Queens Diagnostic Radiology, P.C., as Assignee of Saimun Raymond, Respondent, v. MVAIC (2025)

ORDERED that the order, insofar as appealed from, is reversed, with $30 costs, and defendant's motion for summary judgment dismissing the complaint is granted.

In this action by a provider to recover assigned first-party no-fault benefits, defendant Motor Vehicle Accident Indemnification Corporation (sued herein as MVAIC) appeals from so much of an order of the Civil Court (Delsia G. Marshall, J.) entered July 13, 2024 as denied defendant's motion for summary judgment dismissing the complaint.

It is undisputed that plaintiff was required to submit its claim forms to MVAIC within 45 days after the services at issue had been rendered (see 11 NYCRR 65-1.1; Synergy First Med., PLLC v MVAIC, 44 Misc 3d 127[A], 2014 NY Slip Op 50964[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2014]) and that plaintiff did not do so. In support of its motion for summary judgment, MVAIC established that it had timely denied plaintiff's claims, based upon plaintiff's untimely submissions, and that it had informed plaintiff that MVAIC could excuse the delay if plaintiff provided "reasonable justification" for the delay (11 NYCRR 65-3.3 [e]; see Matter of Medical Socy. of State of NY v Serio, 100 NY2d 854, 862-863 [2003]; Schottenstein Pain & Neuro, PLLC v MVAIC, 72 Misc 3d 131[A], 2021 NY Slip Op 50643[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2021]). In opposition to MVAIC's motion, plaintiff alleged that it had initially sent the claims at issue to an insurance company, but after plaintiff learned that plaintiff's assignor met the criteria for a covered person for MVAIC benefits, plaintiff sent the claims to MVAIC. However, plaintiff did not establish that it had provided MVAIC with a reasonable justification for its untimely submission to MVAIC of the claim forms as it did not explain why it had initially submitted the claims to the insurance company (see Good Samaritan Hosp. v MVAIC Ins. Co., 77 Misc 3d 126[A], 2022 NY Slip Op 51100[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2022]; Schottenstein Pain & Neuro, PLLC, 2021 NY Slip Op 50643[U]; Synergy First Med., PLLC, 2014 NY Slip Op 50964[U]).

Accordingly, the order, insofar as appealed from, is reversed and defendant's motion for summary judgment dismissing the complaint is granted.

BUGGS and OTTLEY, JJ., concur.

TOUSSAINT, P.J., taking no part.

ENTER:

Paul Kenny

Chief Clerk

Decision Date: June 6, 2025