Olmecs Med. Supplies, Inc. v Motor Veh. Acc. Indem. Corp.
Annotate this CaseDecided on May 9, 2006
Suffolk District Court
Olmecs Medical Supplies, Inc., a/a/o Regine Dieujuste, Plaintiff,
against
Motor Vehicle Accident Indemnification Corporation, Defendant.
HUC 2698-03
C. Stephen Hackeling, J.
This is an action brought by Olmecs Medical Supplies, a/a/o Regine Dieujuste, against the Motor Vehicle Accident Indemnification Corporation ("MVAIC") to recover unpaid medical bills. The Court notes that the Third Cause of Action for Plaintiff Radiology Imaging Associates, PC a/a/o Soo Yun Maeng has been settled and discontinued. A stipulation is to be filed. The Defendant moves now for summary judgment dismissing the Plaintiff's action on the ground that the claimant Dieujuste, the Plaintiff's assignor, has failed to qualify for MVAIC no-fault benefits. The Plaintiff opposes the relief demanded arguing, inter alia, that the Defendant must still comply with the no-fault regulations, and therefore, must pay or deny the Plaintiff's claim within thirty (30) days from receipt of the claim, or, if the Defendant needs additional verification to process the claim, the Defendant must request such verification within ten (10) days of the receipt of the Plaintiff's claim.
On a motion for summary judgment the test to be applied is whether triable issues of fact exist or whether on the proof submitted judgment can be granted to a party as a matter of law (Andre v. Pomeroy, 35 NY2d 361). It is incumbent on the proponent of the motion to set forth a prima facie showing of entitlement to judgment as a matter of law, tendering sufficient evidence to demonstrate the absence of any material issues of fact (Alvarez v. Prospect Hospital, 68 NY2d 320). Upon the proponent making out a prima facie case, the burden shifts to the opponent of the motion to produce evidentiary proof in admissible form sufficient to establish the existence of material issues of fact (Zuckerman v. City of New York, 49 NY2d 557).
In the matter sub judice, the Court has reviewed the pleadings, the affidavits and [*2]documentary exhibits submitted. Based upon such a review, the Court is of the opinion that the Defendant, MVAIC, has failed to satisfy its burden of demonstrating a prima facie case entitling it to summary judgment as a matter of law dismissing the Plaintiff's cause of action.
The Defendant argues that the Plaintiff failed to establish that Plaintiff's assignor was qualified to make a claim against MVAIC. More specifically, the Defendant contends that the Plaintiff's assignor is not qualified for MVAIC benefits since he failed to provide a copy of the police report and ambulance report, as well as failed to provide a notarized affidavit providing proof of lack of insurance within the household on the date of loss. Hence, the Defendant argues that Regine Dieujuste, the Plaintiff's assignor, is not a "qualified person" under Insurance Law §5202(b) and, as such, he had no rights to assign to the Plaintiff. The Plaintiff in opposition to the Defendant's motion argues, inter alia, that its claim for benefits was submitted to the Defendant, and that the Defendant did not timely deny the claim or timely demand additional verification.
The Court notes that the Plaintiff's assignor did file within 180 days of the accrual of the cause of action an affidavit of his intention to file a claim as is required by Insurance Law §5208[a][1], which is a condition precedent to the right to apply for payment from the Defendant (see, Ocean Diagnostic Imaging v. MVAIC, 803 NYS2d 19, 2005 {8 Misc 3d 137(A)} WL 1919996, 2005 NY slip Op. 51271[U]). The assignor's timely filing of a Notice of Intention to Make a Claim is supported by the Defendant's own correspondence annexed to the moving papers as Exhibit B.
MVAIC is subject to the same thirty (30) day time requirement as is applicable to an insurer subject to Article 51 of the Insurance Law (see, New York Hospital Medical Center of Queens v. MVAIC, 12 AD3d 429 [2d Dept., 2004]; Insurance Law §5221[b][3]). MVAIC must pay or deny a claim within thirty (30) days of receipt or must extend the time by requesting verification. Importantly, the thirty (30) day period starts to run whether or not the injured party has been qualified (see, New York Hospital Medical Center of Queens v. MVAIC, Id.). The Appellate Division, Second Department, has stated on this issue that "[w]e reject the Defendant's contention that the 30-day time requirement contained in 11 NYCRR 65.15 (g) (3) does not apply to it until after it has 'qualified' an injured party... Moreover, the subject regulation expressly applies to the defendant [see, 11 NYCRR 65.15]. To permit the Defendant to obviate the 30-day time requirement would frustrate the purpose and objective of the No-Fault Law..." (New York Hospital Medical Center of Queens v. MVAIC, supra ). Further, the Appellate Term, 2d & 11th Judicial Districts has recently held that "the 30-day time requirement, which applies to Defendant Motor Vehicle Accident Indemnification Corp. ... begins to run 'after proof of claim is received' [11 NYCRR 65.15(g)(3)] and not after Defendant has 'qualified' an eligible insured..." (A.B. Medical Services PLLC v. Motor Vehicle Accident Indemnification Corp., 6 Misc 3d 131(A), 2005 WL 263757 [NY Sup. App. Term, Feb. 1, 2005]).
Hence, in the matter sub judice, the Defendant's argument that it is entitled to summary judgment dismissing the Plaintiff's complaint since the Plaintiff's claimant failed to qualify for [*3]MVAIC benefits is without merit. Under the circumstances of this case, demonstrating that a claimant/assignor is a "qualified person" under the Insurance Law is not a condition precedent to making a no-fault claim to the MVAIC, and when a claim is submitted setting forth the fact and amount of the loss sustained, the Defendant's thirty (30) day time requirement begins to run after the proof of claim is received by MVAIC and not after the Defendant has qualified the claimant. In the instant action, since the Defendant's Qualifications Examiner avers that she was responsible for the Plaintiff's claim, and since the Defendant failed to pay or deny the claim within thirty (30) days or to request additional verification within ten (10) days, there is no ground to support the Defendant's motion to dismiss the Plaintiff's complaint.
Accordingly, the Defendant's motion is denied.
Dated: May 9, 2006_________________________
J.D.C.
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