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St. Barnabas Hospital v. Government Employees Insurance Co.

Supreme Court, Nassau County

February 1, 2017

St. Barnabas Hospital, a/a/o DAWN HENRY, Plaintiff,
v.
Government Employees Insurance Company, Defendant.

          Joseph Henig, P.C. Attorneys for the Plaintiff

          Law Offices of Printz & Goldstein Attorneys for the Defendant

          Danielle M. Medeiros, Esq. Assistant Law Clerk

          RANDY SUE MARBER, J.

         Papers Submitted:

         Notice of Motion

         Notice of Cross-Motion and

         Affirmation in Opposition

         Reply and Opposition to Cross-Motion

         Reply Affirmation

         Upon the foregoing papers, the motion by the Plaintiff, ST. BARNABAS HOSPITAL, a/a/o DAWN HENRY (hereinafter "St. Barnabas") (Mot. Seq. 01), seeking an Order pursuant to CPLR §3212, granting it summary judgment against the Defendant, GOVERNMENT EMPLOYEES INSURANCE COMPANY (hereinafter "GEICO"), and the cross-motion by the Defendant, GEICO, (Mot. Seq. 02), seeking an Order pursuant to CPLR §3212 granting it summary judgment and dismissing the Complaint, are determined as hereinafter provided.

         This is an action to recover no-fault benefits on a hospital no-fault billing. The Plaintiff, St. Barnabas, is the assignee for health-related services rendered to GEICO's insured, Dawn Henry, during the period of April 10, 2016 through April 13, 2016, for injuries sustained as a result of a motor vehicle accident that occurred on April 10, 2016. At issue is whether the Defendant, GEICO, timely and properly requested additional verification from the Plaintiff, St. Barnabas, upon its receipt of proof of the claim which effectively tolls the 30-day time period within which GEICO must pay or deny the claim for such services rendered in the amount of $43, 212.59.

         On April 21, 2016, the Plaintiff, St. Barnabas, billed the Defendant, GEICO, utilizing a Hospital Facility Form (Form NF-5) and a UB-04, seeking payment of a hospital bill in the sum of $43, 212.59 (See Exhibit "1" attached to Plaintiff's motion). The billing was sent via certified mail, return receipt requested, and was received by the Defendant, GEICO, on April 25, 2015 (See Exhibit "2" attached to Plaintiff's motion). On May 16, 2016, GEICO served a request for additional verification. On May 20, 2016, St. Barnabas served a response letter acknowledging receipt of GEICO's request wherein it objected to the validity of the request. GEICO received St. Barnabas' response on May 23, 2016. On June 20, 2016, GEICO served a second follow-up request for additional verification. St. Barnabas never responded to GEICO's second request. The instant action was filed shortly thereafter.

         The Plaintiff alleges that the Defendant, GEICO, failed to either pay the hospital bill or issue a timely denial. In opposition, the Defendant, GEICO, contends that the Plaintiff failed to demonstrate its prima facie entitlement to summary judgment on the grounds that the Plaintiff: (i) failed to show the claims were not denied within thirty (30) days or that the basis for the denial was conclusory, vague or had no merit; (ii) the Plaintiff's supporting affidavit is deficient in that it cannot be demonstrated that the affiant, employed by a third party claims administrator, has personal knowledge of the hospital's practices or ...


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