Majority
In an action to recover no-fault benefits under a policy of automobile insurance, the defendant appeals from an order of the Supreme Court, Nassau County (Brown, J.), entered December 20, 2011, which granted the motion of the plaintiff Wyckoff Heights Medical Center, as assignee of Aida Ruiz, for summary judgment on the first cause of action.
Ordered that the order is reversed, on the law, with costs, and the motion of the plaintiff Wyckoff Heights Medical Center, as assignee of Aida Ruiz, for summary judgment on its first cause of action is denied.
The plaintiff Wyckoff Heights Medical Center, as assignee of Aida Ruiz (hereinafter the plaintiff), made a prima facie showing of entitlement to judgment as a matter of law on to the first cause of action by submitting evidence that the prescribed statutory billing forms were mailed to and received by the defendant, which failed to either pay or deny the claim within the requisite 30-day period (see Insurance Law § 5106 [a]; 11 NYCRR 65-3.8 [c]; Presbyterian Hosp. in City of N.Y. v Maryland Cas. Co., 90 NY2d 274 , 278 [1997]; Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 114 AD3d 33 [2013]; Westchester Med. Ctr. v Hereford Ins. Co., 95 AD3d 1306 , 1306-1307 [2012]; Westchester Med. Ctr. v Lancer Ins. Co., 94 AD3d 984 [2012]; NYU-Hosp. for Joint Diseases v American Intl. Group, Inc., 89 AD3d 702 , 703 [2011]; Mount Sinai Hosp. v Country Wide Ins. Co., 85 AD3d 1136 , 1137 [2011]).
Contrary to the plaintiffs contention, the fact that the defendant attached to its denial of claim form an unaffirmed and unsworn peer review report, which contained a stamped facsimile of the physician’s signature and did not comply with CPLR 2106, did not render the denial of claim ineffective, since the defendant was not obligated to submit the peer review report in the first instance (see CPLR 2106; cf. Vista Surgical Supplies, Inc. v Travelers Ins. Co., 50 AD3d 778 [2008]). The relevant no-fault regulations do not require that a denial of claim form be supported by a peer review report or other medical evidence at the time that the denial of claim form is issued (cf. 11 NYCRR 65-3.8). Indeed, this Court has previously held that a defendant is not required to set forth a medical rationale in its denial of claim form (see New York Univ. Hosp. Rusk Inst. v Government Empls. Ins. Co., 39 AD3d 832 , 832-833 [2007]; A.B. Med. Servs., PLLC v Liberty Mut. Ins. Co., 39 AD3d 779 , 780 [2007]; A.B. Med. Servs., PLLC v GEICO Cas. Ins. Co., 39 AD3d 778 , 779 [2007]).
Accordingly, the Supreme Court should have denied the plaintiffs motion for summary judgment on the first cause of action. Rivera, J.P, Chambers, Hall and Miller, JJ., concur.
Cases cited
- Presbyterian Hospital v. Maryland Casualty Co. 90 NY2d 274 at 278 p. 855
- Viviane Etienne Medical Care, P.C. v. Country-Wide Ins. 114 AD3d 33 p. 855
- Westchester Medical Center v. Hereford Insurance 95 AD3d 1306 at 1306-1307 p. 855
- Westchester Medical Center v. Lancer Insurance 94 AD3d 984 p. 855
- NYU-Hospital for Joint Diseases v. American International Group, Inc. 89 AD3d 702 at 703 p. 855
- Mount Sinai Hospital v. Country Wide Insurance 85 AD3d 1136 at 1137 p. 855
- Alvarez v. Prospect Hospital 68 NY2d 320 at 324 p. 856
- NYU-Hospital v. Esurance Insurance 84 AD3d 1190 at 1191-1192 p. 856
- St. Barnabas Hospital v. Penrac, Inc. 79 AD3d 733 at 734 p. 856
- Vista Surgical Supplies, Inc. v. Travelers Insurance 50 AD3d 778 p. 856
- New York University Hospital Rusk Institute v. Government Employees Insurance 39 AD3d 832 at 832-833 p. 856
- A.B. Medical Services v. Liberty Mutual Insurance 39 AD3d 779 at 780 p. 856