Northshore Chiropractic Diagnostics, P.C. v A. Cent. Ins. Co.

[*1] Northshore Chiropractic Diagnostics, P.C. v A. Cent. Ins. Co. 2014 NY Slip Op 51825(U) Decided on December 17, 2014 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 This opinion is uncorrected and will not be published in the printed Official Reports.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 December 17, 2014
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2012-1790 RI C

Northshore Chiropractic Diagnostics, P.C. as Assignee of JOHN JACOBS, Respondent,

against

A. Central Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Richmond County (Mary Kim Dollard, J.), entered June 28, 2012. The order denied defendant's motion for summary judgment dismissing the complaint and granted plaintiff's cross motion for summary judgment.

ORDERED that the order is modified by providing that plaintiff's cross motion for summary judgment is denied; as so modified, the order is affirmed, without costs.

In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint, arguing that the

action is premature because plaintiff had not provided verification as requested by defendant, and plaintiff cross-moved for summary judgment. The Civil Court denied defendant's motion and granted plaintiff's cross motion, finding that defendant's initial verification request was untimely. Since a claim need not be paid or denied until all duly requested verification is provided (see Westchester County Med. Ctr. v New York Cent. Mut. Fire Ins. Co., 262 AD2d 553, 554 [1999]), any action to recover payment is premature when a provider has failed to respond to a timely request for verification (see Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492, 493 [2005]). In support of its motion, defendant demonstrated that it had mailed initial and follow-up requests for verification (see St. Vincent's Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]). Contrary to the finding of the Civil Court, both sets of requests were timely mailed (see 11 NYCRR 65-3.5 [b]; 65-3.6 [b]). However, upon the record before us, we find that there is a triable issue of fact as to whether plaintiff adequately responded to those verification requests. Accordingly, the order is modified by providing that plaintiff's cross motion for summary judgment is denied.

Pesce, P.J., Aliotta and Solomon, JJ., concur.

Decision Date: December 17, 2014