Mount Sinai Hospital v. Allstate Insurance Co.

9 Citing cases

  1. Westchester Medical Center v. Country Wide Ins. Co.

    84 A.D.3d 790 (N.Y. App. Div. 2011)

    Ordered that one bill of costs is awarded to the defendant. The plaintiff New York Hospital Medical Center of Queens, as assignee of Merna Ishak (hereinafter the plaintiff), established, prima facie, its entitlement to judgment as a matter of law on the second cause of action by demonstrating that the necessary billing forms were mailed to and received by the defendant and that payment of no-fault benefits was overdue ( see Insurance Law § 5106 [a]; 11 NYCRR 65-3.8 [a] [1]; Wyckoff Hgts. Med. Ctr. v Country-Wide Ins. Co., 71 AD3d 1009, 1010, lv granted 15 NY3d 709; New York Presbyt. Hosp. v Countrywide Ins. Co., 44 AD3d 729, 730). However, in opposition, the defendant raised a triable issue of fact as to whether the plaintiff fully complied with the defendant's demand for verification ( see St. Barnabas Hosp. v American Tr. Ins. Co., 57 AD3d 517, 518; Westchester Med. Ctr. v Allstate Ins. Co., 53 AD3d 481; Mount Sinai Hosp. v Allstate Ins. Co., 25 AD3d 673, 674). The defendant was not obligated to pay or deny the claim until all demanded verification was provided by the plaintiff ( see St. Barnabas Hosp. v American Tr. Ins. Co., 57 AD3d at 518).

  2. Barnabas Hosp. v. American Transit

    57 A.D.3d 517 (N.Y. App. Div. 2008)   Cited 14 times

    The plaintiff St. Barnabas Hospital, as assignee of Miguel Jimenez (hereinafter the Hospital), made a prima facie showing of entitlement to judgment as a matter of law on the first cause of action to recover no-fault benefits by demonstrating that the prescribed statutory billing forms were mailed to and received by the defendant and that payment was overdue ( see Westchester Med. Ctr. v Allstate Ins. Co., 53 AD3d 481; Hospital for Joint Diseases v New York Cent. Mut. Fire Ins. Co., 44 AD3d 903, 904; New York Presbyt. Hosp. v Countrywide Ins. Co., 44 AD3d 729, 730). However, in opposition, the defendant raised a triable issue of fact as to whether the Hospital timely complied with the demand for verification ( see Mount Sinai Hosp. v Allstate Ins. Co., 25 AD3d 673, 674). The defendant was not obligated to pay or deny the claim until all demanded verification was provided by the Hospital ( see New York Presbyt. Hosp. v Allstate Ins. Co., 31 AD3d 512, 513; Nyack Hosp. v General Motors Acceptance Corp., 27 AD3d 96, 100-101, mod on other grounds 8 NY3d 294; Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492, 493).

  3. New York University Hospital Rusk Institute v. Illinois National Insurance

    31 A.D.3d 511 (N.Y. App. Div. 2006)   Cited 9 times

    "A [defendant] seeking to vacate a default judgment pursuant to CPLR 5015 (a) (1) 'must demonstrate a reasonable excuse for its delay in appearing and answering the complaint and a meritorious defense to the action'" ( New York Presbyt. Hosp. v American Home Assur. Co., 28 AD3d 442, quoting Eugene Di Lorenzo, Inc. v A.C. Button Lbr. Co., 67 NY2d 138, 141). The defendants established both a reasonable excuse for their failure to timely appear and answer the complaint and potentially meritorious defenses, namely, the failure of the plaintiff New York University Hospital Rusk Institute to comply with the defendants' demands for verification of the claim ( see 11 NYCRR 65-3.8 [a] [1]; Mount Sinai Hosp. v All-state Ins. Co., 25 AD3d 673, 674; Nyack Hosp. v General Motors Acceptance Corp., 27 AD3d 96) and the alleged exhaustion of the policy limits through payment of prior claims ( see Mount Sinai v Allstate Ins. Co., 28 AD3d 727; New York Presbyt. Hosp. v Allstate Ins. Co., 12 AD3d 579). Accordingly, in view of the strong public policy that actions be resolved on their merits, the relatively brief delay involved, the defendants' lack of wilfulness, and the absence of prejudice to the plaintiff, the Supreme Court improvidently exercised its discretion in denying the defendants' motion, inter alia, to vacate the December 8, 2004, judgment ( see New York Presbyt. Hosp. v American Home Assur. Co., supra; New York Presbyt. Hosp. v Auto One Ins. Co., 28 AD3d 441; New York Presbyt. Hosp. v Travelers Prop. Cas. Ins. Co., 27 AD3d 708; Hospital for Joint Diseases v Dollar Rent A Car, 25 AD3d 534).

