New York Supreme and/or Appellate Courts SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
March 6, 2012
MSSA CORP. AS ASSIGNEE OF ANGEL CURET, RESPONDENT, --
PRAETORIAN INSURANCE COMPANY, APPELLANT.
Appeal from an order of the Civil Court of the City of New York, Kings County (Genine D. Edwards, J.), entered January 26, 2010.
MSSA Corp. v Praetorian Ins. Co.
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This opinion is uncorrected and will not be published in the printed Official Reports.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 March 6, 2012
PRESENT: WESTON, J.P., RIOS and ALIOTTA, JJ
The order denied defendant's motion for summary judgment dismissing the complaint.
ORDERED that the order is affirmed, without costs.
In this action by a provider to recover assigned first-party no-fault
benefits, defendant's motion for summary judgment dismissing the
complaint was properly denied, as defendant failed to demonstrate that
the claim had been timely denied. Defendant's denial of claim form was
not issued within 30 days of receipt of plaintiff's claim form, and
the affidavit of defendant's claims examiner failed to demonstrate
that defendant had tolled its time to pay or deny the claim by timely
mailing its request for verification to plaintiff (see Insurance
Department Regulations [11 NYCRR] § 65-3.5 [b]; § 65-3.8 [a] ) in
accordance with defendant's standard office practices and procedures
(see St. Vincent's Hosp. of Richmond v Government Empls. Ins. Co., 50
AD3d 1123 ; Delta Diagnostic Radiology, P.C. v Chubb Group of
Ins., 17 Misc 3d 16 [App Term, 2d
& 11th Jud Dists 2007]). As a result, defendant failed to demonstrate that its
defense of lack of medical necessity was not precluded (see e.g. Delta
Diagnostic Radiology, P.C. v Republic W. Ins. Co., 15 Misc 3d 33 [App Term, 2d & 11th Jud Dists 2007]).
Accordingly, the order of the Civil Court denying defendant's motion for summary judgment dismissing the complaint is affirmed.
Weston, J.P., Rios and Aliotta, JJ., concur.
Decision Date: March 06, 2012
© 1992-2012 VersusLaw Inc.