MEDICAL SERVICES PLLC v. NATIONWIDE MUTUAL INSURANCE COMPANY (2004)

Order insofar as appealed from unanimously affirmed without costs.

 In this action to recover assigned no-fault benefits, plaintiffs submitted the affidavit of David Safir, wherein he states that he is the “practice and medical billing manager of plaintiff.”   The affidavit is insufficient to establish that plaintiffs provided defendant with properly completed claim forms (see A.B. Med. Servs. v. Allstate Ins. Co., 3 Misc.3d 129(A), 787 N.Y.S.2d 675, 2004 WL 1049228, 2004 N.Y. Slip Op. 50373[U] [App. Term, 2d & 11th Jud. Dists.] ).   Accordingly, plaintiffs failed to establish a prima facie entitlement to no-fault benefits and their motion for summary judgment was properly denied.

 We note that the trial court denied plaintiffs' motion for summary judgment on the ground that plaintiffs did not submit admissible proof authenticating the signature of plaintiffs' assignor on the assignment form.   The insurance regulations, however, do not require that a claimant's signature be authenticated. Pursuant to the insurance regulations, a health care provider is only required to submit to the insurer a “properly executed assignment” on (1) the prescribed verification of treatment by the attending physician or other provider of service form (N.Y.S. form NF-3), or (2) the prescribed verification of hospital treatment form (N.Y.S. form NF-4), or the prescribed hospital facility form (N.Y.S. form NF-5), or (3) the prescribed no-fault assignment of benefits form (N.Y.S. form NF-AOB) (11 NYCRR 65-3.11[b][2] ).   A health care provider thus satisfies its burden by proof of submission of an assignment to the insurer that conforms to the regulations.

 We further observe that defendant's failure to seek verification of the assignment, or to allege any deficiency in the assignment in its denial of claim form, constitutes a waiver of any defenses with respect thereto (see New York Hosp. Med. Ctr. of Queens v. New York Cent. Mut. Fire Ins. Co., 8 A.D.3d 640, 779 N.Y.S.2d 548 [2004];  Presbyterian Hosp. v. Aetna Cas. & Sur. Co., 233 A.D.2d 433, 650 N.Y.S.2d 602 [1996];  Diagnostic Rehab. Medicine Serv. PC v. Travelers Indem. Co., 6 Misc.3d 68, 792 N.Y.S.2d 288, 2004 N.Y. Slip Op. 24505 [decided herewith];  Park Health Ctr. v. Eveready Ins. Co., 2001 N.Y. Slip Op. 40665[U], 2001 WL 1807733 [App. Term, 2d & 11th Jud. Dists.] ).