Reported in New York Official Reports at Flushing Traditional Acupuncture, P.C. v GEICO Ins. Co. (2020 NY Slip Op 51337(U))
| Flushing Traditional Acupuncture, P.C. v GEICO Ins. Co. |
| 2020 NY Slip Op 51337(U) [69 Misc 3d 140(A)] |
| Decided on November 6, 2020 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports.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 November 6, 2020
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : THOMAS P. ALIOTTA, P.J., DAVID ELLIOT, BERNICE D. SIEGAL, JJ
2018-2154 K C
against
GEICO Ins. Co., Respondent.
The Rybak Firm, PLLC (Damin J. Toell of counsel), for appellant. Law Office of Goldstein, Flecker & Hopkins (Lawrence J. Chanice of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Odessa Kennedy, J.), entered September 12, 2018. The order, insofar as appealed from, denied the branches of plaintiff’s motion seeking summary judgment upon so much of the complaint as sought to recover upon the unpaid portion of claims for services billed under CPT codes 97810 and 97811, and granted the branches of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the unpaid portion of those claims.
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, plaintiff moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint, arguing that it had properly used the workers’ compensation fee schedule applicable to chiropractors who render the same services as acupuncturists to reimburse plaintiff for the acupuncture services plaintiff had rendered. Insofar as is relevant to this appeal, the Civil Court denied the branches of plaintiff’s motion seeking summary judgment upon so much of the complaint as sought to recover upon the unpaid portion of claims for services, rendered in 2009, billed under CPT codes 97810 and 97811, and granted the branches of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the unpaid portion of those claims.
Contrary to plaintiff’s contention, the proof submitted by defendant in support of its motion was sufficient to give rise to a presumption that the denial of claim forms had been timely [*2]mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). Defendant further demonstrated that it had fully paid plaintiff for the services at issue in accordance with the workers’ compensation fee schedule for acupuncture services performed by chiropractors (see Great Wall Acupuncture, P.C. v Geico Ins. Co., 26 Misc 3d 23 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2009]). Consequently, defendant established its entitlement to judgment as a matter of law as to the services at issue.
Accordingly, the order, insofar as appealed from, is affirmed.
ALIOTTA, P.J., ELLIOT and SIEGAL, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 6, 2020
Reported in New York Official Reports at Healing Art Acupuncture, P.C. v GEICO Ins. Co. (2020 NY Slip Op 51336(U))
| Healing Art Acupuncture, P.C. v GEICO Ins. Co. |
| 2020 NY Slip Op 51336(U) [69 Misc 3d 140(A)] |
| Decided on November 6, 2020 |
| 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 November 6, 2020
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : THOMAS P. ALIOTTA, P.J., DAVID ELLIOT, BERNICE D. SIEGAL, JJ
2018-2114 K C
against
GEICO Ins. Co., Respondent.
The Rybak Firm, PLLC (Damin J. Toell of counsel), for appellant. Law Office of Goldstein, Flecker & Hopkins (Lawrence J. Chanice of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Michael Gerstein, J.), entered August 9, 2018. The order denied plaintiff’s motion for summary judgment and granted defendant’s cross 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 moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint, arguing that it had properly used the workers’ compensation fee schedule applicable to chiropractors who render the same services as acupuncturists to reimburse plaintiff for the acupuncture services plaintiff had rendered. The Civil Court denied plaintiff’s motion and granted defendant’s cross motion.
For the reasons stated in Flushing Traditional Acupuncture, P.C., as Assignee of Thomas, Latecia v GEICO Ins. Co. (___ Misc 3d ___, 2020 NY Slip Op _____ [appeal No. 2018-2154 K C], decided herewith), the order is affirmed.
ALIOTTA, P.J., ELLIOT and SIEGAL, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 6, 2020
Reported in New York Official Reports at ABC Physical Therapy, P.C. v GEICO Ins. Co. (2020 NY Slip Op 51335(U))
| ABC Physical Therapy, P.C. v GEICO Ins. Co. |
| 2020 NY Slip Op 51335(U) [69 Misc 3d 140(A)] |
| Decided on November 6, 2020 |
| 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 November 6, 2020
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : THOMAS P. ALIOTTA, P.J., DAVID ELLIOT, BERNICE D. SIEGAL, JJ
2018-2105 K C
against
GEICO Ins. Co., Respondent.
The Rybak Firm, PLLC (Damin J. Toell of counsel), for appellant. Rivkin Radler, LLP (Stuart M. Bodoff of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Michael Gerstein, J.), entered September 5, 2018. 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 modified by providing that the branch of defendant’s motion seeking summary judgment dismissing the first cause of action is denied; as so modified, the order is affirmed, without costs.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court which granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross motion for summary judgment.
