendar days after receipt of the proof of claim” (Hospital for Joint Diseases v Travelers Prop. Cas. Ins. Co., 9 NY3d 312, 317 [2007]; see 11 NYCRR 65-3.8 [c]). Indeed, Insurance Law § 5106 (a) provides that no-fault “benefits are overdue if not paid within thirty days after the claimant supplies proof of the fact and amount of loss sustained” (see 11 NYCRR{**76 Misc 3d at 33}65-3.8 [a]; Roman Chiropractic, P.C. v Lumbermens Mut. Cas. Co., 33 Misc 3d 138[A], 2011 NY Slip Op 52090[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2011])—the “claim determination period.” Thus, in a case where an insurance company failed to pay or deny a no-fault claim, and where there had been no timely verification requests, this court stated that “[a] first-party no-fault cause of action accrues 30 days after the insurer’s receipt of the claim” (DJS Med. Supplies, Inc. v Clarendon Natl. Ins. Co., 32 Misc 3d 129[A], 2011 NY Slip Op 51304[U], *1 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2011]; see Cautious Care Med., P.C. v Omni Indem. Co., 69 Misc 3d 145[A], 2020 NY Slip Op 51384[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2020]). Of course, the claim determination period does not always run exactly from receipt of the claim form, nor is it always a full 30 days long. As stated by the Court of Appeals:
“If an insurer seeks additional verification, however, the 30-day window is tolled until it receives the relevant information requested (see 11 NYCRR 65-3.8 [a] [1]). . . .
“[A]n insurer that requests additional verification after the 10- or 15-business-day periods but before the 30-day claim denial window has expired is entitled to verification. In these instances, the 30-day time frame to pay or deny the claim is correspondingly reduced (see 11 NYCRR 65-3.8 [j]; Nyack Hosp. v General Motors Acceptance Corp., 8 NY3d 294, 300 [2007])” (Hospital for Joint Diseases, 9 NY3d at 317-318).
Whether or not there is a toll,[FN1] if the insurer fails to pay or deny the claim within the claim determination period, the cause of action to recover on that claim accrues at the close of that period (see New Millenium Med. Supply v Clarendon Natl. Ins. Co., 29 Misc 3d 130[A], 2010 NY Slip Op 51820[U], *1 [App Term, 1st Dept 2010] [“the cause of action accrued on the date the claim became overdue—here, 30 days after defendant’s receipt of the claim—not the date of defendant’s untimely {**76 Misc 3d at 34}denial of the claim”]). However, when a claim is timely denied prior to the expiration of the claim determination period, the Appellate Division, First Department, has held [*3]that the cause of action accrues immediately upon the denial (see Matter of Travelers Indem. Co. of Conn. v Glenwood Med., P.C., 48 AD3d 319, 320 [2008] [the claim therein “was not timely interposed where it had been denied in full by the insurer . . . more than six years before the provider” sought to recover on the claim]).
In New York Med. Rehab., P.C. v Travelers Ins. Co. (40 Misc 3d 76 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2013]), wherein the claim was received by the defendant on December 16, 2002, this court held that the no-fault cause of action therein had accrued, i.e., that payment became “overdue,” on January 14, 2003, the date that the insurer “issued and mailed its denial of claim form” (id. at 81 [emphasis added]). In the motion herein, defendant acknowledged that it had received the claim at issue on September 17, 2011, requiring defendant to pay or deny the claim by October 17, 2011, absent any toll in effect, which plaintiff has not shown to be the case here. Plaintiff commenced this action on October 6, 2017, within six years of October 17, 2011. However, defendant, citing New York Med. Rehab., P.C., argued that plaintiff’s claim accrued prior to October 17, 2011. Defendant demonstrated, prima facie, that it mailed a denial of the relevant claim on October 3, 2011, i.e., six years and three days prior to the commencement of the action on October 6, 2017. Thus, defendant argued, pursuant to New York Med. Rehab., P.C., the action was barred by the statute of limitations.
