| St. Barnabas Hosp. v Allstate Ins. Co. |
| 2009 NY Slip Op 07824 [66 AD3d 996] |
| October 27, 2009 |
| Appellate Division, Second Department |
| St. Barnabas Hospital, as Assignee of Patrick Bateman,Respondent, et al., Plaintiff, v Allstate Insurance Company,Appellant. |
—[*1] Joseph Henig, P.C., Bellmore, N.Y., for respondent.
In an action to recover no-fault medical payments under two insurance contracts, thedefendant appeals, as limited by its brief, from so much of an order of the Supreme Court,Nassau County (Woodard, J.), entered September 25, 2008, as denied that branch of its motionwhich was pursuant to CPLR 5015 to vacate so much of a judgment of the same court enteredMay 15, 2008, as, upon its default in appearing or answering the complaint, is in favor of theplaintiff St. Barnabas Hospital, as assignee of Patrick Bateman, and against it in the principalsum of $4,309.64.
Ordered that the order is affirmed insofar as appealed from, with costs.
A defendant seeking to vacate a judgment entered upon its default in appearing or answeringthe complaint must demonstrate a reasonable excuse for its delay in appearing or answering, aswell as a meritorious defense to the action (see CPLR 5015 [a] [1]; Westchester Med. Ctr. v Hartford Cas. Ins.Co., 58 AD3d 832, 832 [2009]; Verde Elec. Corp. v Federal Ins. Co., 50 AD3d 672, 672-673[2008]).
"A proper denial of [a] claim [for no-fault benefits] must include the information called forin the prescribed denial of claim form (see 11 NYCRR 65-3.4 [c] [11]) and must'promptly apprise the claimant with a high degree of specificity of the ground or grounds onwhich the disclaimer is predicated' " (Nyack Hosp. v State Farm Mut. Auto. Ins. Co., 11 AD3d 664, 664[2004], quoting General Acc. Ins. Group v Cirucci, 46 NY2d 862, 864 [1979]).However, a timely denial of a no-fault insurance medical claim alone does not avoid preclusionwhere said denial is factually insufficient, conclusory, vague, or otherwise involves a defensewhich has no merit as a matter of law (see Nyack Hosp. v Metropolitan Prop. & Cas. Ins. Co., 16 AD3d564, 565 [2005]).
The defendant insurer, Allstate Insurance Company (hereinafter Allstate), issued a timelydenial of claim within 30 days of its receipt of the completed hospital facility form (NYS FormN-F 5) from the plaintiff St. Barnabas Hospital, as assignee of Patrick Bateman (hereinafter theplaintiff) (see 11 NYCRR 65-3.5 [g]; 65-3.8 [c]). Contrary to Allstate's contention,however, the Supreme Court properly determined that the denial of claim, which incorrectlystated the amount of the claim and gave an invalid reason for the denial (see 11 NYCRR65-3.3 [d]; 65-3.5 [g]; see alsoWestchester Med. Ctr. v Lincoln [*2]Gen. Ins. Co., 60 AD3d1045, 1046 [2009]; Nyack Hosp. vEncompass Ins. Co., 23 AD3d 535, 536 [2005]), was fatally defective (see NyackHosp. v Metropolitan Prop. & Cas. Ins. Co., 16 AD3d at 565; Nyack Hosp. v State FarmMut. Auto. Ins. Co., 11 AD3d at 665; Presbyterian Hosp. in City of N.Y. v MarylandCas. Co., 226 AD2d 613, 614 [1996]). Thus, Allstate failed to demonstrate the existence of ameritorious defense (see CPLR 5015 [a] [1]).
Accordingly, the Supreme Court properly denied that branch of Allstate's motion which waspursuant to CPLR 5015 to vacate so much of a judgment of the same court entered May 15,2008, as, upon its default in appearing or answering the complaint, is in favor of the plaintiff andagainst it in the principal sum of $4,309.64. Skelos, J.P., Covello, Santucci and Balkin, JJ.,concur.