For the reasons stated in NL Quality Med., P.C., as Assignee of Munno, Daniel v GEICO Ins. Co. (___ Misc 3d ___, 2020 NY Slip Op _____ [appeal No. 2018-2283 K C], decided herewith), the order is modified by providing that the branch of defendant’s motion seeking summary judgment dismissing the first cause of action is denied.
ALIOTTA, P.J., ELLIOT and SIEGAL, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 6, 2020
Reported in New York Official Reports at Lacina v Hereford Ins. Co. (2020 NY Slip Op 51333(U))
| Lacina v Hereford Ins. Co. |
| 2020 NY Slip Op 51333(U) [69 Misc 3d 139(A)] |
| Decided on November 6, 2020 |
| 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 November 6, 2020
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : THOMAS P. ALIOTTA, P.J., DAVID ELLIOT, BERNICE D. SIEGAL, JJ
2018-2040 K C
against
Hereford Insurance Co., Respondent.
The Rybak Firm, PLLC (Damin J. Toell of counsel), for appellant. Goldberg, Miller & Rubin, P.C. (Timothy Bishop of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Michael Gerstein, J.), entered August 10, 2018. The order denied plaintiff’s motion for summary judgment and granted defendant’s cross 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 of the Civil Court which denied plaintiff’s motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint.
Contrary to plaintiff’s contention on appeal, the affidavit executed by defendant’s no-fault supervisor and the contemporaneous affidavits executed by defendant’s mailing officer were sufficient to establish the proper mailing of the denial of claim forms (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]).
Accordingly, the order is affirmed.
ALIOTTA, P.J., ELLIOT and SIEGAL, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 6, 2020
Reported in New York Official Reports at Alpine Chiropractic, P.C. v Integon Natl. Ins. Co. (2020 NY Slip Op 51332(U))
| Alpine Chiropractic, P.C. v Integon Natl. Ins. Co. |
| 2020 NY Slip Op 51332(U) [69 Misc 3d 139(A)] |
| Decided on November 6, 2020 |
| 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 November 6, 2020
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : THOMAS P. ALIOTTA, P.J., DAVID ELLIOT, BERNICE D. SIEGAL, JJ
2018-2014 K C
against
Integon National Ins. Co., Appellant.
Law Offices of Moira Doherty, P.C. (Maureen Knodel of counsel), for appellant. Kopelevich & Feldsherova, P.C. (David Landfair of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Sharon Bourne-Clarke, J.), entered August 14, 2018. The order denied defendant’s motion for summary judgment dismissing the complaint.
ORDERED that the order 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 appeals from an order of the Civil Court denying defendant’s motion which had sought summary judgment dismissing the complaint on the ground that plaintiff’s assignor failed to appear for duly scheduled independent medical examinations (IMEs) and examinations under oath (EUOs).
Defendant established that initial and follow-up letters scheduling IMEs had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]); that plaintiff’s assignor failed to appear on the scheduled dates (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]); and that the claims had been timely denied on that ground (see St. Vincent’s Hosp. of Richmond, 50 AD3d 1123; Greenway Med. Supply Corp. v Travelers Ins. Co., 58 Misc 3d 131[A], 2017 NY Slip Op 51765[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2017]). As plaintiff failed to raise a triable issue of fact in opposition to defendant’s motion (see 11 NYCRR 65-3.8 [h]), defendant is entitled to summary judgment dismissing the complaint and we need not reach defendant’s contention regarding plaintiff’s assignor’s failure to appear for duly scheduled EUOs.
Accordingly, the order is reversed and defendant’s motion for summary judgment dismissing the complaint is granted.
ALIOTTA, P.J., ELLIOT and SIEGAL, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 6, 2020
Reported in New York Official Reports at EA Chiropractic Diagnostics, P.C. v GEICO Ins. (2020 NY Slip Op 51331(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
GEICO Insurance, Appellant.
Rivkin Radler, LLP (Stuart M. Bodoff of counsel), for appellant. Zara Javakov, P.C. (Zara Javakov of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Odessa Kennedy, J.), entered September 12, 2018. The order, insofar as appealed from, denied defendant’s cross motion for summary judgment dismissing the complaint.
ORDERED that the order, insofar as appealed from, is modified by providing that the branch of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon a claim for services rendered from May 19, 2016 through May 25, 2016 is granted; 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 appeals from so much of an order of the Civil Court as denied defendant’s cross motion which had sought summary judgment dismissing the complaint on the grounds that plaintiff had failed to appear for duly scheduled examinations under oath (EUOs) and that plaintiff’s assignor had failed to appear for duly scheduled independent medical examinations (IMEs).
