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Garden State Anesthesia Associates v. Progressive Casualty Ins. Co.

District Court of Nassau County, First District

September 26, 2013

Garden State Anesthesia Associates, PA A/A/O ANGELA GOWAN-WALKER, Plaintiff,
v.
Progressive Casualty Ins. Co., Defendant.

Attorneys - Baker, Sanders, LLC - for plaintiff

McCormack & Mattei, P.C. - for defendant

FRED J. HIRSH, J.

The following named papers numbered 1 - 3

submitted on this motion on July 16, 2013 Papers Numbered Notice of Motion and Affidavits Annexed1-2

Order to Show Cause and Affidavits Annexed

Affirmation in Opposition3

Replying Affidavits

Defendant moves for summary judgment dismissing this action to obtain payment of first party no-fault benefits.

BACKGROUND

Garden State Anesthesia Associates, P.A. ("GSAA") provided anesthesia services to Angela Gowan-Walker ("Gowan-Walker") on March 8, 2011, March 29, 2011, April 12, 2011 and June 7, 2011. GSAA took an assignment of benefits from Gowan-Walker and submitted its claim for payment to defendant Progressive Casualty Insurance Company. ("Progressive"). Progressive acknowledged receipt of the claim for services provided as follows: (1) March 8, 2011 on April 27, 2011, (2) March 29, 2011 on May 9, 2011, (3) April 12, 20111 on May 23, 2011, and (4)June 7, 2011 on July 5, 2011. Progressive has not paid or denied any of these claims.

By letter dated May 4, 2011, Progressive advised GSAA its claim for services provided on March 8, 2011 was being delayed pending Gowan-Walker appearing for an examination under oath.

Even though Gowan-Walker appeared for an Examination Under Oath on May 27, 2011, Progressive issued a follow-up letter to GSAA dated June 6, 2011 advising GSAA its claim for services provided on March 8, 2011 was being delayed pending Gowan-Walker appearing for an examination under oath.

Progressive sent a letter dated June 17, 2011 to GSAA advising GSAA processing of its claim for medical services provided on March 8, 2011 was being delayed pending receipt of medical records from Garden State Pain Management, Dr. David Brizer, Dr. Rajan Gulati, Dr. Moinhuddin Ahmed, Dr. Jennifer Heinze, Dr. Ralph Bowman, Dr. Minesh Patel, the complete worker's compensation file from the worker's compensation carrier who had paid worker's compensation benefits to Gowan-Walker in connection with a February 14, 2009 accident, the complete worker's compensation file from the worker's compensation carrier who had paid Gowan-Walker with worker's compensation benefits for a March ...


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