Brooklyn Hgts. Physical Therapy, P.C. v New York Cent. Mut. Fire Ins. Co., 2012 NY Slip Op 52406(U)(App. Term 2d Dept. 2012)
I am lost on this one. I feel like I am writing a matrimonial appeal again and am in utter confusion with what the court is saying. This is how it begins:
“defendant appeals from an order of the Civil Court entered October 25, 2010 which denied defendant’s motion for summary judgment dismissing the complaint and granted plaintiff’s cross motion for summary judgment, finding that defendant’s denials were nullities because they had not been issued in duplicate”
And this how it ends:
“Defendant also submitted an affidavit by the chiropractor/acupuncturist who was to perform the IMEs which established that plaintiff’s assignor hd failed to appear for the scheduled IMEs. An affidavit executed by defendant’s litigation examiner demonstrated that denial of claim forms, which denied the claims based upon the failure of plaintiff’s assignor to appear for the IMEs, had been timely mailed to plaintiff, plaintiff’s assignor, and plaintiff’s assignor’s attorney (see St. Vincent’s Hosp. of Richmond, 50 AD3d 1123; Delta Diagnostic Radiology, P.C., 17 Misc 3d 16).
Insurance Department Regulations (11 NYCRR) § 65-3.8 (c) (1) requires that, upon deciding to deny a claim, “the insurer shall notify the applicant or the authorized representative on the prescribed denial of claim form, in duplicate.” Plaintiff has offered no argument as to why defendant’s mailing of each denial of claim form to plaintiff, plaintiff’s assignor and plaintiff’s assignor’s attorney, respectively, does not satisfy this requirement. Accordingly, defendant established its prima facie entitlement to judgment as a matter of law”
How does a duplicate mailing requirement get satisfied through mailing the denial to the provider, assignor and counsel for assignor? And what is weird is that this Court has previously said – in the verification context- that the letters only need to be sent to the provider if it is from him/her who information is sought. A bit confused here.