In support of the branch of its cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon a claim for services rendered from May 19, 2016 through May 25, 2016, defendant submitted an affidavit by the general manager of Empire Stat Med Review, P.C., which had been retained by defendant to schedule IMEs, which affidavit sufficiently established that the IME scheduling letters had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). Defendant also established that the assignor failed to appear for the duly scheduled IMEs (see Stephen Fogel [*2]Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]). Thus, defendant demonstrated that plaintiff failed to comply with a condition precedent to coverage (id. at 722). As defendant’s cross motion further established that defendant timely denied (see St. Vincent’s Hosp. of Richmond, 50 AD3d 1123) the claim on that ground, and plaintiff failed to raise a triable issue of fact in opposition to this branch of defendant’s cross motion, the branch of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon a claim for services rendered from May 19, 2016 through May 25, 2016 should have been granted.
Contrary to defendant’s contention, defendant’s cross motion failed to establish that defendant had timely denied the remaining claims at issue after plaintiff allegedly failed to appear at both an initial and a follow-up EUO. As defendant did not demonstrate that it is not precluded from raising this proffered defense (see Westchester Med. Ctr. v Lincoln Gen. Ins. Co., 60 AD3d 1045 [2009]), defendant is not entitled to summary judgment upon the branch of its cross motion seeking summary judgment dismissing the remaining portion of the complaint.
Accordingly, the order, insofar as appealed from, is modified by providing that the branch of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon a claim for services rendered from May 19, 2016 through May 25, 2016 is granted.
ALIOTTA, P.J., ELLIOT and SIEGAL, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 6, 2020
Reported in New York Official Reports at Lenex Servs., Inc. v American Tr. Ins. Co. (2020 NY Slip Op 51330(U))
| Lenex Servs., Inc. v American Tr. Ins. Co. |
| 2020 NY Slip Op 51330(U) [69 Misc 3d 139(A)] |
| Decided on November 6, 2020 |
| 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 November 6, 2020
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : THOMAS P. ALIOTTA, P.J., DAVID ELLIOT, BERNICE D. SIEGAL, JJ
2018-1972 K C
against
American Transit Insurance Company, Respondent.
Zara Javakov, P.C. (Zara Javakov of counsel), for appellant. Law Office of Daniel J. Tucker (Daniel Sullivan of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Michael Gerstein, J.), entered August 7, 2018. The order, insofar as appealed from, granted the branches of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims for services rendered to Love Olatunjiojo, Cathy Gaymon, Delia Morales, Antoinette Affoon, and Oscar Collaguazo Salinas.
ORDERED that the appeal is dismissed.
In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint. By order entered August 7, 2018, the Civil Court granted the branches of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims for services rendered to Love Olatunjiojo, Cathy Gaymon, Delia Morales, Antoinette Affoon, and Oscar Collaguazo Salinas.
Plaintiff did not submit any papers in opposition to defendant’s motion giving rise to the August 7, 2018 order (see CPLR 2219 [a]; Matter of Dondi, 63 NY2d 331, 339 [1984]), and the order does not recite the substance of plaintiff’s arguments, if any, made at oral argument. In these circumstances, the order, insofar as appealed from, cannot be reviewed on direct appeal (see Benitez v Olson, 29 AD3d 503 [2006]; Viggiani v Grodotzke, 306 AD2d 273 [2003]; see also M & C Bros., Inc. v Torum, 75 AD3d 869 [2010]; cf. Matter of 144 Stuyvesant, LLC v Goncalves, 119 AD3d 695 [2014]). Plaintiff’s remedy, if it be so advised, is to move in the Civil Court to vacate the order.
Accordingly, the appeal is dismissed.
ALIOTTA, P.J., ELLIOT and SIEGAL, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 6, 2020
Reported in New York Official Reports at Lacina v Hereford Ins. Co. (2020 NY Slip Op 51329(U))
| Lacina v Hereford Ins. Co. |
| 2020 NY Slip Op 51329(U) [69 Misc 3d 139(A)] |
| Decided on November 6, 2020 |
| 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 November 6, 2020
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : THOMAS P. ALIOTTA, P.J., DAVID ELLIOT, BERNICE D. SIEGAL, JJ
2018-1848 K C
against
Hereford Insurance Co., Respondent.
The Rybak Firm, PLLC (Damin J. Toell of counsel), for appellant. Goldberg, Miller & Rubin, P.C. (Timothy Bishop of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Lorna J. McAllister, J.), entered August 3, 2018. The order denied plaintiff’s motion for summary judgment and granted defendant’s cross 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 of the Civil Court which denied its motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint.
