O'Brien v Group Health

[*1] O'Brien v Group Health 2004 NY Slip Op 50225(U) Decided on March 31, 2004 Appellate Term, Second Department Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on March 31, 2004
SUPREME COURT OF THE STATE OF NEW YORK
APPELLATE TERM : 2nd and 11th JUDICIAL DISTRICTS
PRESENT: ARONIN, J.P., GOLIA and RIOS, JJ.
NO. 2003-724 RI C

STEPHEN M. O'BRIEN, Appellant,

against

GROUP HEALTH INCORPORATED, Respondent.

Appeal by plaintiff from a small claims judgment of the Civil Court, Richmond County (B. Panepinto, J.), entered February 6, 2003, in favor of defendant dismissing the action.

Judgment unanimously affirmed without costs.

In this small claims action, plaintiff sought to recover the unpaid balance of an insurance claim for services rendered by a non-participating provider. The record established that defendant was willing to pay $344 towards the $960 bill but actually paid $169 because of an unsatisfied deductible amount of $175. Plaintiff argued that he was entitled to recover 80% of the insurance claim he submitted to defendant for services rendered by the non-participating provider based on an "advertisement" on defendant's website. We note that the "advertisement" is a bulletin from defendant to brokers discussing a new health care charge policy and plaintiff failed to establish that the subject "advertisement" modified plaintiff's insurance contract with defendant. Thus, plaintiff's claim is lacking in merit and the lower court's judgment in favor of defendant dismissing plaintiff's action rendered substantial justice between the parties in accordance with the rules and principles of substantive law (CCA 1807).


Decision Date: March 31, 2004