November 26, 2013

J.C. Healing Touch Rehab, P.C. v Nationwide Ins. (2013 NY Slip Op 52011(U))

Headnote

The main issue in this case was whether defendant's motion for summary judgment dismissing the complaint should be granted. The relevant facts considered by the court were that the plaintiff, a provider seeking first-party no-fault benefits, had failed to appear for duly scheduled examinations under oath (EUOs), and the defendant had timely denied the claims at issue based on this failure. The court held that the EUO scheduling letters had been timely mailed and were therefore sufficient to toll the claim determination period, contrary to the plaintiff's argument. Additionally, the court found that the letters submitted by the defendant to delay payment of the claims were also sufficient to toll the 30-day statutory time period within which a claim must be paid or denied. The court also ruled that the affidavit submitted by defendant to prove that the denial of claim forms had been timely mailed should be considered, and the argument raised by plaintiff regarding non-compliance with CPLR 2309 (c) was waived and, therefore, the order to grant defendant's motion for summary judgment dismissing the complaint was affirmed.

Reported in New York Official Reports at J.C. Healing Touch Rehab, P.C. v Nationwide Ins. (2013 NY Slip Op 52011(U))

J.C. Healing Touch Rehab, P.C. v Nationwide Ins. (2013 NY Slip Op 52011(U)) [*1]
J.C. Healing Touch Rehab, P.C. v Nationwide Ins.
2013 NY Slip Op 52011(U) [41 Misc 3d 141(A)]
Decided on November 26, 2013
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This opinion is uncorrected and will not be published in the printed Official Reports.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 November 26, 2013

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ
2011-3242 K C.
J.C. Healing Touch Rehab, P.C. as Assignee of CHARAE HATWOOD, Appellant, —

against

Nationwide Ins., Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Pamela L. Fisher, J.), entered November 2, 2011. The order granted defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order is affirmed, with $25 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 granted defendant’s motion for summary judgment dismissing the complaint. Defendant’s motion papers set forth that defendant had timely denied the claims at issue based upon plaintiff’s failure to appear for duly scheduled examinations under oath (EUOs).

Contrary to plaintiff’s argument, the affirmation submitted by defendant established that the EUO scheduling letters had been timely mailed in accordance with its law firm’s standard office practices and procedures (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]). Furthermore, while plaintiff argues that certain [*2]letters submitted by defendant, which purported to delay payment of the claims, were insufficient to toll the 30-day statutory time period within which a claim must be paid or denied (see Points of Health Acupuncture, P.C. v Lancer Ins. Co., 28 Misc 3d 133[A], 2010 NY Slip Op 51338[U] [App Term, 2d, 11th & 13th Jud Dists 2010]), in this case the EUO scheduling letters themselves were sufficient to toll the claim determination period.

Finally, plaintiff argues that the affidavit submitted by defendant in order to prove that the denial of claim forms had been timely mailed should not have been considered because it did not comply with CPLR 2309 (c). However, that argument is raised for the first time on appeal, and is therefore waived (see Mani Med., P.C. v NY Cent. Mut. Ins. Co., 19 Misc 3d 128[A], 2008 NY Slip Op 50508[U] [App Term, 2d & 11th Jud Dists 2008]; Infinity Health Prods. Ltd. v State Farm Mut. Auto. Ins. Co., 16 Misc 3d 135[A], 2007 NY Slip Op 51611[U] [App Term, 2d & 11th Jud Dists 2007]).

Accordingly, the order is affirmed.

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

Decision Date: November 26, 2013