Barakat, P.T., P.C. v. Liberty Mutual Fire Ins. Co.
Docket Number | Index No. CV-752151-18/KI,Cal. Nos. 52,53,Motion Seq. Nos. 7,8,NYSCEF Doc. No. 18 |
Decision Date | 14 November 2023 |
Parties | BARAKAT, P.T., P.C., A/A/O HERMENEGILDO, MONTAS, Plaintiff, v. LIBERTY MUTUAL FIRE INS. CO., Defendant. |
Court | New York Civil Court |
Unpublished Opinion
DECISION AND ORDER
Recitation as required by CPLK § 2219(a) of the papers considered in review of this Motion:
Papers
Notice of Motion and Affidavits Annexed 1
Cross-Motion .........2
Opposition & Reply .........3
Exhibits .........4
Other .........
Upon the foregoing cited papers, after oral arguments the Decision/Order on Defendant's and Plaintiffs Motions for Summary Judgment are decided as follows:
Defendants Motion for Summary Judgment is DENIED and Plaintiffs Motion for Summary Judgment is GRANTED.
As an initial matter. Defendant failed to establish its policy exhaustion defense. "Under the no-fault system, payments of benefits 'shall be made as the loss is incurred.' Under this regulatory scheme, 'an insurer shall pay benefits directly to the 'applicant,' or, upon assignment by the applicant, 'shall pay benefits directly to providers of health care services.' In addition 'an insurer is required to either pay or deny a claim for no-fault automobile insurance benefits within 30 days from the date an applicant supplies proof of claim'". See Alleviation Med. Servs.. P.C. v. Allstate Ins. Co.. 191 A.D.3d 934 (2d Dep't, 2021) (internal citations omitted). '"[A]n insurer must pay or deny only a verified claim-that is, a claim that has been verified to the extent compliance with section 65-3.5 dictates in the particular case-within 30 calendar days of receipt: and conversely, is not obligated to pay any claim until it has been so verified.' Once claims have been verified they are subject to the priority of payment regulation, 11 NYCRR 65-3.15." See Alleviation Med. Servs., P.C. v. Allstate Ins. Co.. 191 A.D.3d 934 (2d Dep't. 2021). Alleviation Med. Servs., P.C. v Allstate Ins. Co., 55 Misc.3d 44, 45-46 (App. Term, 2d Dep't, 2017) (internal citation omitted) affirmed by Alleviation Med. Servs., P.C. v. Allstate Ins. Co., 191 A.D.3d 934 (2d Dep't, 2021).
Secondly, Defendant failed to establish the timely and proper mailing of the denials as the denials attached to Defendant's Motion contain material errors from in Box # 30 having stated an incorrect amount that was billed by the Plaintiff to Box # 32 to erroneously stating the wrong amount in dispute, and in one instance on COA # 3 even identifying wrong date of service in the denial. It has been well established that St. Barnabas Hosp, v. Allstate Ins. Co.. 66 A.D.3d 996 (2d Dep't, 2009) (internal quotation marks, brackets, and citations omitted). See also General Acc. Ins. Group v. Cirucci. 46 N.Y.2d 862 (1979); St. Vincent's Hosp. & Med. Ctr. v. New Jersey Mfrs. Ins. Co., 82 A.D.3d 871 (2d Dep't, 2011).
Finally Defendant failed to establish its "post-IME cut off defense of medical necessity for all causes of action. James J. Kim, L. Ac.. P.C. v. Allstate Ins. Co., 75 Misc.3d 1230(A) (Civ. Ct., Kings County, 2022) (Moyne, J.). ...
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