February 2, 2005

SZ Med. P.C. v State-Wide Ins. Co. (2005 NY Slip Op 50103(U))

Headnote

The court considered the evidence submitted by the plaintiffs, including claim forms and medical reports, in a case to recover assigned first-party no-fault benefits. The main issue decided was whether the plaintiffs had established a prima facie entitlement to summary judgment by proving that payment of the benefits was overdue. The court held that in order to establish that payment on the claims was overdue, the plaintiffs had to demonstrate that the 30 calendar days had elapsed from the time the insurer received proof of the claim. Since there was no evidence as to when the claim forms were submitted to the defendant and the defendant's letters did not specify which claims were received, the court found that the plaintiffs were unable to establish whether payments on any of the claims were overdue. Therefore, the plaintiffs' motion for summary judgment was properly denied.

Reported in New York Official Reports at SZ Med. P.C. v State-Wide Ins. Co. (2005 NY Slip Op 50103(U))

SZ Med. P.C. v State-Wide Ins. Co. (2005 NY Slip Op 50103(U)) [*1]

SZ Med. P.C. v State-Wide Ins. Co.

2005 NY Slip Op 50103(U)

Decided on February 2, 2005

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This opinion is uncorrected and will not be published in the printed Official Reports.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 February 2, 2005

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 2nd and 11th JUDICIAL DISTRICTS

PRESENT: February 2, 2005 SUPREME COURT OF THE STATE OF NEW YORK APPELLATE TERM : 2nd and 11th JUDICIAL DISTRICTS PRESENT : PESCE, P.J., PATTERSON and RIOS, JJ.
2004-388 Q C

SZ MEDICAL P.C. LIFE CHIROPRACTIC P.C. DANIEL KIM’S ACUPUNCTURE P.C. a/a/o Monica Campbell Eleanor Dawkins, Appellants,
against
STATE-WIDE INSURANCE COMPANY, Respondent.

Appeal by plaintiffs from an order of the Civil Court, Queens County (J. Golia, J.), entered June 10, 2003, denying their motion for summary judgment.

Order unanimously affirmed without costs.

In this action to recover assigned first-party no-fault benefits, plaintiffs’ motion for summary judgment was supported by the affidavit of Janet Safir, “the practice and billing manager of each plaintiff company,” who averred that she submitted to defendant
the “claim forms and medical reports” which were annexed to the motion papers. There was, however, no allegation in the affidavit as to when the fifteen annexed claim forms were submitted. A plaintiff establishes a prima facie entitlement to summary judgment by offering evidentiary proof that it submitted statutory claim forms setting forth the fact and the amount of the loss sustained, and that payment of no-fault benefits was overdue (see Insurance Law § 5106; Mary Immaculate Hosp. v Allstate Ins. Co., 5 AD3d 742 [2004]). No-fault benefits are overdue if not paid within 30 calendar days after the insurer receives proof of claim, which includes verification of all relevant information requested (see 11 NYCRR 65.15 [g] [1], now 11 NYCRR [*2]65-3.8 [a] [1]). In the instant case, in order to establish that payment on the claims being sued upon was overdue, plaintiffs had to demonstrate that the requisite 30 calendar days had elapsed, which they sought to do by relying upon defendant’s letters, dated February 13, 2002, acknowledging receipt of claims, but not specifying the particular claims received. In the absence of any evidence as to when plaintiffs submitted their claim forms to defendant, and in the absence of any specification in defendant’s letters of February 13, 2002 as to which claims it had received prior thereto, plaintiffs were unable to establish whether payments as to all, or even any, of the claims being sued upon [*3]
were overdue. Accordingly, having failed to make a prima facie showing of entitlement to judgment as a matter of law, plaintiffs’ motion for summary judgment was properly denied by the court below.
Decision Date: February 02, 2005