September 13, 2004

Hospital for Joint Diseases v Countrywide Ins. Co. (2004 NY Slip Op 06513)

Headnote

The case involved an action to recover no-fault medical payments, with the plaintiffs appealing from an order denying their motion for summary judgment. The plaintiffs argued that the defendant insurance company had not responded to their claims for no-fault medical benefits within the required 30 days. However, the defendant submitted evidence that the claims had been billed over a year earlier and denial of claim forms had been mailed at that time. The defendant's evidence raised triable issues of fact as to the timing of the claims and whether the defendant properly denied them. The court ultimately held that the evidence submitted by both parties created a genuine issue of fact and denied the motion for summary judgment.

Reported in New York Official Reports at Hospital for Joint Diseases v Countrywide Ins. Co. (2004 NY Slip Op 06513)

Hospital for Joint Diseases v Countrywide Ins. Co.

2004 NY Slip Op 06513 [10 AD3d 628]

September 13, 2004

Appellate Division, Second Department

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

As corrected through Thursday, February 24, 2005

Hospital for Joint Diseases et al., Appellants,
v
Countrywide Insurance Company, Respondent.

—[*1]

In an action to recover no-fault medical payments, the plaintiffs appeal from an order of the Supreme Court, Nassau County (Cozzens, J.), dated October 1, 2003, which denied their motion for summary judgment.

Ordered that the order is affirmed, without costs or disbursements.

In support of their motion for summary judgment, the plaintiffs submitted evidentiary proof that the defendant insurance company had not responded to their February 19, 2003, and January 15, 2003, claims for no-fault medical benefits within 30 days as required by Insurance Law § 5106 (a) and 11 NYCRR 65.15 (g) (3). In opposition to the motion, the defendant submitted documentary evidence and an affidavit of an employee asserting that the same claims had originally been billed over one year earlier and that timely denial of claim forms had been mailed to the plaintiffs at that time.

The evidence submitted by the plaintiffs satisfied their burden of establishing a prima facie entitlement to judgment as a matter of law (see Winegrad v New York Univ. Med. Ctr., 64 NY2d 851, 853 [1985]). However, the defendant submitted admissible evidence in opposition to the motion, which raised triable issues of fact as to the dates on which the plaintiffs mailed the no-fault claims to the defendant (see New York Hosp. Med. Ctr. of Queens v Country-Wide Ins. Co., 295 AD2d 583, 585 [2002]) and whether the defendant properly denied those claims (see Hospital for Joint Diseases v Nationwide Mut. Ins. Co., 284 AD2d 374, 375 [2001]). Accordingly, the Supreme Court correctly denied the motion for summary judgment. Florio, J.P., S. Miller, Rivera and Lifson, JJ., concur.