June 20, 2005

Nyack Hosp. v State Farm Mut. Auto. Ins. Co. (2005 NY Slip Op 05278)

Headnote

The court considered the action to recover no-fault medical payments, where the plaintiff was Nyack Hospital, as the assignee of Ray Rodriguez. The main issue was to determine whether the denial of plaintiff's motion for summary judgment and the granting of the defendant's cross motion for summary judgment dismissing the complaint were appropriate. The holding of the court was that the Supreme Court properly denied the plaintiff's motion for summary judgment and correctly granted the defendant's cross motion for summary judgment dismissing the complaint. The insurer was not obligated to pay or deny a claim until it had received verification of all relevant information requested, and since the defendant had not received the verification requested, any claim for payment was premature. Therefore, the period within which the defendant was required to respond to the plaintiff's claim did not begin to run.

Reported in New York Official Reports at Nyack Hosp. v State Farm Mut. Auto. Ins. Co. (2005 NY Slip Op 05278)

Nyack Hosp. v State Farm Mut. Auto. Ins. Co.

2005 NY Slip Op 05278 [19 AD3d 569]

June 20, 2005

Appellate Division, Second Department

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

As corrected through Wednesday, August 24, 2005

Nyack Hospital, as Assignee of Ray Rodriguez, Appellant,
v
State Farm Mutual Automobile Insurance Company, Respondent.

—[*1]

In an action to recover no-fault medical payments, the plaintiff appeals from an order of the Supreme Court, Nassau County (Brandveen, J.), dated September 22, 2004, which denied its motion for summary judgment and granted the defendant’s cross motion for summary judgment dismissing the complaint.

Ordered that the order is affirmed, with costs.

The Supreme Court properly denied the plaintiff’s motion for summary judgment and correctly granted the defendant’s cross motion for summary judgment dismissing the complaint. An insurer is not obligated to pay or deny a claim until it has received verification of all relevant information requested (see 11 NYCRR 65.15 [d], [g] [1], [7]; St. Vincent’s Hosp. of Richmond v American Tr. Ins. Co., 299 AD2d 338, 340 [2002]). It is undisputed that the plaintiff’s assignor and Good Samaritan Hospital failed to respond to the defendant’s verification requests for the record containing the assignor’s post-accident blood alcohol level. Accordingly, the period within which the defendant was required to respond to the plaintiff’s claim did not begin to run, and any claim for payment was premature (see Hospital for Joint Diseases v State Farm Mut. Auto. Ins. Co., 8 AD3d 533 [2004]; New York & Presbyt. Hosp. v Progressive Cas. Ins. Co., 5 AD3d 568 [2004]; cf. Presbyterian Hosp. in City of N.Y. v Aetna Cas. & Sur. Co., 233 AD2d 431 [1996]). Schmidt, J.P., S. Miller, Santucci and Mastro, JJ., concur.