Defendant further opposed plaintiff's motion asserting that the alleged injuries do not arise out of a covered incident ( see Central Gen. Hosp. v Chubb Group of Ins. Cos., 90 NY2d 195). However, the affidavit by an investigator for the special investigation unit of defendant failed to allege facts either upon personal knowledge or based upon evidence in admissible form with sufficient particularity to establish a "founded belief that the alleged injur[ies] do[ ] not arise out of an insured incident" ( see Central Gen. Hosp., 90 NY2d at 199; A.B. Med. Servs. v State Farm Mut. Auto. Ins. Co., 3 Misc 3d 130 [A], 2004 NY Slip Op 50387[U] [App Term, 2d 11th Jud Dists 2004]; A.B. Med. Servs. v Eagle Ins. Co, 3 Misc 3d 8 [App Term, 2d 11th Jud Dists 2003]). Consequently, the court properly granted plaintiff's motion for summary judgment and denied defendant's cross motion for summary judgment.
In the instant case, the lower court properly found that plaintiff's moving papers were insufficient to demonstrate that any of the claim forms were properly mailed. However, said deficiency was cured by defendant's acknowledgment of receipt in its denial of claim forms ( see A.B. Med. Servs. v. New York Cent. Mut. Fire Ins. Co., 3 Misc 3d 136 [A], 2004 NY Slip Op 50507[U] [App Term, 2d 11th Jud Dists]; A.B. Med. Servs. v. State Farm Mut. Auto. Ins. Co., 3 Misc 3d 130 [A], 2004 NY Slip Op 50387[U] [App Term, 2d 11th Jud Dists]) and by the admissions of the claims' receipt in the affidavits of defendant's claims adjusters. Accordingly, plaintiff established a prima facie case, and the burden then shifted to defendant to demonstrate a triable issue of fact ( see Alvarez v. Prospect Hosp., 68 NY2d 320, 324).
PRESENT: ANGIOLILLO, J.P., McCABE and TANENBAUM, JJ In this action to recover assigned first-party no-fault benefits, plaintiff health care provider failed to establish a prima facie entitlement to summary judgment since it did not adequately establish that it submitted its claim forms to defendant ( see A.B. Med. Servs. v. State Farm Mut. Auto. Ins. Co., 3 Misc 3d 130 [A], 2004 NY Slip Op 50387[U] [App Term, 2d 11th Jud Dists]). Proof of proper mailing requires evidence of "actual mailing or . . . a standard office practice or procedure designed to ensure that items are properly addressed and mailed" ( Residential Holding Corp. v. Scottsdale Ins. Co., 286 AD2d 679, 680), neither of which was demonstrated in the instant case ( see generally New York Presbyt. Hosp. v. Allstate Ins. Co., ___ AD3d ___, 2006 NY Slip Op 03558).
In his affidavit, plaintiffs' "practice and billing manager" alleged that he "issued all of the billings," that he "personally billed out the claim," and that "[a]ll billing of plaintiff was sent to defendant." The foregoing allegations in the affidavit are insufficient to demonstrate personal knowledge of the mailing of the claim forms, and do not contain an adequately detailed description of standard office mailing procedure so as to create a presumption of mailing ( see Residential Holding Corp. v. Scottsdale Ins. Co., 286 AD2d 679, 680; A.B. Med. Servs. v. State Farm Mut. Auto. Ins. Co., 3 Misc 3d 130 [A], 2004 NY Slip Op 50387[U] [App Term, 2d 11th Jud Dists]). Accordingly, having failed to establish the facts constituting the claim (CPLR 3215 [f]), namely, the submission of the claims to defendant, upon reargument, the motion by defendant for renewal should have been granted and plaintiffs' underlying motion for leave to enter a default judgment denied. Moreover, the court erred in adhering to that portion of its earlier order which denied renewal of the underlying cross motion.
In an action to recover first-party no-fault benefits, a plaintiff establishes a prima facie entitlement to summary judgment by proof that it submitted a claim, setting forth the fact and the amount of the loss sustained, and that payment of no-fault benefits was overdue ( see Insurance Law § 5106 [a]; Mary Immaculate Hosp. v. Allstate Ins. Co., 5 AD3d 742). In the instant case, plaintiffs failed to demonstrate an entitlement to summary judgment on the first cause of action regarding assignor Robert Gevorkov since they failed to adequately establish that they submitted the claim forms to defendant ( see A.B. Med. Servs. v. State Farm Mut. Auto. Ins. Co., 3 Misc 3d 130 [A], 2004 NY Slip Op 50387[U] [App Term, 2d 11th Jud Dists]). Proof of proper mailing requires evidence of "actual mailing or . . . a standard office practice or procedure designed to ensure that items are properly addressed and mailed" ( Residential Holding Corp. v. Scottsdale Ins. Co., 286 AD2d 679, 680; see also Matter of Rodriguez v. Wing, 251 AD2d 335, 336; Amaze Med. Supply v. Allstate Ins. Co., 2 Misc 3d 138 [A], 2004 NY Slip Op 50264[U] [App Term, 2d 11th Jud Dists]; S M Supply, Inc. v. GEICO Ins., 2003 NY Slip Op 51192[U] [App Term, 2d 11th Jud Dists]).
