December 17, 2014

New York Diagnostic Med. Care, P.C. v Geico Gen. Ins. Co. (2014 NY Slip Op 51808(U))

Headnote

The court considered the case of New York Diagnostic Medical Care, P.C. as the assignee of Kenneth Smith, who appealed from an order of the Civil Court of the City of New York, Kings County, which denied plaintiff's motion for summary judgment in an action to recover assigned first-party no-fault benefits. The main issue was whether the provider had established its prima facie entitlement to judgment as a matter of law. The court held that while the provider had submitted evidence in admissible form that the claim forms were mailed to the insurer, and that the insurer failed to pay those claims within the prescribed 30-day period, the affidavit failed to demonstrate that the insurer had either failed to deny the claims within the requisite 30-day period or issued timely denial of claim forms which were conclusory, vague, or without merit as a matter of law. Therefore, the court affirmed the order denying plaintiff's motion for summary judgment.

Reported in New York Official Reports at New York Diagnostic Med. Care, P.C. v Geico Gen. Ins. Co. (2014 NY Slip Op 51808(U))

New York Diagnostic Med. Care, P.C. v Geico Gen. Ins. Co. (2014 NY Slip Op 51808(U)) [*1]

New York Diagnostic Med. Care, P.C. v Geico Gen. Ins. Co.

2014 NY Slip Op 51808(U) [46 Misc 3d 129(A)]

Decided on December 17, 2014

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This opinion is uncorrected and will not be published in the printed Official Reports.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 December 17, 2014

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

PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2012-1299 K C

New York Diagnostic Medical Care, P.C. as Assignee of KENNETH SMITH, Appellant,
against
Geico General Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Reginald A. Boddie, J.), entered April 26, 2012. The order denied plaintiff’s motion for summary judgment.

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 denied plaintiff’s motion for summary judgment.

A no-fault provider establishes its prima facie entitlement to judgment as a matter of law by submitting evidence, in admissible form, that claim forms were mailed to the defendant insurer, and that the insurer failed to pay or deny those claims within the prescribed 30-day period or issued timely denial of claim forms that were conclusory, vague or without merit as a matter of law (see Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 114 AD3d 33 [2013]; Ave T MPC Corp. v Auto One Ins. Co., 32 Misc 3d 128[A], 2011 NY Slip Op 51292[U] [App Term, 2d, 11th & 13th Jud Dists 2011]; see also Westchester Med. Ctr. v Nationwide Mut. Ins. Co., 78 AD3d 1168 [2010]).

While the supporting affidavit by plaintiff’s employee established that plaintiff had mailed the claim forms in question to defendant, and that defendant had failed to pay those claims within the requisite 30-day period, the affidavit failed to demonstrate that defendant had either failed to deny the claims within the requisite 30-day period or that defendant had issued timely denial of claim forms which were conclusory, vague or without merit as a matter of law. As plaintiff failed to meet its initial burden of establishing its prima facie entitlement to judgment as a matter of law, plaintiff’s motion for summary judgment was properly denied (see Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 114 AD3d 33).

Accordingly, the order is affirmed.

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

Decision Date: December 17, 2014