In Line Chiropractic, P.C. v Motor Veh. Acc. Indem. Corp.
Annotate this CaseDecided on January 25, 2005
Civil Court of the City of New York, Bronx County
IN LINE CHIROPRACTIC, P.C. Assignee of DEMOND WEBB, Plaintiff,
against
MOTOR VEHICLE ACCIDENT INDEMNIFICATION CORPORATION, Defendant.
73238BCV2002
Larry S. Schachner, J.
Upon the papers submitted and after oral argument, the defendant's motion for summary judgment is decided as follows:
Plaintiff, a medical provider, commenced this action to recover unpaid first-party no-fault insurance health service benefits rendered to Demond Webb, the assignor of its claims. Defendant now moves for summary judgment dismissing plaintiff's complaint upon the ground that plaintiff violated the 3-year Statute of Limitations as it applies to defendant Motor Vehicle Accident Indemnification Corporation ("MVAIC").
In support of its motion for summary judgment, defendant submits, among other things, a copy of the pleadings and an affidavit from its Claims Examiner, Rod Kinsey, in which he avers that the subject motor vehicle accident occurred on July 9, 1999; the instant complaint was brought against MVAIC on September 27, 2002; and MVAIC declined payment for the medical services rendered to plaintiff's assignor because plaintiff violated the 3-year Statute of Limitations by bringing its claim more than 3 years after the claim had accrued. Defendant asserts that the 3-year Statute of Limitations begins to accrue from the date of the accident.In opposition to the motion, plaintiff submits a copy of the denial of claim form indicating, among other things, the dates that the bills were received by the insurer, to wit, November 15 and December 20, 1999 and January 28, 2000; and that all were denied on May 31, 2002. Plaintiff contends that its cause of action begins to accrue on the date the denial is issued.
There is no dispute between the parties that the 3-year Stature of Limitations is applicable to the instant matter. See generally, Motor Veh. Acc. Indem. Corp. v Aetna Cas. & Sur. Co., 89 NY2d 214 (1996). Rather, the issue before this court is when does the 3-year Statute of Limitations begin to run from the date of the accident, from the date the denial is issued, or, from the time a cause of action accrues in accordance with the applicable statutory framework.
Generally, the applicable Statute of Limitations is activated once a cause of action [*2]accrues. id. at 221 (citing CPLR 203 [a]; 1 Weinstein-Korn-Miller, NY Civ Prac ¶ 203.01, at 2-83). Moreover, for the purpose of determining the Statute of Limitations, a cause of action accrues "when all of the facts necessary to the cause of action have occurred so that the party would be entitled to obtain relief in court." id. (quoting Aetna Life & Cas. Co. v Nelson, 67 NY2d 169, 175 [1986]). Further, in order to recover in an action where liability is created or imposed by statute, commencement of the action must be in accordance with the language of the statute generating the liability. id. (citations omitted).
Insurance Law § 5106 (a) requires insurers to either pay claims within 30 days of submission of proof that the claimant was involved in an automobile accident and the amount of loss sustained, or, issue a denial of the claim on the appropriate form. See also, 11 NYCRR 65-3.8 (c). Failure to either pay or deny the claim in whole or in part within 30 calendar days renders the claim overdue and precludes the insurer from denying the claim. Insurance Law
§ 5106 (a); 11 NYCRR 65-3.8 (c). However, the insurer has 10 business days from receipt of the completed claim application for motor vehicle no-fault benefits to forward any prescribed verification forms required prior to payment of the initial claim. 11 NYCRR 65-3.5 (a). The insurer also has 15 business days from receipt of the completed prescribed verification form(s) to request any subsequent additional verification. 11 NYCRR 65-3.5 (b). But, the insurer must schedule any requested additional verification that is a medical examination within 30 calendar days from the date of receipt of the prescribed verification forms. 11 NYCRR 65-3.5 (d).
Thus, if no additional verification is requested tolling the period an insurer has to pay or deny a claim, then a cause of action accrues once the claim is overdue. If the denial is timely issued then the cause of action, for purposes of measuring the Statute of Limitations period, would accrue from the date of the denial. In the instant matter, the denial form indicates receipt of the bills on November 15, 1999, December 20, 1999 and January 28, 2000, and there is no supporting documentation in the papers before the court of any requested additional verification that tolled the 30-day rule even though the reason for the denial, dated May 31, 2002, indicates that the "claim loss was not proven or verifyable" (sic). Since the facts of this case indicate that none of the submitted claims were paid or denied within 30 days of receipt, all of the facts necessary to the causes of action occurred and plaintiff would be entitled to obtain relief in court after the 30th day. Therefore, the 3-year Statute of Limitations was triggered once the 30-day period expired and the claims became overdue as, at that point, all the facts necessary to the causes of action had occurred. As plaintiff commenced this action by service of summons and complaint on or about September 27, 2002, the action is not time barred.
Accordingly, defendant's motion for summary judgment dismissing plaintiff's complaint is denied.
This constitutes the decision and order of the court.
___________________________LARRY S. SCHACHNER, J.C.C.[*3]
Dated: January 25, 2005
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