Delta Diagnostic Radiology, P.C. v MVAIC

[*1] Delta Diagnostic Radiology, P.C. v MVAIC 2007 NY Slip Op 52143(U) [17 Misc 3d 1125(A)] Decided on November 7, 2007 Civil Court Of The City Of New York, Kings County Edwards, J. 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 This opinion is uncorrected and will not be published in the printed Official Reports.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 November 7, 2007
Civil Court of the City of New York, Kings County

Delta Diagnostic Radiology, P.C., a/a/o Bettye Coates, Plaintiff,

against

MVAIC, Defendant.



72705/04

Genine D. Edwards, J.

At the outset of this trial to recoup no-fault benefits, the parties stipulated that plaintiff's bills were submitted 45 days after the services were rendered; the defendant submitted a timely denial; and the plaintiff's prima facie case was established. After a bench trial of this matter, the parties were required to submit post-trial memoranda regarding whether the defendant properly denied the late submitted claims. Both parties submitted their post-trial memoranda.

It is plaintiff's contention that when a claim for no-fault benefits is submitted to the defendant beyond the 45-day period, the defendant should perform a supervisory review of the subject claim pursuant to 11 NYCRR §65-3.5. The review should ascertain whether there was any reasonable justification for the delay. Matter of Medical Society of the State of New York v. Serio, 100 NY2d 854 (2003); Hempstead Pain & Med. Services, P.C. v. General Assurance Co., 13 Misc 3d 980 (Dist. Ct. Suffolk County 2006).

The defendant counters that the claim was timely denied in December 2003 due to plaintiff's failure to comply with the 45-day rule. 11 NYCRR §65-1.1. The plaintiff did not provide any rationale for its late submission. The justification provided by the plaintiff in May 2007 did not provide any reason for the late submission of the claim.

This Court finds that prior to the defendant conducting a supervisory review, the plaintiff was required to provide an explanation for the lateness of its claims. NY Arthroscopy & Sports Medicine PLLC v. MVAIC, 15 Misc 3d 89, 836 N.Y.S.2d 753 (App. Term 1st Dept. 2007); Jacob Nir, M.D. v. MVAIC, 2007 NY Slip Op. 52124(U) (App. Term 2nd & 11th Jud. Dists). Thereafter, the defendant had the duty to conduct a review. The evidence before this Court reveals that the plaintiff failed to offer any excuse for its delay in submitting the claims to the defendant. NY Arthroscopy & Sports Medicine PLLC , supra; Jacob Nir, M.D., supra. Pursuant to the regulations, the defendant's denial indicated "you may submit written proof providing clear and reasonable justification for the failure to comply with such time limitation". 11 NYCRR §65-3.3. No further submission was provided by the plaintiff prior to the initiation of this lawsuit. The defendant's claim examiner credibly testified that the document purporting to be plaintiff's written justification, which was received by the defendant one month prior to this trial, failed to explain the delay. Hence, the defendant's duty to conduct a supervisory review was never triggered.

Accordingly, it is hereby

ORDERED that judgment is in favor of the defendant. The complaint is hereby dismissed. [*2]

This constitutes the decision and order of the Court.

Dated: November 7, 2007__________________________________

Genine D. Edwards, J.C.C.