Performance Plus Med., P.C. v. Nationwide Ins.

Appellate Terms of the Supreme Court of New York

Performance Plus Med., P.C. v. Nationwide Ins.

CourtAppellate Terms of the Supreme Court of New York

DecidedMarch 16, 2016

Docket2016 NYSlipOp 50366(U)

StatusPublished

This text of Performance Plus Med., P.C. v. Nationwide Ins. (Performance Plus Med., P.C. v. Nationwide Ins.) is published on Counsel Stack Legal Research, covering Appellate Terms of the Supreme Court of New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Performance Plus Med., P.C. v. Nationwide Ins., (N.Y. Ct. App. 2016).

Pincite

Opinion

Performance plus Medical, P.C. as Assignee of FABIOLA NOEL, Appellant,

against

Nationwide Ins., Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Robin Kelly Sheares, J.), entered May 31, 2013. The order granted defendant's 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 appeals from an order of the Civil Court which granted defendant's motion for summary judgment dismissing the complaint.

Since a claim need not be paid or denied until all demanded verification with respect thereto has been provided (see Westchester County Med. Ctr. v New York Cent. Mut. Fire Ins. Co., 262 AD2d 553, 554 [1999]), a timely verification request tolls an insurer's time to pay or deny the entire claim. Thus, any action to recover payment on that claim is premature when the provider has failed to respond to a request for verification (see Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492, 493 [2005]). Contrary to plaintiff's contention on appeal, defendant's moving papers were sufficient to establish defendant's prima facie entitlement to summary judgment dismissing the second through tenth causes of action on the ground that defendant had not received the requested verification.

With respect to the branch of defendant's motion seeking summary judgment dismissing the first cause of action, the affidavit by defendant's claims representative was sufficient to demonstrate prima facie that defendant had properly denied the claims for the services at issue in the first cause of action pursuant to the workers' compensation fee schedule. In opposition to this branch of defendant's motion, plaintiff failed to raise a triable issue of fact.

Accordingly, the order is affirmed.

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

Decision Date: March 16, 2016

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Performance plus Medical, P.C. as Assignee of FABIOLA NOEL, Appellant,

against

Nationwide Ins., Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Robin Kelly Sheares, J.), entered May 31, 2013. The order granted defendant's 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 appeals from an order of the Civil Court which granted defendant's motion for summary judgment dismissing the complaint.

Since a claim need not be paid or denied until all demanded verification with respect thereto has been provided (see Westchester County Med. Ctr. v New York Cent. Mut. Fire Ins. Co., 262 AD2d 553, 554 [1999]), a timely verification request tolls an insurer's time to pay or deny the entire claim. Thus, any action to recover payment on that claim is premature when the provider has failed to respond to a request for verification (see Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492, 493 [2005]). Contrary to plaintiff's contention on appeal, defendant's moving papers were sufficient to establish defendant's prima facie entitlement to summary judgment dismissing the second through tenth causes of action on the ground that defendant had not received the requested verification.

With respect to the branch of defendant's motion seeking summary judgment dismissing the first cause of action, the affidavit by defendant's claims representative was sufficient to demonstrate prima facie that defendant had properly denied the claims for the services at issue in the first cause of action pursuant to the workers' compensation fee schedule. In opposition to this branch of defendant's motion, plaintiff failed to raise a triable issue of fact.

Accordingly, the order is affirmed.

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

Decision Date: March 16, 2016

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