July 10, 2008
North N.Y. Med. Care, P.C. v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 51557(U))
Headnote
Reported in New York Official Reports at North N.Y. Med. Care, P.C. v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 51557(U))
| North N.Y. Med. Care, P.C. v New York Cent. Mut. Fire Ins. Co. |
| 2008 NY Slip Op 51557(U) [20 Misc 3d 138(A)] |
| Decided on July 10, 2008 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports. |
SUPREME COURT OF THE STATE OF NEW YORK
APPELLATE TERM: 9th and 10th JUDICIAL DISTRICTS
PRESENT: : RUDOLPH, P.J., McCABE and SCHEINKMAN, JJ
2007-992 N C.
against
New York Central Mutual Fire Insurance Company, Respondent.
Appeal from an order of the District Court of Nassau County, Third District (Norman Janowitz, J.), dated May 14, 2007. The order, insofar as appealed from, denied plaintiff’s motion for summary judgment as to the sum of $1,937.58, representing an unpaid balance of a February 15, 2001 no-fault insurance claim.
Order, insofar as appealed from, reversed without costs, plaintiff’s motion for summary judgment upon the $1,937.58 unpaid portion of its claim dated February 15, 2001 granted and matter remanded to the court below for the calculation of statutory interest and an assessment of attorney’s fees thereon.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment. Insofar as is relevant to this appeal, the court below denied plaintiff’s motion for summary judgment upon the unpaid $1,937.58 balance of its NF-3 claim form dated February 15, 2001 on the ground that defendant raised an issue of fact as to medical necessity. This appeal by plaintiff ensued.
An insurance carrier is required to either pay or deny a claim for no-fault benefits within 30 days of the date the insurer receives the proof of claim (see Insurance Department Regulations [11 NYCRR] § 65.15 [g] [3], now Insurance Department Regulations [11 NYCRR] § 65-3.8; Presbyterian Hosp. in City of N.Y. v Maryland Cas. Co., 90 NY2d 274 [1997]). Insurance [*2]Department Regulations (11 NYCRR) § 65.15 (d) (2) provides that additional verification required by an insurer is to be requested within 10 business days of receipt of a prescribed claim form. Where, as here, defendant requested additional verification 12 business days after receiving plaintiff’s NF-3 claim form, the 30-day period within which defendant was required to pay or deny plaintiff’s claim was correspondingly reduced to 28 days (Insurance Department Regulations [11 NYCRR] § 65.15 [g] [10], now Insurance Department Regulations [11 NYCRR] § 65-3.8 [j]; see Hospital for Joint Diseases v Travelers Prop. Cas. Ins. Co., 9 NY3d 312, 318 [2007]). Since defendant concedes that it received the requested verification on May 16, 2001, defendant was required to pay or deny the claim at issue on or before June 13, 2001. As defendant did not deny plaintiff’s claim until June 14, 2001, defendant’s denial of plaintiff’s claim was untimely and defendant is precluded from raising its proffered defense of lack of medical necessity (see Presbyterian Hosp. in City of N.Y. v Maryland Cas. Co., 90 NY2d 274 [1997], supra).
Accordingly, plaintiff was entitled to summary judgment upon the $1,937.58 unpaid portion of its claim dated February 15, 2001, and the matter is remanded to the court below for the calculation of statutory interest and an assessment of attorney’s fees thereon pursuant to Insurance Law § 5106 (a) and the regulations promulgated thereunder.
Rudolph, P.J., McCabe and Scheinkman, JJ., concur.
Decision Date: July 10, 2008