| Westchester Med. Ctr. v Countrywide Ins. Co. |
| 2007 NY Slip Op 09024 [45 AD3d 676] |
| November 13, 2007 |
| Appellate Division, Second Department |
| Westchester Medical Center, Respondent, v CountrywideInsurance Company, Appellant. |
—[*1] Joseph Henig, P.C., Bellmore, N.Y., for respondent.
In an action to recover no-fault medical payments, the defendant appeals from a judgment ofthe Supreme Court, Nassau County (Jonas, J.), entered August 23, 2006, which, upon an order ofthe same court dated August 14, 2006, granting the plaintiff's motion for summary judgment onthe complaint and denying its cross motion for summary judgment dismissing the first cause ofaction, is in favor of the plaintiff and against it in the principal sum of $13,491.40.
Ordered that the judgment is affirmed, with costs.
In support of its motion for summary judgment, the plaintiff demonstrated its prima facieentitlement to judgment as a matter of law by submitting, inter alia, the requisite billing forms,the affidavits from its billers, as well as the certified mail receipts, and the signed return receiptcards which referenced the patients and the forms (see New York & Presbyt. Hosp. v Travelers Prop. Cas. Ins. Co., 37AD3d 683 [2007]; Hospital forJoint Diseases v Travelers Prop. Cas. Ins. Co., 34 AD3d 532 [2006]; New York & Presbyt. Hosp. v Allstate Ins.Co., 30 AD3d 492, 493 [2006]). This evidence demonstrated that the defendant receivedproof of the claims and failed to pay the bills or issue a denial of claim form within the requisite30-day period (see Insurance Law § 5106 [a]; 11 NYCRR 65-3.8 [a]).
In opposition to the plaintiff's motion, the defendant failed to raise a triable issue of fact, andin support of its cross motion for summary judgment dismissing the first cause of action, thedefendant failed to make a prima facie showing of its entitlement to judgment as a matter of law.The defendant contended that the claim for payment with respect to the first cause of action was[*2]premature because the plaintiff had failed to respond to itsverification requests (see 11 NYCRR 65-3.5 [b]; New York & Presbyt. Hosp. v Progressive Cas. Ins. Co., 5 AD3d568, 570 [2004]). The defendant submitted the affidavit of a supervisor employed in itsclaims department, which stated, with respect to the first cause of action, that a timelyverification request was mailed on August 11, 2005, and a follow-up request was mailed onSeptember 10, 2005. The supervisor, however, had no personal knowledge that the verificationrequests were actually mailed on the dates they were issued, and her conclusory allegationsregarding the defendant's office practice and procedure failed to establish that the practice andprocedure was designed to ensure that the verification requests were addressed to the properparty and properly mailed (see Matter of Phoenix Ins. Co. v Tasch, 306 AD2d 288[2003]; Hospital for Joint Diseases v Nationwide Mut. Ins. Co., 284 AD2d 374, 375[2001]; Matter of Government Empls. Ins. Co. [Hartford Ins. Co.], 112 AD2d 226,227-228 [1985]). The defendant's submissions were insufficient to create a presumption that theverification requests were received by the proper party (see Matter of Gonzalez [Ross],47 NY2d 922, 923 [1979]; Nassau Ins. Co. v Murray, 46 NY2d 828 [1978]; New York & Presbyt. Hosp. v Allstate Ins.Co., 29 AD3d 547 [2006]; New York & Presbyt. Hosp. v Progressive Cas. Ins.Co., 5 AD3d at 568; Matter of Phoenix Ins. Co. v Tasch, 306 AD2d 288 [2003]).Furthermore, the defendant's failure to timely object to the completeness of the assignment ofbenefits forms or to seek verification of the assignments constituted a waiver of any defensesbased thereon (see Hospital for JointDiseases v Travelers Prop. Cas. Ins. Co., 34 AD3d 532 [2006]; Nyack Hosp. v Encompass Ins. Co., 23AD3d 535 [2005]; Hospital forJoint Diseases v Allstate Ins. Co., 21 AD3d 348 [2005]). Accordingly, the SupremeCourt properly granted the motion and denied the cross motion. Spolzino, J.P., Krausman, Carniand Dickerson, JJ., concur.