Monday, December 8, 2008

Question of Fact Found on Hospital's Compliance with Verification Requests

St. Barnabas Hosp. v. American Tr. Ins. Co.

(2nd Dept., decided 12/2/2008)

In this no-fault medical provider case, the Second Department MODIFIED Nassau Supreme's order granting summary judgment to plaintiff hospital on its first cause of action. The Second Department held that although plaintiff "made a prima facie showing of entitlement to judgment as a matter of law on the first cause of action to recover no-fault benefits by demonstrating that the prescribed statutory billing forms were mailed to and received by the defendant and that payment was overdue * * * the defendant raised a triable issue of fact as to whether the Hospital timely complied with the demand for verification[.]"

The Second Department added that American Transit "was not obligated to pay or deny the claim until all demanded verification was provided by the Hospital[.]" No mention or explanation of why the court did not dismiss the first cause of action as premature rather than denying summary judgment to both parties. Perhaps it had something to do with the sufficiency of American Transit's cross motion papers, alike Allstate's papers in Mount Sinai Hosp. v Allstate Ins. Co., 25 AD3d 673 (2d Dept 2006), to which the Second Department cited in this case.

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