Westchester Med. Ctr. v. Nationwide Mut. Ins. Co.
| Decision Date | 30 November 2010 |
| Citation | 911 N.Y.S.2d 907,78 A.D.3d 1168 |
| Parties | WESTCHESTER MEDICAL CENTER, as assignee of Sharon Bayly, appellant, v. NATIONWIDE MUTUAL INSURANCE COMPANY, respondent. |
| Court | New York Supreme Court — Appellate Division |
Joseph Henig, P.C., Bellmore, N.Y., for appellant.
Epstein, Frankini & Grammatico, Woodbury, N.Y. (Frank J. Marotta of counsel), for respondent.
In an action to recover no-fault medical benefits under an insurance contract, the plaintiff appeals from an order of the Supreme Court, Nassau County (Murphy, J.), entered April 6, 2010, which denied its motion for summary judgment on the complaint.
ORDERED that the order is affirmed, with costs.
Pursuant to the statutory and regulatory framework governing the payment of no-fault automobile benefits, insurance companies are required to either pay or deny a claim for benefits within 30 days of receipt of the claim ( see Insurance Law § 5106[a]; 11 NYCRR 65-3.8[c] ). Here, the plaintiff failed to establish its prima facie entitlement to judgment as a matter of law on its claim for benefits since the evidence demonstrates that the defendant made a partial payment and a partial denial of the claim within 30 days after receipt thereof ( see New York & Presbyt. Hosp. v. Allstate Ins. Co., 31 A.D.3d 512, 818 N.Y.S.2d 583; see generally Alvarez v. Prospect Hosp., 68 N.Y.2d 320, 508 N.Y.S.2d 923, 501 N.E.2d 572).
Furthermore, under the circumstances of this case, the minor factual discrepancy contained in the defendant's denial of claim form did not invalidate the denial. In addition, the denial was not conclusory or vague, and did not otherwise involve a defense which had no merit as a matter of law ( see Nyack Hosp. v. State Farm Mut. Auto. Ins. Co., 11 A.D.3d 664, 665, 784 N.Y.S.2d 136 quoting Amaze Med. Supply v. Allstate Ins. Co., 3 Misc.3d 43, 44, 779 N.Y.S.2d 715; cf. New York Univ. Hosp. Rusk Inst. v Hartford Acc. & Indem. Co., 32 A.D.3d 458, 460, 820 N.Y.S.2d 309; Nyack Hosp. v. Metropolitan Prop. & Cas. Ins. Co., 16 A.D.3d 564, 791 N.Y.S.2d 658).
Since the plaintiff failed to establish its prima facie entitlement to judgment as a matter of law, we need not consider the sufficiency of the defendant's papers in opposition to the motion ( see Moore v. Stasi, 62 A.D.3d 764, 878 N.Y.S.2d 440; Marshak v. Migliore, 60 A.D.3d 647, 874 N.Y.S.2d 240). Accordingly, the Supreme Court properly denied the plaintiff's motion for summary judgment on the complaint.
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