December 21, 2012

Brooklyn Hgts. Physical Therapy, P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 52398(U))

Headnote

The court considered whether the defendant was entitled to summary judgment dismissing the complaint and whether the plaintiff was entitled to summary judgment. The main issue was whether the defendant established its entitlement to summary judgment by proving the timely mailing of the NF-10 denial of claim forms at issue. The holding was that the defendant failed to establish its entitlement to summary judgment because the affidavit of the defendant's litigation examiner was insufficient to establish the timely mailing of the NF-10 denial of claim forms. As a result, the plaintiff also failed to establish its entitlement to summary judgment with respect to its claims for $1,180, $550.44, $780.98, and $489.28. Therefore, the court denied the branches of the plaintiff's cross motion seeking summary judgment with respect to those claims.

Reported in New York Official Reports at Brooklyn Hgts. Physical Therapy, P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 52398(U))

Brooklyn Hgts. Physical Therapy, P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 52398(U)) [*1]

Brooklyn Hgts. Physical Therapy, P.C. v New York Cent. Mut. Fire Ins. Co.

2012 NY Slip Op 52398(U) [38 Misc 3d 129(A)]

Decided on December 21, 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This opinion is uncorrected and will not be published in the printed Official Reports.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

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

PRESENT: : PESCE, P.J., WESTON and RIOS, JJ
2010-1887 K C.

against
Brooklyn Heights Physical Therapy, P.C. as Assignee of RAYMOND BONE, Respondent, New York Central Mutual Fire Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Genine D. Edwards, J.), entered September 24, 2009. The order denied defendant’s motion for summary judgment dismissing the complaint and granted plaintiff’s cross motion for summary judgment. The appeal from the order entered September 24, 2009 brings up for review so much of an order of the same court entered September 2, 2010 as, upon granting the branch of defendant’s motion seeking leave to reargue defendant’s prior motion for summary judgment dismissing the complaint and plaintiff’s prior cross motion for summary judgment, adhered to the portions of the prior order which denied defendant’s prior motion and granted the branches of plaintiff’s prior cross motion seeking summary judgment with respect to so much of the complaint as sought to recover upon claims for $1,180, $550.44, $780.98, and $489.28 (see CPLR 5517 [b]).

ORDERED that the appeal from the order entered September 24, 2009 is dismissed, as that order was superseded by the order entered September 2, 2010, made upon reargument; and it is further,

ORDERED that the order entered September 2, 2010, insofar as reviewed, is modified by [*2]providing that, upon reargument, the branches of plaintiff’s cross motion seeking summary judgment with respect to so much of the complaint as sought to recover upon claims for $1,180, $550.44, $780.98, and $489.28 are denied; as so modified, the order entered September 2, 2010, insofar as reviewed, is affirmed, without costs.

Plaintiff commenced this action to recover assigned first-party no-fault benefits and asserted seven causes of action seeking to recover upon claims for $1,180, $550.44, $780.98, $489.28, $305.80, $183.48, and $122.32, respectively. Defendant moved for summary judgment dismissing the complaint, and plaintiff cross-moved for summary judgment. The Civil Court, by order entered September 24, 2009, denied defendant’s motion and granted plaintiff’s cross motion. Thereafter, defendant moved for leave to reargue. By order entered September 2, 2010, the Civil Court granted reargument and, upon reargument, adhered to so much of the prior order as denied defendant’s motion for summary judgment dismissing the complaint and granted the branches of plaintiff’s cross motion seeking summary judgment with respect to so much of the complaint as sought to recover upon claims for $1,180, $550.44, $780.98, and $489.28.

The affidavit of defendant’s litigation examiner was insufficient to establish timely mailing of the NF-10 denial of claim forms 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]). Consequently, defendant failed to establish its entitlement to summary judgment dismissing the complaint.

A no-fault provider establishes its prima facie entitlement to summary judgment by proof of the submission to the defendant of a claim form, proof of the fact and the amount of the loss sustained, and proof either that the defendant had failed to pay or deny the claim within the requisite 30-day period, or that the defendant had issued a timely denial of claim that was conclusory, vague or without merit as a matter of law (see Insurance Law § 5106 [a]; Westchester Med. Ctr. v Nationwide Mut. Ins. Co., 78 AD3d 1168 [2010]; Avenue T MPC Corp. v Auto One Ins. Co., 33 Misc 3d 128[A], 2011 NY Slip Op 51292[U] [App Term, 2d, 11th & 13th Jud Dists 2011]). Inasmuch as plaintiff failed to demonstrate that defendant had untimely denied the claims or that defendant had issued NF-10 denial of claim forms which were conclusory, vague or without merit as a matter of law, plaintiff failed to established its prima facie entitlement to summary judgment with respect to its claims for $1,180, $550.44, $780.98, and $489.28.

Accordingly, the order entered September 2, 2010, insofar as reviewed, is modified by providing that, upon reargument, the branches of plaintiff’s cross motion seeking summary judgment with respect to so much of the complaint as sought to recover upon claims for $1,180, $550.44, $780.98, and $489.28 are denied.

Pesce, P.J., Weston and Rios, JJ., concur.

Decision Date: December 21, 2012