June 6, 2016

Island Life Chiropractic, P.C. v National Liab. & Fire Ins. Co. (2016 NY Slip Op 50927(U))

https://www.beynensonlaw.com/case-law/island-life-chiropractic-p-c-v-national-liab-fire-ins-co-2016-ny-slipop-50927u/

Court: Appellate Term, Second Department
Decided: June 6, 2016
Citation: 2016 NY Slip Op 50927(U) · 52 Misc 3d 129(A)
Posture: Summary judgment
Outcome: Split result
Issues: Verification requests
Legal questions: Outstanding verification and premature actions (see the maps)

Cite as

Island Life Chiropractic, P.C. v National Liab. & Fire Ins. Co., 52 Misc 3d 129(A), 2016 NY Slip Op 50927(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2016)

Posture, outcome, issues and treatment by other decisions are Beynenson Law’s classification. Treatment labels are assigned by a language model reading the citing decision; negative and appeal-history labels are checked by a second reader.

Summary

Editorial summary by Beynenson Law, not part of the court’s decision.

The insurer's summary judgment cross motion asserting prematurity for failure to provide requested verification was denied on appeal. The Appellate Term, Second Department, modified the order to deny the cross motion, leaving denial of the provider's motion intact, for the reasons stated in the companion appeal decided the same day, Great Health Care Chiropractic, P.C. v Hereford Ins. Co., No. 2013-1720 Q C.

Reported in New York Official Reports at Island Life Chiropractic, P.C. v National Liab. & Fire Ins. Co. (2016 NY Slip Op 50927(U))

[*1]

Island Life Chiropractic, P.C. v National Liab. & Fire Ins. Co.

2016 NY Slip Op 50927(U) [52 Misc 3d 129(A)]

Decided on June 6, 2016

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This opinion is uncorrected and will not be published in the printed Official Reports.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 June 6, 2016

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-2326 Q C

Island Life Chiropractic, P.C., as Assignee of PATRICK JOSEPH, Appellant,
against
National Liability & Fire Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Cheree A. Buggs, J.), entered September 9, 2013. 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 modified by providing that defendant’s cross motion for summary judgment dismissing the complaint 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 moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint on the ground that the action was premature because plaintiff had failed to provide requested verification. By order entered September 9, 2013, the Civil Court denied plaintiff’s motion and granted defendant’s cross motion.

For the reasons stated in Great Health Care Chiropractic, P.C., as Assignee of Carlos Thomas v Hereford Ins. Co. (___ Misc 3d ___, 2016 NY Slip Op ___ [appeal No. 2013-1720 Q C], decided herewith), the order is modified by providing that defendant’s cross motion for summary judgment dismissing the complaint is denied.

Pesce, P.J., Aliotta and Solomon, JJ., concur.

Decision Date: June 06, 2016

Legal questions

A question of no-fault law this decision rules on, from our Legal Questions pages. Bars count the decisions on the question by year and court, coloured by category; circles are this decision and the decisions on the question it cites or that cite it. Point at a bar or circle for details. The categories and summaries are Beynenson Law’s classification, made by a language model and checked by a second reading.

Outstanding verification and premature actions

Open the full map

Did unanswered verification requests make the provider’s claim premature, or justify denying it for nonresponse?

This decision: Fact issues remain on whether the verification defense applies

Denied the insurer's cross motion to dismiss the action as premature for unanswered verification requests, for the reasons stated in a companion decision, while leaving the denial of the provider's motion in place.

Premature: verification outstandingNonresponse denial upheldTriable issueInsurer's showing failsProvider compliedThis decision

Of the 385 decisions on this question in the Second Department courts and the Court of Appeals, 114 (this one included) are in the same category.

Similar decisions

Island Life Chiropractic, P.C. v American Tr. Ins. Co. (2016 NY Slip Op 51541(U))The insurer's cross motion for summary judgment dismissing the provider's claims as premature for outstanding verification was denied on appeal.
Island Life Chiropractic, P.C. v Travelers Ins. Co. (2016 NY Slip Op 51413(U))The provider's mailing affidavit raised a factual issue whether the insurer received requested verification, precluding dismissal as premature.
Great Health Care Chiropractic, P.C. v Hereford Ins. Co. (2016 NY Slip Op 50910(U))The provider's owner's affidavit raised a factual issue as to receipt of requested verification and whether the action was premature.
Island Chiropractic Testing, P.C. v Praetorian Ins. Co. (2014 NY Slip Op 51795(U))The provider's verification responses presented a factual dispute that precluded summary judgment for either party.
Island Life Chiropractic, P.C. v 21st Century Ins. Co. (2017 NY Slip Op 51824(U))The provider failed to establish that its claims were denied late or that timely denials were conclusory, vague or legally meritless.