PRESENT: PESCE, P.J., WESTON PATTERSON and BELEN, JJ. In this action to recover first-party no-fault benefits for medical supplies provided to its assignor, plaintiff did not establish its prima facie entitlement to summary judgment since it failed to conclusively show that it submitted its claim form to defendant ( see A.B. Med. Servs. v. State Farm Mut. Auto. Ins. Co., 3 Misc 3d 130 [A], 2004 NY Slip Op 50387[U] [App Term, 2d 11th Jud Dists]). Counsel's affirmation was of no probative value since it was based upon allegations of a person without personal knowledge that the claim form was actually mailed to defendant ( see e.g. Melbourne Med., P.C. v. Utica Mut. Ins. Co., 4 Misc 3d 92 [App Term, 2d 11th Jud Dists 2004]).
The facts alleged in an entirely conclusory fashion in the attorney's affirmation in opposition to the summary judgment motion were not based on counsel's personal knowledge and, as unsubstantiated hearsay, were clearly of no probative value ( Penny v. Pembrook Mgt., 280 AD2d 590, 591; Amstel Chiropractic v. Omni Indem. Co., 2 Misc 3d 129[A], 2004 NY Slip Op 50088[U] [App Term, 2d 11th Jud Dists]). The bare conclusory statement in a claims representative's affidavit, that her file review "reveal[ed] that based upon Allstate's investigation of this claim, [assignor] engaged in staging a fraudulent accident," merited the lower court's determination that defendant failed to interpose a triable issue of fraud ( id.; Melbourne Med., P.C. v. Utica Mut. Ins. Co., 4 Misc 3d 92, 94 [App Term, 2d 11th Jud Dists 2004]; A.B. Med. Servs. v. State Farm Mut. Auto. Ins. Co., 3 Misc 3d 130[A], 2004 NY Slip Op 50387[U] [App Term, 2d 11th Jud Dists]; A.B. Med. Servs. v. Eagle Ins. Co., 3 Misc 3d 8, 9-10 [App Term, 9th 10th Jud Dists 2003]).
We have also rejected the argument that the absence of an EUO provision in the former verification scheme may be remedied by reference to policy provisions requiring that an insured cooperate with the insurer's investigation of a claim, even if a clause therein explicitly provides for cooperation in that form (e.g. King's Med. Supply v Kemper Auto & Home Ins. Co., 3 Misc 3d 131[A], 2004 NY Slip Op 50401[U] [App Term, 2d & 11th Jud Dists]). Such provisions may not be invoked to alter the terms of the mandatory no-fault endorsement because the "internally complete and distinct part of the insurance policy . . . cannot be qualified by. . . conditions . . . of the liability portions of the policy" (Utica Mut. Ins. Co. v Timms, 293 AD2d 669, 670 [2002]; A.B. Med. Servs. v State Farm Mut. Auto. Ins. Co., 3 Misc 3d 130[A], 2004 NY Slip Op 50387[U] [App Term, 2d & 11th Jud Dists]). Finally, an insurer may not rely on a letter, even if denominated a verification request, that merely informs a claimant that a decision on the claim is delayed pending an investigation, and without specifying a particular form of verification and the person or entity from whom the verification is sought, to toll the 30-day claim determination period (Ocean Diagnostic Imaging v Nationwide Mut. Ins. Co., supra; see also 11 NYCRR 65.15 [e] [2]; Sehgal v Royal Ins. Co. of Am., NYLJ, Apr. 15, 1999, at 31, col 4 [App Term, 9th & 10th Jud Dists] [letter informing claimant that a peer review was to be conducted is not a proper verification request]).
. Such provisions may not be invoked to alter the terms of the mandatory no-fault endorsement because the "internally complete and distinct part of the insurance policy . . . cannot be qualified by . . . conditions . . . of the liability portions of the policy" ( Utica Mut. Ins. Co. v. Timms, 293 AD2d 669, 670; A.B. Med. Servs. v. State Farm Mut. Auto. Ins. Co., 3 Misc 3d 130[A], 2004 NY Slip Op 50387[U] [App Term, 2d 11th Jud Dists]). Finally, an insurer may not rely on a letter, even if denominated a verification request, that merely informs a claimant that a decision on the claim is delayed pending an investigation, and without specifying a particular form of verification and the person or entity from whom the verification is sought, to toll the 30-day claim determination period ( Ocean Diagnostic Imaging v. Nationwide Mut. Ins. Co., supra; see also 11 NYCRR 65.15 [e] [2]; Sehgal v. Royal Ins. Co. of Am., NYLJ, Apr. 15, 1999, at 31, col 4 [App Term, 9th 10th Jud Dists] [letter informing claimant that a peer review was to be conducted is not a proper verification request]).