June 1, 2018

Gl Acupuncture, P.C. v Allstate Ins. Co. (2018 NY Slip Op 50841(U))

Headnote

The court considered the denial of a claim form being timely mailed, and whether a provider was entitled to recover assigned first-party no-fault benefits for services rendered prior to April 1, 2013. The main issue was whether the amounts sought for recovery were in excess of the workers' compensation fee schedule. The holding of the case was that the affidavits submitted by the defendant did not sufficiently set forth a standard office practice or procedure to ensure that the denial of claim form had been timely mailed. As a result, the defendant was not entitled to summary judgment dismissing the complaint, and the order was reversed in favor of the plaintiff.

Reported in New York Official Reports at Gl Acupuncture, P.C. v Allstate Ins. Co. (2018 NY Slip Op 50841(U))

Gl Acupuncture, P.C. v Allstate Ins. Co. (2018 NY Slip Op 50841(U)) [*1]

GL Acupuncture, P.C. v Allstate Ins. Co.

2018 NY Slip Op 50841(U) [59 Misc 3d 151(A)]

Decided on June 1, 2018

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This opinion is uncorrected and will not be published in the printed Official Reports.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 June 1, 2018

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

PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, DAVID ELLIOT, JJ
2015-2949 Q C

GL Acupuncture, P.C., as Assignee of Landarau, Rafael, Appellant,
against
Allstate Insurance Company, Respondent.

The Rybak Firm, PLLC (Damin J. Toell of counsel), for appellant. Robert P. Tusa, for respondent (no brief filed).

Appeal from an order of the Civil Court of the City of New York, Queens County (Terrence C. O’Conner, J.), entered September 23, 2015. The order, insofar as appealed from as limited by the brief, granted defendant’s cross motion for summary judgment dismissing the complaint.

ORDERED that the order, insofar as appealed from, is reversed, with $30 costs, and defendant’s cross motion for summary judgment dismissing the complaint is denied.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals, as limited by the brief, from so much of an order of the Civil Court as granted defendant’s cross motion for summary judgment dismissing the complaint on the ground that the amounts plaintiff sought to recover, for services rendered prior to April 1, 2013, were in excess of the workers’ compensation fee schedule.

Plaintiff correctly argues on appeal that the affidavits submitted by defendant did not sufficiently set forth a standard office practice or procedure that would ensure that the denial of claim form had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). As defendant did not demonstrate that it is not precluded from asserting its proffered defense (cf. 11 NYCRR 65-3.8 [g] [1] [ii]), defendant is not entitled to [*2]summary judgment dismissing the complaint.

Accordingly, the order, insofar as appealed from, is reversed and defendant’s cross motion for summary judgment dismissing the complaint is denied.

PESCE, P.J., ALIOTTA and ELLIOT, JJ., concur.

ENTER:
Paul Kenny
Chief Clerk
Decision Date: June 01, 2018