March 29, 2004

Mary Immaculate Hosp. v Allstate Ins. Co. (2004 NY Slip Op 02359)

Headnote

The main issue in this case was whether Mary Immaculate Hospital and two other hospitals, as assignees of certain insurance claimants, were entitled to recover no-fault medical payments under certain insurance contracts. The defendant, Allstate Insurance Company, appealed from a judgment in favor of the hospitals, which had been granted summary judgment on their first, fourth, fifth, and seventh causes of action. The defendant argued that the evidence provided by the plaintiff hospitals did not show their entitlement to judgment as a matter of law. However, the court found that the hospitals had made a prima facie showing of their entitlement by providing evidentiary proof that the statutory billing forms had been mailed and received, and that payment of no-fault benefits was overdue. The court also found that the defendant's submissions in opposition were insufficient to raise an issue of fact as to whether it timely issued a partial denial of the claim or paid the claim asserted by the hospitals. Therefore, the judgment in favor of the plaintiff hospitals was affirmed.

Reported in New York Official Reports at Mary Immaculate Hosp. v Allstate Ins. Co. (2004 NY Slip Op 02359)

Mary Immaculate Hosp. v Allstate Ins. Co.

2004 NY Slip Op 02359 [5 AD3d 742]

March 29, 2004

Appellate Division, Second Department

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

As corrected through Wednesday, November 10, 2004

Mary Immaculate Hospital et al., Respondents,
v
Allstate Insurance Company, Appellant.

—

In an action to recover no-fault medical payments under certain insurance contracts, the defendant appeals from so much of a judgment of the Supreme Court, Nassau County (Skelos, J.), dated April 7, 2003, which, upon granting those branches of the plaintiffs’ motion which were for summary judgment on their first, fourth, fifth, and seventh causes of action, is in favor of the plaintiff Mary Immaculate Hospital, as assignee of Lucretia Hall and Sosamma Johnkutty, and against it in the total sum of $124,035.43, in favor of the plaintiff New York United Hospital, as assignee of Jean A. Cudilio, and against it in the total sum of $6,633.33, and in favor of the plaintiff White Plains Hospital, as assignee of Rashid Chugstai, and against it in the total sum of $116.14.

Ordered that the judgment is affirmed insofar as appealed from, with costs.

Contrary to the defendant’s contention, the plaintiff hospitals made a prima facie showing of their entitlement to judgment as a matter of law by submitting evidentiary proof that the prescribed statutory billing forms had been mailed and received, and that payment of no-fault benefits was overdue (see Insurance Law § 5106 [a]; 11 NYCRR 65.15 [g] [3]; St. Luke’s Roosevelt Hosp. v American Tr. Ins. Co., 1 AD3d 498 [2003]; St. Luke’s Roosevelt Hosp. v Allstate Ins. Co., 303 AD2d 743 [2003]; New York & Presbyt. Hosp. v Allstate Ins. Co., 295 AD2d 412 [2002]; see also Matter of Pradip Das/N.Y. Med. Rehab v Allstate Ins. Co., 297 AD2d 321 [2002]). Furthermore, the defendant’s submissions in opposition were insufficient to raise an issue of fact as to whether it timely issued a partial denial of the claim asserted by the plaintiff Mary Immaculate Hospital, as assignee of Lucretia Hall, or paid the claim asserted by the plaintiff New York United Hospital, as assignee of Jean A. Cudilio. Santucci, J.P., Krausman, Luciano and Townes, JJ., concur.