Central General Hosp. v. Chubb Group of Ins. Companies

• Citation: 228 A.D.2d 406,643 N.Y.S.2d 654
• Parties: CENTRAL GENERAL HOSPITAL, as Assignee of Pamela Mandresh, Respondent, v. CHUBB GROUP OF INSURANCE COMPANIES, a/k/a Chubb and Son, Inc., Appellant.
• Decision Date: 03 June 1996
• Court: New York Supreme Court Appellate Division

Page 654

643 N.Y.S.2d 654

228 A.D.2d 406

CENTRAL GENERAL HOSPITAL, as Assignee of Pamela Mandresh, Respondent, v. CHUBB GROUP OF INSURANCE COMPANIES, a/k/a Chubb and Son, Inc., Appellant.

Supreme Court, Appellate Division,

Second Department.

June 3, 1996.

Bertram Herman, P.C., East Norwich, for appellant.

Joseph Henig, P.C., Bellmore, for respondent.

Before ROSENBLATT, J.P., and MILLER, PIZZUTO and GOLDSTEIN, JJ.

MEMORANDUM BY THE COURT.

In an action pursuant to Insurance Law § 5106(a) to recover the payment of a hospital no-fault billing, the defendant appeals from (1) an order of the Supreme Court, Nassau County (Segal, J.), dated April 27, 1995, which, inter alia, granted the plaintiffs' motion for summary judgment, and (2) a judgment of the same court, dated May 12, 1995, entered upon the order, which is in favor of the plaintiff and against the defendant in the sum of $3,957.35.

ORDERED that the appeal from the order is dismissed; and it is further,

ORDERED that the judgment is affirmed; and it is further,

ORDERED that the respondent is awarded one bill of costs.

The appeal from the intermediate order must be dismissed because the right of direct appeal therefrom terminated with the entry of judgment in the action (see, Matter of Aho, 39 N.Y.2d 241, 248). The issues raised on appeal from the order are brought up for review and have been considered on the appeal from the judgment (CPLR 5501[a][1].

The plaintiff's assignee received medical treatment from the plaintiff on four occasions for injuries she allegedly sustained in an automobile accident. Chubb Group of Insurance Companies (hereinafter Chubb) insured the automobile in which the plaintiff's assignee was riding when she was allegedly injured. The plaintiff submitted standard requests for payment of the no-fault claims which Chubb ultimately rejected on the grounds, inter alia, that the injuries sustained by its insured were pre-existing, work-related injuries which did not arise from the accident, and that the treatments provided were not medically necessary. Chubb did not, however, pay the claims within 30 days as required by Insurance Law § 5106(a), and did not request further verification or deny the claim within the appropriate time frames (see, 11 NYCRR 65.15; 11 NYCRR 65.15[g]. The Supreme Court awarded summary judgment to the plaintiff as it concluded that Chubb's failure to take timely action on the claims for payment precluded it from litigating its defenses. We agree.

Contrary to Chubb's contentions, the Supreme Court correctly determined that preclusion of the claimed defenses was warranted (see, Presbyterian Hosp. in the City of N.Y. v. Atlanta Cas. Co., 210 A.D.2d 210, 619 N.Y.S.2d 337). Chubb failed to abide by the requirements of Insurance Law § 5106(a) and, thus, preclusion is the appropriate remedy (see, Presbyterian Hosp. in the City of New York v. Maryland Cas. Co., 226 A.D.2d 260, 641 N.Y.S.2d 266; Presbyterian Hosp. in the City of N.Y. v. Maryland...