| Hospital for Joint Diseases v New York Cent. Mut. Fire Ins.Co. |
| 2007 NY Slip Op 08038 [44 AD3d 903] |
| October 23, 2007 |
| Appellate Division, Second Department |
| Hospital for Joint Diseases, as Assignee of Tami Cohen, et al.,Appellants, v New York Central Mutual Fire Insurance Company,Respondent. |
—[*1] Law Offices of Peter X. Dodge, P.C., Melville, N.Y. (Sean T. Carew and Alex Monroy ofcounsel), for respondent.
In an action to recover no-fault medical payments under insurance contracts, the plaintiffsappeal from so much of an order of the Supreme Court, Nassau County (Palmieri, J.), dated April11, 2007, as denied that branch of their motion which was for summary judgment on the firstcause of action to recover payments for medical services rendered by the plaintiff Hospital forJoint Diseases, as assignee of Tami Cohen, and, upon searching the record, awarded thedefendant summary judgment dismissing the first cause of action.
Ordered that the appeals by the plaintiffs Westchester County Medical Center, as assignee ofIesa Rivera, and Mary Immaculate Hospital, as assignee of Dwayne Cumberbatch, are dismissed,as those plaintiffs are not aggrieved by the order appealed from (see CPLR 5511); and itis further,
Ordered that the order is affirmed insofar as appealed from by the plaintiff Hospital for JointDiseases, as assignee of Tami Cohen; and it is further,
Ordered that one bill of costs is awarded to the respondent.
Pursuant to the statutory and regulatory framework governing the payment of no-faultautomobile insurance benefits, insurance companies are required either to pay or deny a claim forbenefits within 30 days of receipt of the claim (see Insurance Law § 5106 [a]; 11NYCRR 65-3.8 [c]). However, the 30-day period in which to pay or deny a claim may beextended where the insurer [*2]makes a request for additionalinformation within 15 business days of its receipt of the claim (see 11 NYCRR 65-3.5[b]; New York & Presbyt. Hosp. vAllstate Ins. Co., 31 AD3d 512, 513 [2006]; Hospital for Joint Diseases v ELRAC, Inc., 11 AD3d 432, 434[2004]; New York & Presbyt. Hosp. vProgressive Cas. Ins. Co., 5 AD3d 568, 569 [2004]), and an insurer is not obligated topay or deny a claim until all demanded verification is provided (see Mount Sinai Hosp. v Chubb Group ofIns. Cos., 43 AD3d 889 [2007]; New York & Presbyt. Hosp. v Allstate Ins. Co.,31 AD3d at 513; Central Suffolk Hosp.v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492, 493 [2005]).
The plaintiff Hospital for Joint Diseases, as assignee of Tami Cohen (hereinafter the hospital)made a prima facie showing of its entitlement to judgment as a matter of law on the first cause ofaction to recover payment for medical services by submitting, inter alia, the requisite billingforms, a certified mail receipt referencing the patient, a signed return receipt card alsoreferencing the patient, and the affidavit of its biller averring that the defendant failed to pay thebill or issue a timely denial of claim form within 30 days (see Westchester Med. Ctr. v Safeco Ins. Co. of Am., 40 AD3d 984[2007]; New York Univ. Hosp. RuskInst. v Government Empls. Ins. Co., 39 AD3d 832 [2007]; New York & Presbyt. Hosp. v TravelersProp. Cas. Ins. Co., 37 AD3d 683, 683-684 [2007]; Westchester Med. Ctr. v AIG, Inc., 36 AD3d 900 [2007]).However, in opposition to the motion, the defendant submitted evidentiary proof that it timelyrequested additional information from the hospital to verify its claim, and that when therequested information was not received, it made a timely follow-up request. The defendant alsooffered unrebutted proof that the hospital ignored its verification requests. Since the requestedverification was not provided, the 30-day period within which the defendant was obligated to payor deny the hospital's claim did not begin to run (see Hospital for Joint Diseases v ELRAC, Inc., 11 AD3d 432[2004]; Hospital for Joint Diseases vState Farm Mut. Auto. Ins. Co., 8 AD3d 533, 534-535 [2004]; Westchester CountyMed. Ctr. v New York Cent. Mut. Fire Ins. Co., 262 AD2d 553, 555 [1999]), and the firstcause of action was premature.
The hospital's contention that the additional information which the defendant requested toverify its claim was improper or irrelevant is advanced for the first time on appeal, and thus is notproperly before this Court (see Ozelkanv Tyree Bros. Envtl. Servs., Inc., 29 AD3d 877 [2006]; Hospital for Joint Diseases v HertzCorp., 9 AD3d 391, 392 [2004]; St. Vincent's Hosp. & Med. Ctr. v Allstate Ins.Co., 294 AD2d 425, 426 [2002]; Weber v Jacobs, 289 AD2d 226, 227 [2001]; St.Clare's Hosp. v Allstate Ins. Co., 215 AD2d 641, 642 [1995]). Crane, J.P., Spolzino,Krausman and McCarthy, JJ., concur.