Opinion
No. 2012–1646 Q C.
2014-05-29
SYNERGY FIRST MEDICAL, PLLC as Assignee of Stephanie Washington, Respondent, v. MVAIC, Appellant.
Present: PESCE, P.J., ALIOTTA and SOLOMON, JJ.
Appeal from an order of the Civil Court of the City of New York, Queens County (Cheree A. Buggs, J.), entered June 6, 2012. The order denied defendant's motion for summary judgment dismissing the complaint.
ORDERED that the order is reversed, with $30 costs, and defendant's motion for summary judgment dismissing the complaint is granted.
In this action by a provider to recover assigned first-party no-fault benefits, defendant Motor Vehicle Accident Indemnification Corporation (sued herein as MVAIC) appeals from an order of the Civil Court which denied MVAIC's motion for summary judgment dismissing the complaint.
It is undisputed that plaintiff was required to submit its claim form to MVAIC within 45 days after the services at issue had been rendered ( see Insurance Department Regulations [11 NYCRR] § 65–1 .1; AAA Chiropractic, P.C. v. MVAIC, 29 Misc.3d 131[A], 2010 N.Y. Slip Op 51896[U] [App Term, 2d, 11th & 13th Jud Dists 2010]; Nir v. MVAIC, 17 Misc.3d 134[A], 2007 N.Y. Slip Op 52124 [U] [App Term, 2d & 11th Jud Dists 2007]; NY Arthroscopy & Sports Medicine PLLC v. Motor Veh. Acc. Indem. Corp., 15 Misc.3d 89, 836 N.Y.S.2d 753 [App Term, 1st Dept 2007] ) and that plaintiff did not do so. MVAIC's denial of plaintiff's claim, based upon plaintiff's untimely submission, informed plaintiff that MVAIC could excuse the delay if plaintiff provided “written justification” for the delay ( see Insurance Department Regulations [11 NYCRR] § 65–3.3[e]; see also Matter of Medical Socy. of State of N.Y. v. Serio, 100 N.Y.2d 854, 862–863 [2003]; Nir, 17 Misc.3d 134[A], 2007 N.Y. Slip Op 52124[U] ). In opposition to MVAIC's motion for summary judgment, plaintiff demonstrated that, after receiving MVAIC's denial of claim form, it sent MVAIC a letter advising that it had previously submitted the claim to an insurance company within 45 days after the services had been rendered. However, plaintiff did not establish that it had provided MVAIC with a written justification as to why it had initially submitted the claim to that insurance company and that, after learning that the claim was to be submitted to MVAIC, plaintiff did so within a reasonable period of time. As a result, plaintiff did not establish that it had provided MVAIC with a “written justification” for its untimely submission to MVAIC of the claim form.
Accordingly, the order is reversed and MVAIC's motion for summary judgment dismissing the complaint is granted.