MVAIC S RESPONSE TO NO-FAULT BILLS DOES NOT DEPEND ON QUALIFIED PERSON STATUS Nathaniel Aronoff DC a/a/o Serge Cooks et al. v. Motor Veh. Acc. Indem. Corp.Message 1 of 1 , May 9, 2007View Source
MVAIC'S RESPONSE TO NO-FAULT BILLS DOES NOT DEPEND ON "QUALIFIED PERSON" STATUS
Nathaniel Aronoff DC a/a/o Serge Cooks et al. v. Motor Veh. Acc. Indem. Corp. 2007 NYSlipOp 50958(U) Decided on May 8, 2007 Appellate Term, First Department Edited by Lawrence N. Rogak Index no. 570531/2006In a decision which implicitly overrules a line of Civil Court cases, the Appellate Term, 1st Department has held that MVAIC's obligation to address no-fault bills in a timely fashion, in accordance with the Regulations, does not depend on whether or not the applicant is a "qualified person" who has complied with Insurance Law requirements for MVAIC claims.
MVAIC appealed here from a judgment of the Civil Court, Bronx County (Nelida Malave, J.), in favor of plaintiffs in the amount of $31,980.06.
"Contrary to defendant's contention," held the Appellate Term, "plaintiffs made a prima facie showing of entitlement to judgment as a matter of law by submitting evidentiary proof that the prescribed statutory billing forms had been mailed and received and that payment of no-fault benefits was overdue. In opposition, defendant failed to raise a triable issue of fact."
"It is undisputed on this record that defendant did not pay or deny the subject claims within the 30-day period after it received proof of claims, including additional verifications requested by it, as required by the insurance regulations (see 11 NYCRR 65.15 [g][I]; ). The 30-day requirement applies to defendant by the express terms of the insurance regulation (11 NYCRR 65.15), and does not hinge upon whether the injured person had been deemed a "qualified person" by defendant (see New York Hosp. Med. Ctr. of Queens v Motor Veh. Acc. Indem. Corp., 12 AD3d at 430).
Comment: This decision appears to fly in the face of Insurance Law section 5208, which provides, in pertinent part, that :
"The protection provided by the corporation on account of motor vehicle accidents caused by financially irresponsible motorists shall be available to:"
"(1) Any qualified person having a cause of action because of death or bodily injury, arising out of a motor vehicle accident occurring within this state, who files with the corporation within one hundred eighty days of the accrual of the cause of action, as a condition precedent to the right to apply for payment from the corporation, an affidavit stating that:"
"(A) the person has a cause of action for damages arising out of the accident and setting forth the facts in support, (B) the cause of action is against the owner or operator of a designated uninsured motor vehicle, and (C) the person is making a claim for such damages. See: Hempstead General Hospital v. MVAIC, 97 AD2d 544, 468 NYS2d 48 (2nd Dept. 1983) wherein the failure to file a Notice of Intention pursuant to Insurance Law § 5208 resulted in the dismissal of the Petitioner's claim even though the Respondent's denial, based thereon, was not made in excess of two (2) years."
If being a "qualified person" is a condition precedent to payment, how can the Appellate Term hold to the contrary? Yet, here's the decision saying so. While I respectfully disagree, this is the law in the First Department until a higher court rules otherwise.