Appeal from an order of the Civil Court of the City of New York, Kings County (Devin P. Cohen, J.), entered July 16, 2010.
Parsons Med. Supply, Inc. v Progressive Northeastern Ins. Co.
Decided on August 23, 2012
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This opinion is uncorrected and will not be published in the printed Official Reports.
PRESENT: PESCE, P.J., RIOS and SOLOMON, JJ
The order, insofar as appealed from as limited by the brief, granted defendant's cross motion for summary judgment dismissing the complaint. The appeal is deemed to be from a judgment of the same court entered October 4, 2010 dismissing the complaint (see CPLR 5512 [a]).
ORDERED that the judgment is reversed, without costs, so much of the order entered July 16, 2010 as granted defendant's cross motion for summary judgment dismissing the complaint is vacated and defendant's cross motion is denied.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals, as limited by its brief, from so much of an order of the Civil Court as granted defendant's cross motion for summary judgment dismissing the complaint. A judgment was subsequently entered, from which the appeal is deemed to have been taken (see CPLR 5512 [a]).
Defendant admits that it received plaintiff's claims for the sums of
$865 and $1,737 on January 28, 2008 and February 6, 2008,
respectively, and it is undisputed that the claims were not paid
or denied within 30 days of their receipt. The letters sent by
defendant to plaintiff after the receipt of the claims informed
plaintiff that defendant was investigating the claims and was in the
process of obtaining verification, which included examinations under
oath. It is well settled that an insurer's delay letters, which
request no verification, are insufficient to toll the 30-day statutory
time period within which a claim must be paid or denied (see Nyack
Hosp. v Encompass Ins. Co., 23 AD3d 535 ; Points of Health
Acupuncture, P.C. v Lancer Ins. Co., 28 Misc 3d 133[A], 2010 NY Slip
Op 51338[U] [App Term, 2d, 11th
& 13th Jud Dists 2010]). Consequently, defendant failed to
demonstrate that the claims had been timely denied and, therefore,
defendant has not established that its defense of lack of medical necessity is
not precluded (see Presbyterian Hosp. in City of NY v Maryland Cas. Co., 90
NY2d 274 ). Accordingly, the judgment is reversed, so much of the order as granted
defendant's cross motion for summary judgment dismissing the complaint is vacated and defendant's cross motion is denied.
Pesce, P.J., Rios and Solomon, JJ., concur.
Decision Date: August 23, 2012
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