December 17, 2014

Northshore Chiropractic Diagnostics, P.C. v A. Cent. Ins. Co. (2014 NY Slip Op 51825(U))

Headnote

The main issues considered in this case were whether a provider's action to recover payment of first-party no-fault benefits was premature when the provider had failed to respond to a timely request for verification, and whether the provider had adequately responded to the verification requests. The court considered the fact that the defendant had mailed initial and follow-up requests for verification in support of its motion, and that both sets of requests were timely mailed. The Civil Court had denied the defendant's motion for summary judgment and granted the plaintiff's cross motion, finding that the defendant's initial verification request was untimely. The holding of the case was that while the requests for verification were timely mailed, there was a triable issue of fact as to whether the plaintiff adequately responded to those verification requests, and therefore the plaintiff's cross motion for summary judgment was denied.

Reported in New York Official Reports at Northshore Chiropractic Diagnostics, P.C. v A. Cent. Ins. Co. (2014 NY Slip Op 51825(U))

Northshore Chiropractic Diagnostics, P.C. v A. Cent. Ins. Co. (2014 NY Slip Op 51825(U)) [*1]

Northshore Chiropractic Diagnostics, P.C. v A. Cent. Ins. Co.

2014 NY Slip Op 51825(U) [46 Misc 3d 131(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This opinion is uncorrected and will not be published in the printed Official Reports.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.
2012-1790 RI C

Northshore Chiropractic Diagnostics, P.C. as Assignee of JOHN JACOBS, Respondent,
against
A. Central Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Richmond County (Mary Kim Dollard, J.), entered June 28, 2012. The order denied defendant’s motion for summary judgment dismissing the complaint and granted plaintiff’s cross motion for summary judgment.

ORDERED that the order is modified by providing that plaintiff’s cross motion for summary judgment 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, defendant moved for summary judgment dismissing the complaint, arguing that the

action is premature because plaintiff had not provided verification as requested by defendant, and plaintiff cross-moved for summary judgment. The Civil Court denied defendant’s motion and granted plaintiff’s cross motion, finding that defendant’s initial verification request was untimely. Since a claim need not be paid or denied until all duly requested verification is provided (see Westchester County Med. Ctr. v New York Cent. Mut. Fire Ins. Co., 262 AD2d 553, 554 [1999]), any action to recover payment is premature when a provider has failed to respond to a timely request for verification (see Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492, 493 [2005]). In support of its motion, defendant demonstrated that it had mailed initial and follow-up requests for verification (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]). Contrary to the finding of the Civil Court, both sets of requests were timely mailed (see 11 NYCRR 65-3.5 [b]; 65-3.6 [b]). However, upon the record before us, we find that there is a triable issue of fact as to whether plaintiff adequately responded to those verification requests. Accordingly, the order is modified by providing that plaintiff’s cross motion for summary judgment is denied.

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

Decision Date: December 17, 2014