From Casetext: Smarter Legal Research

Westchester Med. v. Nationwide Mut

Appellate Division of the Supreme Court of New York, Second Department
Nov 30, 2010
78 A.D.3d 1168 (N.Y. App. Div. 2010)

Opinion

No. 2010-03945.

November 30, 2010.

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.

Epstein, Frankini Grammatico, Woodbury, N.Y. (Frank J. Marotta of counsel), for respondent.

Before: Skelos, J.P., Covello, Balkin and Sgroi, JJ.


Ordered that the order is affirmed, with costs.

Pursuant to the statutory and regulatory framework govern-ing the payment of no-fault automobile benefits, insurance companies are required to either pay or deriy 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 AD3d 512; see generally Alvarez v Prospect Hosp., 68 NY2d 320).

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 AD3d 664, 665, citing Amaze Med. Supply v Allstate Ins. Co., 3 Misc 3d 43, 44; cf. New York Univ. Hosp. Rusk Inst, v Hartford Ace. Indem. Co., 32 AD3d 458, 460; Nyack Hosp. v Metropolitan Prop. Cos. Ins. Co., 16 AD3d 564).

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 AD3d 764; Marshak v Migliore, 60 AD3d 647). Accordingly, the Supreme Court properly denied the plaintiffs motion for summary judgment on the complaint.


Summaries of

Westchester Med. v. Nationwide Mut

Appellate Division of the Supreme Court of New York, Second Department
Nov 30, 2010
78 A.D.3d 1168 (N.Y. App. Div. 2010)
Case details for

Westchester Med. v. Nationwide Mut

Case Details

Full title:WESTCHESTER MEDICAL CENTER, as Assignee of Sharon Bayly, Appellant, v…

Court:Appellate Division of the Supreme Court of New York, Second Department

Date published: Nov 30, 2010

Citations

78 A.D.3d 1168 (N.Y. App. Div. 2010)
2010 N.Y. Slip Op. 8933
911 N.Y.S.2d 907

Citing Cases

Top Choice Med. P.C. v. Geico Gen. Ins. Co.

A no-fault provider establishes its prima facie entitlement to summary judgment by proof of the submission…

Yklik, Inc. v. Geico Ins. Co.

We deem defendant's appeal to be from the judgment entered pursuant to the order ( see CPLR 5512 [a]; Neuman…