June 29, 2006

Bronx Expert Radiology, P.C. v Travelers Ins. Co. (2006 NY Slip Op 51227(U))

Headnote

The relevant facts of the case were that Bronx Expert Radiology, P.C. had filed a motion for summary judgment, as it believed that it had responded to Travelers Insurance Co.'s verification request. However, the affidavit of plaintiff's representative did not create a presumption of mailing, as it did not state that the verifications were actually mailed to the defendant, nor did it describe the plaintiff's mailing office practice and procedures. The main issue was whether the insurer was obligated to pay or deny a claim before receiving verification of all relevant information requested. The holding of the case was that the motion for summary judgment should have been denied, as the plaintiff's submission was insufficient to raise a presumption of receipt, and the matter was remanded to Civil Court for further proceedings.

Reported in New York Official Reports at Bronx Expert Radiology, P.C. v Travelers Ins. Co. (2006 NY Slip Op 51227(U))

Bronx Expert Radiology, P.C. v Travelers Ins. Co. (2006 NY Slip Op 51227(U)) [*1]

Bronx Expert Radiology, P.C. v Travelers Ins. Co.

2006 NY Slip Op 51227(U) [12 Misc 3d 135(A)]

Decided on June 29, 2006

Appellate Term, First 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This opinion is uncorrected and will not be published in the printed Official Reports.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 29, 2006

APPELLATE TERM OF THE SUPREME COURT, FIRST DEPARTMENT

PRESENT: DAVIS, J.P., GANGEL-JACOB, SCHOENFELD, JJ
570140/06.

Bronx Expert Radiology, P.C., a/a/o Ivalesse Hinton, Plaintiff-Respondent,
against
Travelers Insurance Co., Defendant-Appellant.

Defendant appeals from an order of the Civil Court, Bronx County (Francis M. Alessandro, J.), entered January 17, 2006, which granted plaintiff’s motion for summary judgment.

PER CURIAM:

Order (Francis M. Alessandro, J.), entered January 17, 2006), reversed, with $10 costs, motion denied, and matter remanded to Civil Court for further proceedings.

An insurer is not obligated to pay or deny a claim until it has received verification of all relevant information requested (see 11 NYCRR 65.15[g][1][I]; 2[iii]; Elite Chiropractic Servs., PC v Travelers Ins. Co., 9 Misc 3d 137[A], 2005 NY Slip Op. 51735[U] [2005]). While plaintiff states that it responded to defendant’s verification request, no presumption of mailing was created because the affidavit of plaintiff’s representative neither stated that she actually mailed the verifications to defendant nor described plaintiff’s mailing office practice and procedures. Since plaintiff’s submission was insufficient to raise a presumption of receipt (see New York and Presbyterian Hospital v Allstate Ins. Co., AD3d [2006], 2006 NY Slip Op. 03558), its motion for summary judgment should have been denied.

This constitutes the decision and order of the court.
Decision Date: June 29, 2006