August 23, 2012

Quality Health Prods. v Country-Wide Ins. Co. (2012 NY Slip Op 51641(U))

Headnote

The court considered the fact that the defendant had timely mailed the initial and follow-up requests for verification to the plaintiff, but had not received the requested verification. As a result, the 30-day period within which the defendant was required to pay or deny the claims did not begin to run and the plaintiff's action was found to be premature. The main issue decided was whether the defendant's failure to receive the requested verification prior to the commencement of the action justified the denial of plaintiff's motion for summary judgment and the granting of defendant's cross motion for summary judgment dismissing the complaint. The holding was that the order denying plaintiff's motion for summary judgment and granting defendant's cross motion for summary judgment dismissing the complaint was affirmed.

Reported in New York Official Reports at Quality Health Prods. v Country-Wide Ins. Co. (2012 NY Slip Op 51641(U))

Quality Health Prods. v Country-Wide Ins. Co. (2012 NY Slip Op 51641(U)) [*1]

Quality Health Prods. v Country-Wide Ins. Co.

2012 NY Slip Op 51641(U) [36 Misc 3d 148(A)]

Decided on August 23, 2012

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This opinion is uncorrected and will not be published in the printed Official Reports.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 August 23, 2012

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

PRESENT: : PESCE, P.J., WESTON and RIOS, JJ
2010-1784 K C.

Quality Health Products as Assignee of BETH McCULLOUGH, Appellant, —
against
Country-wide Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Kenneth P. Sherman, J.), entered November 23, 2009. 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, 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 denied plaintiff’s motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint.

The affidavit of defendant’s litigation supervisor established that defendant had timely mailed (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]) its initial and follow-up requests for verification to plaintiff (see Insurance Department Regulations [11 NYCRR] §§ 65-3.5 [b]; 65-3.6 [b]). 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 and plaintiff’s action is premature (see Insurance Department Regulations [*2][11 NYCRR] § 65-3.8 [a]; Hospital for Joint Diseases v New York Cent. Mut. Fire Ins. Co., 44 AD3d 903 [2007]; Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492 [2005]).

Accordingly, the order is affirmed.

Pesce, P.J., Weston and Rios, JJ., concur.
Decision Date: August 23, 2012