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Careplus Med. Med. Supply Inc. v. Allstate Ins.

Appellate Term of the Supreme Court of New York, Second Department
Sep 30, 2005
2005 N.Y. Slip Op. 51598 (N.Y. App. Term 2005)

Opinion

2004-1372 K C.

Decided September 30, 2005.

Appeal from an order of the Civil Court of the City of New York, Kings County (Robin Garson, J.), entered August 18, 2004. The order, insofar as appealed from, granted plaintiff's motion for summary judgment in regard to causes of action relating to assignors Romana Hernandez and Jaime Diaz.

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


Order, insofar as appealed from, unanimously reversed without costs and plaintiff's motion for summary judgment denied in causes of action relating to Romana Hernandez and Jaime Diaz.

In this action to recover first-party no-fault benefits for medical supplies rendered to their assignors, plaintiff established a prima facie entitlement to summary judgment with regard to the causes of action relating to assignors Romana Hernandez and Jaime Diaz by proof that it submitted claims, setting forth the fact and the amounts of the losses 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; Amaze Med. Supply v. Eagle Ins. Co., 2 Misc 3d 128[A], 2003 NY Slip Op 51701[U] [App Term, 2d 11th Jud Dists]). Inasmuch as defendant failed to pay or deny the claims within the 30-day prescribed period ( 11 NYCRR 65-3.8 [c]), it was precluded from raising most defenses ( see Presbyterian Hosp. in City of N.Y. v. Maryland Cas. Co., 90 NY2d 274, 282).

However, defendant was not precluded from asserting the defense that the various collisions were in furtherance of insurance fraud schemes, despite the untimely denials of the claims ( see Matter of Metro Med. Diagnostics v. Eagle Ins. Co., 293 AD2d 751). The affidavit of defendant's claims representative, that the insureds in both cases were involved in intentionally caused collisions, was sufficient to raise a triable issue of fact as to whether the claims of assignors Hernandez and Diaz were fraudulent ( see A.B. Med. Servs. PLLC v. Prudential Prop. Cas. Ins. Co., 6 Misc 3d 130[A], 2005 NY Slip Op 50076[U] [App Term, 2d 11th Jud Dists]).


Summaries of

Careplus Med. Med. Supply Inc. v. Allstate Ins.

Appellate Term of the Supreme Court of New York, Second Department
Sep 30, 2005
2005 N.Y. Slip Op. 51598 (N.Y. App. Term 2005)
Case details for

Careplus Med. Med. Supply Inc. v. Allstate Ins.

Case Details

Full title:CAREPLUS MEDICAL MEDICAL SUPPLY INC., A/A/O MYRNA ROSADO, ROMANA…

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

Date published: Sep 30, 2005

Citations

2005 N.Y. Slip Op. 51598 (N.Y. App. Term 2005)