Fair Price Med. Supply Corp. v Clarendon Natl. Ins. Co.

[*1] Fair Price Med. Supply Corp. v Clarendon Natl. Ins. Co. 2007 NY Slip Op 50639(U) [15 Misc 3d 130(A)] Decided on March 30, 2007 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 This opinion is uncorrected and will not be published in the printed Official Reports.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 30, 2007
SUPREME COURT OF THE STATE OF NEW YORK
APPELLATE TERM: 2nd and 11th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., WESTON PATTERSON and GOLIA, JJ
2005-1796 K C.

Fair Price Medical Supply Corp. a/a/o Serkan Erdas, Appellant,

against

Clarendon National Insurance Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Eileen Nadelson, J.), entered September 29, 2005. The order denied plaintiff's motion for summary judgment.

Order affirmed without costs.

In this action to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment. In opposition, defendant asserted that it timely denied the claim on the ground of medical necessity based upon a peer review performed once the requested verification was received. The court denied plaintiff's motion for summary judgment and this appeal by plaintiff ensued. On appeal, plaintiff contends, inter alia, that it was entitled to summary judgment because defendant failed to establish timely mailing of the verification requests and the denial of claim form.

Contrary to plaintiff's contention, the affidavits submitted by defendant sufficiently established the timely mailing of the initial and follow-up verification requests as well as the denial of claim form since they described in detail the standard office practice and procedure used to ensure that the verification requests and denial of claim form were properly addressed and mailed (see New York & Presbyt. Hosp. v Allstate Ins. Co., 29 AD3d 547 [2006]; Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [2001]).

Plaintiff further contends that the denial of claim form was defective since it was issued by Media Referral, Inc. which, plaintiff alleged, was acting as an independent insurance adjuster without a license (see Insurance Law § 2101 [g] [1]; § 2102 [a] [1]). However, plaintiff failed to establish the foregoing. Indeed, the affidavit by the representative of Media Referral, Inc. merely set forth that Media Referral, Inc. mailed verification requests, scheduled a peer review [*2]and mailed a denial of claim form at the specific request and on behalf of defendant.

In light of the foregoing, the order is affirmed.

Pesce, P.J., Weston Patterson and Golia, JJ., concur.
Decision Date: March 30, 2007