Contrary to plaintiff’s contention, the affidavits by an employee of Media Referral, Inc., which had been retained by defendant to schedule independent medical examinations (IMEs), which affidavits were executed the same date the IME scheduling letters were mailed, sufficiently established that the IME scheduling letters had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). Defendant also submitted an affidavit from the medical provider who was to perform the IMEs, which sufficiently established that plaintiff’s assignor had failed to appear for those duly scheduled IMEs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]). In addition, an affidavit executed by defendant’s claims examiner demonstrated that the denial of claim form, which denied the claim based on plaintiff’s assignor’s nonappearance at the IMEs, had been timely mailed (see St. Vincent’s Hosp. of Richmond, 50 AD3d 1123). As plaintiff’s remaining contentions lack merit, the Civil Court properly denied plaintiff’s motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint.
Accordingly, the order is affirmed.
ALIOTTA, P.J., ELLIOT and SIEGAL, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 6, 2020
Reported in New York Official Reports at Domny Med. Servs., P.C. v Travelers Ins. Co. (2020 NY Slip Op 51328(U))
| Domny Med. Servs., P.C. v Travelers Ins. Co. |
| 2020 NY Slip Op 51328(U) [69 Misc 3d 139(A)] |
| Decided on November 6, 2020 |
| 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 November 6, 2020
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : THOMAS P. ALIOTTA, P.J., DAVID ELLIOT, BERNICE D. SIEGAL, JJ
2018-1758 K C
against
Travelers Insurance Company, Respondent.
The Rybak Firm, PLLC (Damin J. Toell of counsel), for appellant. Law Office of Aloy O. Ibuzor (Gregory W. Broido of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Rosemarie Montalbano, J.), entered June 21, 2018. 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 which granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross motion for summary judgment.
Contrary to plaintiff’s contentions on appeal, the record was sufficient to establish the proper mailing of the examination under oath scheduling letters to plaintiff’s assignor and the denial of claim forms to plaintiff (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]).
Accordingly, the order is affirmed.
ALIOTTA, P.J., ELLIOT and SIEGAL, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 6, 2020
Reported in New York Official Reports at First Care Med. Equip., LLC v Kemper Ins. Co. (2020 NY Slip Op 51326(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
Kemper Insurance Company, Appellant.
Goldber, Miller & Rubin, P.C. (Timothy Bishop of counsel), for appellant. The Rybak Firm, PLLC (Damin J. Toell of counsel), for respondent.
Appeal from a judgment of the Civil Court of the City of New York, Kings County (Joy F. Campanelli, J.), entered April 23, 2018. The judgment, insofar as appealed from as limited by the brief, entered pursuant to so much of an order of that court entered February 9, 2018 as granted the branch of plaintiff’s motion seeking summary judgment upon the first cause of action, awarded plaintiff the principal sum of $2,523.37 upon the first cause of action.
ORDERED that the judgment, insofar as appealed from, is reversed, with $30 costs, so much of the order entered February 9, 2018 as granted the branch of plaintiff’s motion seeking summary judgment upon the first cause of action is vacated, and that branch of plaintiff’s motion is denied.
In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals, as limited by its brief, from so much of a judgment of the Civil Court entered April 23, 2018 as awarded plaintiff the principal sum of $2,523.37 upon the first cause of action, entered pursuant to so much of an order entered February 9, 2018 as granted the branch of plaintiff’s motion seeking summary judgment upon that cause of action.
Plaintiff failed to establish its prima facie entitlement to summary judgment upon the first cause of action, since plaintiff did not establish either that defendant failed to timely deny the claim at issue (see Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 25 NY3d 498 [2015]), or that defendant issued a timely denial of claim form that was conclusory, vague or without merit as a matter of law (see Westchester Med. Ctr. v Nationwide Mut. Ins. Co., 78 AD3d 1168 [2010]; Ave T MPC Corp. v Auto One Ins. Co., 32 Misc 3d 128[A], 2011 NY Slip [*2]Op 51292[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2011]). In any event, in opposition to the branch of plaintiff’s motion seeking summary judgment upon the first cause of action, defendant established the existence of a triable issue of fact as to whether the supplies allegedly furnished by plaintiff were medically necessary. We note that the non-substantive technical defect on the denial of claim form regarding the date the requested verification was received did not affect the validity of the denial of claim form (see 11 NYCRR 65-3.8 [h]). Therefore, the branch of plaintiff’s motion seeking summary judgment upon the first cause of action should have been denied.
Accordingly, the judgment, insofar as appealed from, is reversed, so much of the order entered February 9, 2018 as granted the branch of plaintiff’s motion seeking summary judgment upon the first cause of action is vacated, and that branch of plaintiff’s motion is denied.
ALIOTTA, P.J., ELLIOT and SIEGAL, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 6, 2020