While this court properly held in New York Med. Rehab., P.C. that the denial of a claim prior to the expiration of the claim determination period commences the running of the statute of limitations (see Matter of Travelers Indem. Co. of Conn., 48 AD3d 319), to the extent that this court further held that a no-fault claimant’s cause of action accrues on the date an insurer “issue[s] and mail[s] its denial of claim form” (40 Misc 3d at 81 [emphasis added]), New York Med. Rehab., P.C. should no longer be followed.[FN2] Instead, “construing the no-fault regulations as a whole and considering their various sections in reference to each other, as we must” (East Acupuncture, P.C. v Allstate{**76 Misc 3d at 35}Ins. Co., 61 AD3d 202, 210 [2009]), we hold that, where a no-fault claimant receives a denial of claim form prior to the expiration of the claim determination period, the claimant’s right to recover upon that claim accrues upon its receipt of the denial. This conclusion is based upon our reading of 11 NYCRR 65-3.9 (c) which provides in part that “[i]f an applicant does not . . . institute a lawsuit within 30 days after the receipt of a denial of claim form . . . interest shall not accumulate on the disputed claim or element of claim until such action is taken” (emphasis added).
[*4]The clear implication of 11 NYCRR 65-3.9 (c) is that interest begins to run immediately upon the applicant’s receipt of a denial of a claim prior to the expiration of the claim determination period, so long as a lawsuit is commenced within 30 days following plaintiff’s receipt of the denial of claim form. If interest begins to run from receipt of the denial, then the accrual date for the cause of action arising from the failure to pay the claim is also logically the date the denial of claim was received by the applicant.
In its motion, defendant, relying on this court’s prior statement that the relevant accrual date was the mailing of the denial, proffered prima facie evidence of such mailing but did not offer any proof as to when, or if, the denial of claim form at issue was received by plaintiff. Plaintiff has not, on this record, acknowledged the date it received the denial or whether it ever received it. While proper proof of mailing creates a rebuttable presumption of receipt (see Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [2001]), it does not create a presumption as to exactly when an item is received. In the absence of any rule or prima facie proof of the actual date of receipt, a duly mailed item is presumed received within a reasonable period of time. What is a reasonable period includes various factors, such as where the item was mailed from, how it was mailed (e.g., first-class mail, overnight mail, or otherwise), the nature of the intervening days (e.g., weekends or legal holidays) and when plaintiff claims to have received it, if at all.
We note that CPLR 2103 (b) (2) provides that
“where a period of time prescribed by law is measured from the service of a paper and service is by{**76 Misc 3d at 36} mail, five days shall be added to the prescribed period if the mailing is made within the state and six days if the mailing is made from outside the state but within the geographic boundaries of the United States.”
“By its terms, of course, CPLR 2103 applies [only] to pending actions” (Matter of ATM One v Landaverde, 2 NY3d 472, 478 [2004]), and the time periods at issue here are in claims processing, not litigation. Moreover, that statute concerns the addition of time at the end of a prescribed period, whereas here the question is when the prescribed period should begin. Nevertheless, CPLR 2103 (b) (2), which was designed “to compensate for the delay in receipt of the papers served that is inherent in service by mail” (HSBC Bank USA, N.A. v Maniatopoulos, 175 AD3d 575, 576 [2019]), appears to reflect a legislative finding as to the approximate last day when various mailings are likely to be received, without fixing any specific date for receipt within that time frame (see id. at 576 [noting that the CPLR time period was extended “from three to five days in 1982 because the existing three-day (period) was seen as inadequate”]). Thus, CPLR 2103 (b) (2) may be useful as a guide to help determine the presumptive reasonable date of receipt; however, a properly-mailed item should not automatically be presumed to be received exactly five or six days thereafter. Rather, receipt can, based on the particular facts presented, be presumed to be less than five or six days (for example if it was mailed from the same zip code as the addressee’s) or greater than five or six days after mailing, depending on the factors outlined above.
Here, defendant mailed its denial of claim form on Monday, October 3, 2011, from Woodbury, New York, to Flushing, New York, and plaintiff commenced this action on October 6, 2017. In order to hold that the commencement of this action occurred after the statute of limitations had expired, this court would have to find that it is reasonable to presume that plaintiff received the denial of claim form by October 5, 2011—two days after it was mailed. In [*5]the circumstances presented on this record, we do not find that to be a reasonable presumption.
As defendant did not establish that the accrual date for plaintiff’s cause of action was on or before October 5, 2011, defendant did not demonstrate, prima facie, that the action is barred by the statute of limitations and, consequently, we need not determine whether the cause of action accrued any earlier than October 17, 2011, the date that the claim determination period terminated.{**76 Misc 3d at 37}
Accordingly, the order, insofar as appealed from, is affirmed.
Aliotta, P.J., Golia and Buggs, JJ., concur.
