Delta Diagnostic Radiology, P.C. v MVAIC |
2007 NY Slip Op 52143(U) [17 Misc 3d 1125(A)] |
Decided on November 7, 2007 |
Civil Court Of The City Of New York, Kings County |
Edwards, J. |
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
This opinion is uncorrected and will not be published in the printed Official Reports. |
Delta Diagnostic
Radiology, P.C., a/a/o Bettye Coates, Plaintiff,
against MVAIC, Defendant. |
At the outset of this trial to recoup no-fault benefits, the parties stipulated that plaintiff's bills
were submitted 45 days after the services were rendered; the defendant submitted a timely denial;
and the plaintiff's prima facie case was established. After a bench trial of this matter, the parties
were required to submit post-trial memoranda regarding whether the defendant properly denied
the late submitted claims. Both parties submitted their post-trial memoranda.
It is plaintiff's contention that when a claim for no-fault benefits is submitted to the
defendant beyond the 45-day period, the defendant should perform a supervisory review of the
subject claim pursuant to 11 NYCRR §65-3.5. The review should ascertain whether there
was any reasonable justification for the delay. Matter of Medical Society of the State of New
York v. Serio, 100 NY2d 854 (2003); Hempstead Pain & Med. Services, P.C. v. General Assurance Co., 13
Misc 3d 980 (Dist. Ct. Suffolk County 2006).
The defendant counters that the claim was timely denied in December 2003 due to
plaintiff's failure to comply with the 45-day rule. 11 NYCRR §65-1.1. The plaintiff did not
provide any rationale for its late submission. The justification provided by the plaintiff in May
2007 did not provide any reason for the late submission of the claim.
This Court finds that prior to the defendant conducting a supervisory review, the
plaintiff was required to provide an explanation for the lateness of its claims. NY Arthroscopy & Sports Medicine PLLC
v. MVAIC, 15 Misc 3d 89, 836 N.Y.S.2d 753 (App. Term 1st Dept. 2007); Jacob
Nir, M.D. v. MVAIC, 2007 NY Slip Op. 52124(U) (App. Term 2nd & 11th Jud. Dists).
Thereafter, the defendant had the duty to conduct a review. The evidence before this Court
reveals that the plaintiff failed to offer any excuse for its delay in submitting the claims to the
defendant. NY Arthroscopy & Sports Medicine PLLC , supra; Jacob Nir,
M.D., supra. Pursuant to the regulations, the defendant's denial indicated "you may
submit written proof providing clear and reasonable justification for the failure to comply with
such time limitation". 11 NYCRR §65-3.3. No further submission was provided by the
plaintiff prior to the initiation of this lawsuit. The defendant's claim examiner credibly testified
that the document purporting to be plaintiff's written justification, which was received by the
defendant one month prior to this trial, failed to explain the delay. Hence, the defendant's duty to
conduct a supervisory review was never triggered.
Accordingly, it is hereby
ORDERED that judgment is in favor of the defendant. The complaint is hereby
dismissed.
[*2]
This constitutes the decision and order of the
Court.
Dated: November 7, 2007__________________________________
Genine D. Edwards, J.C.C.