December 17, 2014

True-Align Chiropractic Care, P.C. v Country Wide Ins. Co. (2014 NY Slip Op 51821(U))

Headnote

The relevant facts considered by the court in this case were that a provider was seeking to recover assigned first-party no-fault benefits. The main issues decided were whether the provider had failed to respond to the insurance company's verification requests and whether the assignor had failed to appear for scheduled independent medical examinations (IMEs). The court held that the insurance company had established the timely and proper mailing of the verification requests and the denial of claim forms, and that the assignor had indeed failed to appear for the scheduled IMEs. As a result, the court affirmed the denial of the provider's motion for summary judgment and granted the insurance company's cross motion for summary judgment, dismissing the complaint.

Reported in New York Official Reports at True-Align Chiropractic Care, P.C. v Country Wide Ins. Co. (2014 NY Slip Op 51821(U))

True-Align Chiropractic Care, P.C. v Country Wide Ins. Co. (2014 NY Slip Op 51821(U)) [*1]

True-Align Chiropractic Care, P.C. v Country Wide Ins. Co.

2014 NY Slip Op 51821(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This opinion is uncorrected and will not be published in the printed Official Reports.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.
2012-1596 K C

True-Align Chiropractic Care, P.C. as Assignee of JOSE REYES, Appellant,
against
Country Wide Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Devin P. Cohen, J.), entered March 26, 2012. 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 affirmed, with $25 costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint on the grounds that plaintiff had failed to respond to defendant’s verification requests and that plaintiff’s assignor had failed to appear for duly scheduled independent medical examinations (IMEs). The Civil Court denied plaintiff’s motion and granted defendant’s cross motion.

Plaintiff’s arguments on appeal lack merit. The affidavit submitted by defendant sufficiently established the timely and proper mailing of the verification requests and the denial of claim forms (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, contrary to plaintiff’s argument with respect to its first cause of action, defendant demonstrated that it had not received the verification requested, and plaintiff did not show that the requested verification had been provided to defendant. Finally, contrary to plaintiff’s argument with respect to the remaining causes of action, defendant established that plaintiff’s assignor had failed to appear for the scheduled IMEs (see Quality Psychological Servs., P.C. v Interboro Mut. Indem. Ins. Co., 36 Misc 3d 146[A], 2012 NY Slip Op 51628[U] [App Term, 2d, 11th & 13th Jud Dists 2012]).

Accordingly, the order is affirmed.

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

Decision Date: December 17, 2014