October 11, 2016

Island Life Chiropractic, P.C. v American Tr. Ins. Co. (2016 NY Slip Op 51541(U))

https://www.beynensonlaw.com/case-law/island-life-chiropractic-p-c-v-american-tr-ins-co-2016-ny-slip-op51541u/

Court: Appellate Term, Second Department
Decided: October 11, 2016
Citation: 2016 NY Slip Op 51541(U) · 53 Misc 3d 142(A)
Posture: Summary judgment
Outcome: Split result
Issues: Verification requests
Legal questions: Outstanding verification and premature actions (see the maps)

Cite as

Island Life Chiropractic, P.C. v American Tr. Ins. Co., 53 Misc 3d 142(A), 2016 NY Slip Op 51541(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2016)

Posture, outcome, issues and treatment by other decisions are Beynenson Law’s classification. Treatment labels are assigned by a language model reading the citing decision; negative and appeal-history labels are checked by a second reader.

Summary

Editorial summary by Beynenson Law, not part of the court’s decision.

The insurer's cross motion for summary judgment dismissing the provider's claims as premature for outstanding verification was denied on appeal. The Appellate Term, Second Department, modified the order based on the companion appeal, Performance Plus Med., P.C. v Nationwide Ins., decided the same day, No. 2013-2766 Q C. The provider's summary judgment motion remained denied.

Reported in New York Official Reports at Island Life Chiropractic, P.C. v American Tr. Ins. Co. (2016 NY Slip Op 51541(U))

[*1]

Island Life Chiropractic, P.C. v American Tr. Ins. Co.

2016 NY Slip Op 51541(U) [53 Misc 3d 142(A)]

Decided on October 11, 2016

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This opinion is uncorrected and will not be published in the printed Official Reports.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 October 11, 2016

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

PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2014-538 Q C

Island Life Chiropractic, P.C., as Assignee of Edison Bond, Appellant,
against
American Transit Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Larry Love, J.), entered February 24, 2014. The order denied plaintiff’s motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint.

ORDERED that the order is modified by providing that defendant’s cross motion for summary judgment dismissing the complaint is denied; as so modified, the order is affirmed, without costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court which denied plaintiff’s motion for summary judgment, and granted defendant’s cross motion for summary judgment dismissing the complaint on the ground that the action was premature because plaintiff had failed to provide requested verification.

For the reasons stated in Performance Plus Med., P.C., as Assignee of Melanna Luckie v Nationwide Ins. (___ Misc 3d ____, 2016 NY Slip Op ______ [appeal No. 2013-2766 Q C], decided herewith), the order is modified by providing that defendant’s cross motion for summary judgment dismissing the complaint is denied.

Pesce, P.J., Aliotta and Solomon, JJ., concur.

Decision Date: October 11, 2016

Legal questions

A question of no-fault law this decision rules on, from our Legal Questions pages. Bars count the decisions on the question by year and court, coloured by category; circles are this decision and the decisions on the question it cites or that cite it. Point at a bar or circle for details. The categories and summaries are Beynenson Law’s classification, made by a language model and checked by a second reading.

Outstanding verification and premature actions

Open the full map

Did unanswered verification requests make the provider’s claim premature, or justify denying it for nonresponse?

This decision: Fact issues remain on whether the verification defense applies (rules on the question, but another ground decided the case)

Denied the insurer's cross motion to dismiss the action as premature for outstanding verification, for the reasons stated in a companion decision, while leaving the provider's summary judgment motion denied.

Premature: verification outstandingNonresponse denial upheldTriable issueInsurer's showing failsProvider compliedThis decision

Of the 367 decisions on this question in the Second Department courts and the Court of Appeals, 112 (this one included) are in the same category.

Similar decisions

Island Life Chiropractic, P.C. v National Liab. & Fire Ins. Co. (2016 NY Slip Op 50927(U))The insurer's summary judgment cross motion asserting prematurity for failure to provide requested verification was denied on appeal.
Island Life Chiropractic, P.C. v Travelers Ins. Co. (2016 NY Slip Op 51413(U))The provider's mailing affidavit raised a factual issue whether the insurer received requested verification, precluding dismissal as premature.
Island Life Chiropractic, P.C. v 21st Century Ins. Co. (2017 NY Slip Op 51820(U))The provider failed to establish that its claims were denied late or that timely denials were conclusory, vague or legally meritless.
Island Chiropractic Testing, P.C. v Praetorian Ins. Co. (2014 NY Slip Op 51795(U))The provider's verification responses presented a factual dispute that precluded summary judgment for either party.
Island Life Chiropractic, P.C. v Allstate Ins. Co. (2017 NY Slip Op 51465(U))The insurer was granted summary judgment because its proof established that it had issued no policy covering the loss.