December 17, 2014

Skymed Med., P.C. v Tri-State Consumer Ins. (2014 NY Slip Op 51833(U))

Headnote

The court considered the fact that the defendant had timely mailed requests and follow-up requests for verification related to the claim at issue, but had not received the requested verification from the plaintiff. The main issue decided was whether the 30-day period within which the defendant was required to pay or deny the claims began to run. The holding of the case was that the defendant had not received the requested verification, and the plaintiff did not show that the verification had been provided to the defendant prior to the commencement of the action, making the plaintiff's action premature. As a result, the court reversed the order and granted the defendant's motion for summary judgment dismissing the complaint.

Reported in New York Official Reports at Skymed Med., P.C. v Tri-State Consumer Ins. (2014 NY Slip Op 51833(U))

Skymed Med., P.C. v Tri-State Consumer Ins. (2014 NY Slip Op 51833(U)) [*1]

Skymed Med., P.C. v Tri-State Consumer Ins.

2014 NY Slip Op 51833(U) [46 Misc 3d 132(A)]

Decided on December 17, 2014

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This opinion is uncorrected and will not be published in the printed Official Reports.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 December 17, 2014

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

PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2012-2229 Q C

Skymed Medical, P.C. as Assignee of CYNTHIA SANTA-ANA, Respondent,
against
Tri-State Consumer Insurance, Appellant.

Appeal from an order of the Civil Court of the City of New York, Queens County (Jodi Orlow, J.), entered July 11, 2012. 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 which denied defendant’s motion for summary judgment dismissing the complaint.

The affidavits submitted by defendant in support of its motion established that defendant had timely mailed requests and follow-up requests for verification related to the claim at issue (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]). Defendant demonstrated that it had not received the requested verification, and plaintiff did not show that the verification had been provided to defendant prior to the commencement of the action. Consequently, the 30-day period within which defendant was required to pay or deny the claims did not begin to run (see 11 NYCRR 65-3.8 [a]; Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492 [2005]; Hospital for Joint Diseases v State Farm Mut. Auto. Ins. Co., 8 AD3d 533 [2004]; D & R Med. Supply v American Tr. Ins. Co., 32 Misc 3d 144[A], 2011 NY Slip Op 51727[U] [App Term, 2d, 11th & 13th Jud Dists 2011]), and, thus, plaintiff’s action is premature.

Accordingly, the order is reversed and defendant’s motion for summary judgment dismissing the complaint is granted.

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

Decision Date: December 17, 2014