  4. Bronx Expert Radiology, P.C. v. Travelers Ins. Co.

    2006 N.Y. Slip Op. 51251 (N.Y. App. Term 2006)

    On the record developed below, issues of fact exist as to whether plaintiff complied with defendant's verification request. The evidence submitted by plaintiff in opposition to defendant's cross motion for summary judgment, while insufficient to conclusively establish that plaintiff responded to defendant's demand for verification, sufficed to raise an issue of fact as to whether plaintiff mailed the verifications ( see Mount Sinai Hosp. v. Allstate Ins. Co., 25 AD3d 673; cf. Central Suffolk Hosp. v. New York Cen. Mut. Fire Ins. Co., 24 AD3d 492).

  5. Country-Wide Ins. Co. v. Senat

    2016 N.Y. Slip Op. 30647 (N.Y. Sup. Ct. 2016)

    The cases on which petitioner rely instead merely state the general principal that an insurer is not obligated to issue a denial of claim form until it receives the additional verification requested pursuant to 11 NYCRR § 65-3.5(b). See, e.g., Mt. Sinai Hosp. v. Allstate Ins. Co., 25 A.D.3d 673, 674 (2nd Dept 2006) (holding that a request for medical records tolled the insurer's time to pay or deny the claim). Arbitrator Marotta's interpretation of the law to require an insurer to establish that it timely scheduled the EUOs where EUO no-shows serve as the basis for the denial of the claim, notwithstanding the fact that the insurer had not yet received unrelated information it previously requested, was not in error.

  6. New York Hosp. Med. Ctr. of Queens v. Country Wide Ins. Co.

    2011 N.Y. Slip Op. 32415 (N.Y. Sup. Ct. 2011)

    An insurer does not have to pay or deny a claim until it has received verification of all of the relevant information requested. See, Montefiore Medical Center v Government Employees Ins. Co., 34 AD3d 771 (2nd Dept 2006); see also, Mount Sinai Hosp. v Allstate Ins. Co., 25 AD3d 673, 674 (2nd Dept 2006). Interest only accrues when payment of a no-fault claim is "overdue."

  7. N.Y. Hosp. Med. Ctr. v. Country Wide Ins. Co.

    2011 N.Y. Slip Op. 32415 (N.Y. Sup. Ct. 2011)

    An insurer does not have to pay or deny a claim until it has received verification of all of the relevant information requested. See, Montefiore Medical Center v Government Employees Ins. Co., 34 AD3d 771 (2nd Dept 2006);see also, Mount Sinai Hosp. v Allstate Ins. Co., 25 AD3d 673, 674 (2nd Dept 2006). Interest only accrues when payment of a no-fault claim is "overdue."

  8. Westchester Med. Ctr. v. Country Wide Ins. Co.

    84 A.D.3d 790 (N.Y. Sup. Ct. 2011)

    The plaintiff New York Hospital Medical Center of Queens, as assignee of Merna Ishak (hereinafter the plaintiff), established, prima facie, its entitlement to judgment as a matter of law on the second cause of action by demonstrating that the necessary billing forms were mailed to and received by the defendant and that payment of no-fault benefits was overdue ( see Insurance Law § 5106 [a]; 11 NYCRR 65–3.8[a][1]; Wyckoff Hgts. Med. Ctr. v. Country–Wide Ins. Co., 71 A.D.3d 1009, 1010, 896 N.Y.S.2d 691,lv. granted15 N.Y.3d 709, 909 N.Y.S.2d 23, 935 N.E.2d 815;New York & Presbyt. Hosp. v. Countrywide Ins. Co., 44 A.D.3d 729, 730, 843 N.Y.S.2d 662). However, in opposition, the defendant raised a triable issue of fact as to whether the plaintiff fully complied with the defendant's demand for verification ( see St. Barnabas Hosp. v. American Tr. Ins. Co., 57 A.D.3d 517, 518, 869 N.Y.S.2d 149;Westchester Med. Ctr. v. Allstate Ins. Co., 53 A.D.3d 481, 859 N.Y.S.2d 567;Mount Sinai Hosp. v. Allstate Ins. Co., 25 A.D.3d 673, 674, 811 N.Y.S.2d 726). The defendant was not obligated to pay or deny the claim until all demanded verification was provided by the plaintiff ( see St. Barnabas Hosp. v. American Tr. Ins. Co., 57 A.D.3d at 518, 869 N.Y.S.2d 149).

  9. Perfect Point Acupuncture, P.C. v. Auto One Ins.

    2010 N.Y. Slip Op. 50010 (N.Y. Civ. Ct. 2010)

    If the verification is not provided 30 calendar days after the original request, "[a]t a minimum . . . the insurer shall, within 10 calendar days, follow up with the party from whom the verification was requested, either by telephone call, properly documented in the file, or by mail" ( 11 NYCRR 65-3.6[b]). An insurer does not have to pay or deny a claim until it has received verification of all of the relevant information requested (see e.g. Montefiore Med. Ctr. v Gov'tEmpls. Ins. Co. , 34 AD3d 771 [2d Dept 2006]; see also Mount Sinai Hosp. vAllstate Ins. Co. , 25 AD3d 673, 674 [2d Dept 2006]).