March 29, 2005

Doshi Diagnostic Imaging Servs. v Progressive Ins. Co. (2005 NY Slip Op 50416(U))

Headnote

The relevant facts that the court considered were that a medical provider submitted bills and an assignment of benefits form to an insurance company for medical services provided to someone involved in an automobile accident. The insurance company requested an additional assignment of benefits form, claiming that the original form was not properly executed. The main issue decided in the case was whether the medical provider had complied with the insurance company's request for additional verification, thus impacting the insurance company's time to pay or deny the claim. The holding of the case was that the medical provider failed to submit a properly executed assignment of benefits and did not comply with the insurance company's request for additional verification, therefore the insurance company's time to pay or deny the claim had not begun to run. As a result, the plaintiff's complaint was dismissed.

Reported in New York Official Reports at Doshi Diagnostic Imaging Servs. v Progressive Ins. Co. (2005 NY Slip Op 50416(U))

Doshi Diagnostic Imaging Servs. v Progressive Ins. Co. (2005 NY Slip Op 50416(U)) [*1]

Doshi Diagnostic Imaging Servs. v Progressive Ins. Co.

2005 NY Slip Op 50416(U)

Decided on March 29, 2005

District Court, Nassau County

Pardes, J.

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This opinion is uncorrected and will not be published in the printed Official Reports.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 March 29, 2005

District Court, Nassau County

Doshi Diagnostic Imaging Services, a/a/o Sami Rexhepi, Plaintiff(s),
against
Progressive Insurance Company, Defendant(s).

14015/04

Sondra K. Pardes, J.

The defendant’s motion and the plaintiff’s cross motion for summary judgment pursuant to CPLR 3212 are decided as follows.

FACTS OF THE CASE

This is an action for recovery of No-Fault Insurance benefits for medical services provided to the assignor in connection with an automobile accident that occurred on September 20, 2003. It is uncontroverted that the plaintiff medical provider provided medical services to the assignor and submitted bills for same, along with an assignment of benefits form dated October 25, 2003, to the defendant. The bills and Assignment of Benefits (“AOB”)form were received by the defendant on November 17, 2003. By letter dated November 19, 2003 the defendant requested that the plaintiff submit an AOB form signed by the plaintiff. The plaintiff forwarded a second AOB, (also dated October 25, 2003), which was received by the defendant on January 8, 2003. The defendant has not [*2]paid or denied the claim.

The defendant now moves for summary judgment on the grounds that the plaintiff failed to obtain a properly executed assignment of benefits pursuant to 11 NYCRR 65-3.11(b)(I). The defendant maintains that its requests for additional verification remains outstanding and therefore its time to pay or deny the claim has not run and this action must be dismissed as premature.

The plaintiff cross moves for summary judgment on the grounds that the AOB form received by the defendant on January 8, 2003 satisfied the request for additional verification and the defendant’s time to pay or deny the claim ended thirty days after that date.

No-Fault Insurance regulations 11 NYCRR 65-3.11(b)(2) provide, in pertinent part, that in order for a health care provider to receive direct payment from an insurer, it must submit “a properly executed assignment on: (i) the prescribed verification of treatment by the attending physician or other provider of service form (N.Y.S. form NF-3), or (ii) the prescribed verification of hospital treatment form (N.Y.S. form NF-4), or the prescribed hospital facility form (N.Y.S. form NF-5), or (iii) the prescribed no-fault Assignment of Benefits form (N.Y.S. form NF-AOB) contained in Appendix 13, infra, or an equivalent form containing nonsubstantive enhancements, but no changes may be made to the assignment language itself…”.

The attorney for the defendant argues that in the instant case the defendant elected to utilize the NF-AOB form. That AOB form, which was received by the defendant on January 18, 2003, contains a line for “Signature of Provider”. The following hand printed statement appears above that line: “- on behalf of Amy Beth Goldman, M”. There is no “signature” on that line. In addition, there is no identification of the individual who allegedly signed “on behalf of” Amy Beth Goldman. Although counsel for the defendant argues “there is no requirement” that a NF-AOB form contain a signature by the provider, the form the plaintiff elected to utilize clearly requires a “Signature of Provider”. The plain language of the No-Fault Insurance regulations requires that the provider submit a “properly executed assignment” on whatever form it chooses to submit.

It is well established that the No-Fault law is in derogation of the common law and must therefore be “strictly construed” (Presbyterian Hosp. In the City of NY v. Atlanta Casualty Co., 210 Ad2d 210, 211 [2nd Dept., 1994]). Based on the above, the court finds that the plaintiff failed to submit a properly executed AOB and therefore it has failed to comply with the defendant’s request for additional verification pursuant to 11 NYCRR 65.15(g)(I). Consequently, this court finds that the defendant’s time to pay or deny the [*3]claim has not begun to run.

Accordingly, based on the above, the plaintiff’s cross motion for summary judgment is denied and the defendant’s motion for summary judgment is granted; and it is

Ordered that the plaintiff’s complaint is dismissed.

So Ordered:

________________________

DISTRICT COURT JUDGE

Dated: March 29, 2005

CC:Friedman, Harfenist, Langer & Kraut

Freiberg & Peck, LLP