Opinion
2007-572 Q C.
Decided April 14, 2008.
Appeal from an order of the Civil Court of the City of New York, Kings County (Diane A. Lebedeff, J.), entered February 8, 2007. The order denied defendant's motion for summary judgment.
Order reversed without costs and defendant's motion for summary judgment dismissing the complaint granted.
PRESENT: PESCE, P.J., WESTON PATTERSON and GOLIA, JJ.
In this action by a provider to recover assigned first-party no-fault benefits, defendant MVAIC moved for summary judgment on the ground that the action was barred by the statute of limitations. The parties do not dispute that plaintiff mailed the claims in question to MVAIC on October 9, 2001. The claims are therefore presumed to have been received ( see Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679, 680). In addition, MVAIC took the position that it received the claims on October 12, 2001. We note that neither side has shown the existence of a verification request that would have postponed the payment due date, and that plaintiff's allegations in its opposition papers did not provide ground to believe that discovery might have revealed one. Accordingly, the payment due date must be deemed to have been in November 2001 that is, 30 days after receipt of the claims ( see Insurance Law § 5106 [a]; Insurance Department Regulations [11 NYCRR] § 65.15 [g], now Insurance Department Regulations [ 11 NYCRR] § 65-3.8).
We reject plaintiff's assertion in its opposing papers that MVAIC's verification request of March 3, 2003 postponed the payment due date. It was submitted beyond the date when payment became overdue, and therefore could not toll the payment due date ( see Insurance Department Regulations [11 NYCRR] § 65.15 [d], [g], now Insurance Department Regulations [ 11 NYCRR] §§ 65-3.5, 65-3.8; see generally Nyack Hosp. v General Motors Acceptance Corp., 8 NY3d 294, 300-301). We disagree with plaintiff's position that its gratuitous compliance with a verification request issued beyond the payment due date, or its apparent willingness now to unilaterally waive the time limit for the sending of a verification request, can render a belated verification request timely and, ultimately, postpone the accrual date of its cause of action. Neither the relevant statute nor the applicable regulations provide for such a waiver.
In view of the foregoing, we find that plaintiff's cause of action accrued in November 2001 ( see Aetna Life Cas. Co. v Nelson, 67 NY2d 169, 175). Because plaintiff did not commence this action until January of 2006, it was barred by the three-year statute of limitations set forth in CPLR 214 (2) ( see Matter of Motor Veh. Acc. Indem. Corp. v Aetna Cas. Sur. Co., 89 NY2d 214; cf. Mandarino v Travelers Prop. Cas. Ins. Co. , 37 AD3d 775 ).
Plaintiff contends, in effect, that MVAIC should be equitably estopped from taking the position that its own verification requests were untimely. Plaintiff also takes the more general position that MVAIC should be equitably estopped from raising the statute of limitations as a defense here. These arguments are best understood in the context of MVAIC's stated position and its practice at the time plaintiff's claim was being processed, which were that neither the 30-day time period for payment or denial nor the time limit for verification requests ( see Insurance Department Regulations [11 NYCRR] § 65.15 [d], [g], now Insurance Department Regulations [ 11 NYCRR] §§ 65-3.5, 65-3.8) began to run until an injured person was "qualified" by MVAIC pursuant to Insurance Law § 5202 ( see New York Hosp. Med. Ctr. of Queens v Motor Veh. Acc. Indem. Corp. , 12 AD3d 429 , 430 [noting MVAIC's position]). Hence, in MVAIC's view at the time, since the assignor was not qualified until February 21, 2003, its request for additional verification of March 3, 2003, was timely. Under this line of reasoning, since plaintiff did not provide requested additional verification until December of 2005, its cause of action would not have accrued before January of 2006, and its lawsuit would have been timely.
In New York Hosp. Med. Ctr. of Queens v Motor Veh. Acc. Indem. Corp. ( 12 AD3d 429 , supra), the Appellate Division, Second Department, rejected MVAIC's position that its obligations only began upon qualification of the injured person ( id. at 430). Thus, under New York Hosp. Med. Ctr. of Queens, plaintiff's cause of action accrued in November 2001. Plaintiff argues, in effect, that MVAIC should be equitably estopped from disavowing its own prior position. MVAIC's conduct was deceptive, plaintiff maintains, because MVAIC's administrative process led plaintiff erroneously to believe that it had an active pending claim up until it provided additional verification in December of 2005. Plaintiff contends that this mistaken belief on its part was the pivotal factor in its delay in bringing the instant suit.
Even if it is assumed, arguendo, that plaintiff's contention raises some sympathy for its plight, this does not mean that the doctrine of equitable estoppel should be applied against MVAIC. In Airco Alloys Div. v Niagara Mohawk Power Corp. ( 76 AD2d 68), the Court said:
"The elements of estoppel are with respect to the party estopped: (1) conduct which amounts to a false representation or concealment of material facts; (2) intention that such conduct will be acted upon by the other party; and (3) knowledge of the real facts" ( id. at 81).
Plaintiff has not demonstrated that MVAIC had "knowledge of the real facts" in particular, knowledge of the fact that plaintiff's cause of action was going to accrue before the qualification process was completed. Indeed, it seems obvious that MVAIC was not aware of this fact.
Plaintiff has demonstrated no attempt on MVAIC's part to make false representations or conceal. Rather, MVAIC simply and openly followed its interpretation of the applicable law and regulations. Indeed, plaintiff could have challenged this interpretation at any time, as did the plaintiff in New York Hosp. Med. Ctr. of Queens v Motor Veh. Acc. Indem. Corp. ( 12 AD3d 429 , supra). General Stencils v Chiappa ( 18 NY2d 125), relied upon heavily by plaintiff in its brief, is readily distinguishable. In General Stencils, the Court held that "the admitted thievery of defendant entitle[d] plaintiff to litigate the issue of equitable estoppel" ( id. at 128). MVAIC's administrative process here, although ultimately held inconsistent with the statutory scheme, did not amount by any stretch of the imagination to "thievery." Thus, we reject plaintiff's argument that MVAIC should be equitably estopped from raising a statute of limitations defense.
Pesce, P.J., Weston Patterson and Golia, JJ., concur.