Footnote 1:We note that, in moving to dismiss a no-fault complaint on statute of limitations grounds, an insurer is not required to demonstrate, prima facie, that a “payment due date was not tolled by a verification request” (A.M. Med., P.C. v Continental Ins. Co., 47 Misc 3d 128[A], 2015 NY Slip Op 50389[U], *1 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]; see Shtarkman v MVAIC, 20 Misc 3d 132[A], 2008 NY Slip Op 51447[U], *1 [App Term, 2d Dept, 2d & 11th Jud Dists 2008]).
Footnote 2:We note that, in order for a denial of claim to be timely, the denial of claim form need only be mailed prior to the expiration of the claim determination period so as to prevent a preclusion of defenses raised in the denial; it does not have to be received prior to the end of that period to avoid preclusion. However, this is a separate question from what the relevant date is as to the accrual of the cause of action.SVP Med Supply, Inc. v GEICO (2022 NY Slip Op 50927(U))
Reported in New York Official Reports at SVP Med Supply, Inc. v GEICO (2022 NY Slip Op 50927(U))
[*1]| SVP Med Supply, Inc. v GEICO |
| 2022 NY Slip Op 50927(U) [76 Misc 3d 134(A)] |
| Decided on September 23, 2022 |
| 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 September 23, 2022
PRESENT: : THOMAS P. ALIOTTA, P.J., MICHELLE WESTON, CHEREÉ A. BUGGS, JJ
2020-93 K C
against
GEICO, Respondent.
The Rybak Firm, PLLC (Damin J. Toell and Richard Rozhik of counsel), for appellant. Rivkin Radler, LLP (Stuart M. Bodoff and Cheryl F. Korman of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Rosemarie Montalbano, J.), entered September 18, 2019. The order granted defendant’s motion for summary judgment dismissing the complaint.
ORDERED that the order is affirmed, with $25 costs.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order granting defendant’s motion for summary judgment dismissing the complaint on the ground that plaintiff failed to appear for duly scheduled examinations under oath (EUOs).
Contrary to plaintiff’s sole argument on appeal, the proof submitted by defendant was sufficient to establish plaintiff’s failure to appear for the EUOs (see Stephen Fogel Psychological, P.C. v. Progressive Cas. Ins. Co., 35 AD3d 720 [2006]; Parisien v Ameriprise Auto & Home, 75 Misc 3d 138[A], 2022 NY Slip Op 50581[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2022]; Sanford Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co., 75 Misc 3d 138[A], 2022 NY Slip Op 50576[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2022]; Gentlecare Ambulatory Anesthesia Servs. v Geico Ins. Co., 57 Misc 3d 150[A], 2017 NY Slip Op 51518[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2017]).
Accordingly, the order is affirmed.
ALIOTTA, P.J., WESTON and BUGGS, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: September 23, 2022New Millennium Med. Imaging, P.C. v GEICO (2022 NY Slip Op 50928(U))
Reported in New York Official Reports at New Millennium Med. Imaging, P.C. v GEICO (2022 NY Slip Op 50928(U))
[*1]| New Millennium Med. Imaging, P.C. v GEICO |
| 2022 NY Slip Op 50928(U) [76 Misc 3d 134(A)] |
| Decided on September 23, 2022 |
| 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 September 23, 2022
PRESENT: : THOMAS P. ALIOTTA, P.J., DONNA-MARIE E. GOLIA, CHEREÉ A. BUGGS, JJ
2020-155 K C
against
GEICO, Appellant.
Law Office of Goldstein, Flecker & Hopkins (Lawrence J. Chanice of counsel), for appellant. Law Office of Damin J. Toell, P.C. (Damin J. Toell of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Sandra E. Roper, J.), entered September 6, 2019. The order, insofar as appealed from, denied defendant’s motion to dismiss the complaint.
ORDERED that the order, insofar as appealed from, is affirmed, with $25 costs.
In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals, as limited by its notice of appeal, from so much of an order of the Civil Court as denied defendant’s motion which had sought to dismiss the complaint, pursuant to CPLR 3211 (a) (5), on the ground that the action is barred by the statute of limitations.
For the reasons stated in New Millennium Med. Imaging, P.C., as Assignee of Shomari Neysmith v GEICO (— Misc 3d —, 2022 NY Slip Op — [appeal No. 2020-96 K C], decided herewith), the order, insofar as appealed from, is affirmed.
ALIOTTA, P.J., GOLIA and BUGGS, JJ., concur.
ENTER:Paul Kenny
Chief Clerk
Decision Date: September 23, 2022