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ALUR MED. SUP. v. PROGRESSIVE INS.

Appellate Term of the Supreme Court of New York, Second Department
Nov 5, 2008
2008 N.Y. Slip Op. 52191 (N.Y. App. Term 2008)

Opinion

2007-1609 Q C.

Decided November 5, 2008.

Appeal from an order of the Civil Court of the City of New York, Queens County (Diane A. Lebedeff, J.), entered August 28, 2007, deemed from a judgment of said court entered September 26, 2007 (see CPLR 5512 [a]; Neuman v Otto, 114 AD2d 791). The judgment, entered pursuant to the August 28, 2007 order granting plaintiff's motion for summary judgment, awarded plaintiff the principal sum of $740.25.

Judgment affirmed without costs.

PRESENT: PESCE, P.J., WESTON PATTERSON and RIOS, JJ.


In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment, asserting, among other things, that defendant had failed to timely deny the claim. The court granted plaintiff's motion, holding that the statutory time period in which defendant had to pay or deny the claim was not tolled because defendant's follow-up verification request letter was premature. The instant appeal by defendant ensued.

Since defendant raises no issue on appeal with respect to plaintiff's establishment of its prima facie entitlement to summary judgment, we do not pass on the propriety of the determination of the court below with respect thereto.

In opposition to plaintiff's motion, defendant argued that the statutory time period in which it had to pay or deny the claim was tolled due to the assignor's delay in appearing for an examination under oath (EUO). However, contrary to defendant's contention, the September 19, 2006 letter did not constitute a proper request for verification since it neither demanded nor required a response ( see New York Presbyt. Hosp. v Eagle Ins. Co. , 17 AD3d 646 ; Englinton Med. P.C. v MVAIC , 14 Misc 3d 135 [A], 2007 NY Slip Op 50164[U] [App Term, 2d 11th Jud Dists 2007]). Consequently, the 30-day claim determination period ( see Insurance Department Regulations [ 11 NYCRR] § 65-3.8 [c]) was not tolled, and defendant's denial of claim form was untimely. As a result, defendant was precluded from raising most defenses, including its proffered defense of lack of medical necessity ( see Presbyterian Hosp. in City of N.Y. v Maryland Cas. Co., 90 NY2d 274, 282). Accordingly, the judgment is affirmed.

In view of the foregoing, we pass on no other issue.

Pesce, P.J., Weston Patterson and Rios, JJ., concur.


Summaries of

ALUR MED. SUP. v. PROGRESSIVE INS.

Appellate Term of the Supreme Court of New York, Second Department
Nov 5, 2008
2008 N.Y. Slip Op. 52191 (N.Y. App. Term 2008)
Case details for

ALUR MED. SUP. v. PROGRESSIVE INS.

Case Details

Full title:ALUR MEDICAL SUPPLY, Inc. a/a/o JEREMY CALDERON, Respondent, v…

Court:Appellate Term of the Supreme Court of New York, Second Department

Date published: Nov 5, 2008

Citations

2008 N.Y. Slip Op. 52191 (N.Y. App. Term 2008)