Nyu–hosp. For Joint Diseases v. Petitioner

• Decision Date: 24 May 2011
• Parties: NYU–HOSPITAL FOR JOINT DISEASES, as assignee of Francisco Romero v et al., appellants-respondents,v.AMERICAN INTERNATIONAL GROUP, INC., etc., respondent-appellant.
• Court: New York Supreme Court — Appellate Division

84 A.D.3d 1192
923 N.Y.S.2d 353
2011 N.Y. Slip Op. 04437

NYU–HOSPITAL FOR JOINT DISEASES, as assignee of Francisco Romero v et al., appellants-respondents,
v.
AMERICAN INTERNATIONAL GROUP, INC., etc., respondent-appellant.

Supreme Court, Appellate Division, Second Department, New York.

May 24, 2011.

Joseph Henig, P.C., Bellmore, N.Y., for appellants-respondents.Bryan M. Rothenberg, Hicksville, N.Y. (Argyria A.N. Kehagias of counsel), for respondent-appellant.

[84 A.D.3d 1192] In an action to recover no-fault medical payments under insurance contracts, the plaintiffs appeal from so much of an order of the Supreme Court, Nassau County (Palmieri, J.), entered March 30, 2010, as denied that branch of their motion which was for summary judgment on the third cause of action, and the defendant cross-appeals from so much of the same order as denied its cross motion for summary judgment dismissing the third cause of action.

ORDERED that the order is modified, on the law, by deleting the provision thereof denying that branch of the plaintiffs' motion which was for summary judgment on the third cause of action and substituting therefor a provision granting that branch of the motion; as so modified, the order is affirmed insofar as appealed from, with costs.

The plaintiffs made a prima facie showing that the plaintiff Westchester Medical Center (hereinafter the hospital) was entitled to judgment as a matter of law on the third cause of action[84 A.D.3d 1193] to recover no-fault insurance medical payments by submitting evidence that the prescribed statutory billing form had been mailed and received by the defendant insurer, which failed to either pay or deny the claim within the requisite 30–day period ( see Insurance Law § 5106[a]; 11 NYCRR 65–3.5; Westchester Med. Ctr. v. Lincoln Gen. Ins. Co., 60 A.D.3d 1045, 1045–1046, 877 N.Y.S.2d 340; Westchester Med. Ctr. v. Progressive Cas. Ins. Co. 51 A.D.3d 1014, 1017, 858 N.Y.S.2d 754; New York & Presbyt. Hosp. v. Selective Ins. Co. of Am., 43 A.D.3d 1019, 1020, 842 N.Y.S.2d 63).

In opposition, the insurer failed to raise a triable issue of fact as to whether it had timely denied the claim. Contrary to the insurer's contention, its letter to the hospital stating that payment of the claim was delayed “pending adjuster's review” and “investigation” did not serve to toll the 30–day statutory period ( see Westchester Med. Ctr. v. Lincoln Gen. Ins. Co., 60 A.D.3d at 1046, 877 N.Y.S.2d 340; Nyack Hosp. v. Encompass Ins. Co...