This proceeding involves a motion by Westchester Medical Center for summary judgment upon Progressive Casualty Insurance Company’s failure to either pay the Hospital’s no-fault benefits or deny its claim within 30 days as required by Insurance Law § 5106(a).
The court denies the motion.
The antecedent facts are as follows:
On 31 October 2010, PV was involved in an accident for which he received medical treatment at Westchester Medical Center. PV was insured pursuant to an automobile liability insurance policy with Progressive Casualty Insurance Company.
On 2 November 2010, the date when PV was discharged, PV assigned his rights to no-fault benefits to the Hospital. On 4 November 2010, pursuant to Progressive’s investigation of no-fault benefits eligibility, Progressive requested certified copies of PV’s admission history, discharge summary, radiology and pathology reports, laboratory test results, consult reports, nurses’ notes, emergency room records, and specifically blood alcohol/drug results and any serum toxicology test results.
On 10 November 2010 a no-fault billing in the amount of $ 9,333.48 was mailed to Progressive, certified mail, return receipt requested. Progressive received the bill on 12 November 2010.
On 15 November 2010, Progressive requested an authorization from PV to obtain his blood alcohol level from the New York State Police and also requested from the police information regarding PV’s blood alcohol results at the time of the accident. Prior to that time, Progressive had obtained a copy of the police report which indicated that PV was arrested for DWI or Driving While Intoxicated.
On 26 November 2010, Progressive sent a verification request delaying the payment of benefits pending the receipt of PV’s authorizations, blood and alcohol levels, supporting deposition/ DWI bill of particulars and emergency room records including all laboratory tests and/or the police accident report.
On 6 December 2010, the Hospital mailed the complete medical records, including all laboratory and toxicology reports, to Progressive. This mailing, which was received by Progressive on 8 December 2010, also included a copy of the assignment of benefits.
On 29 December 2010, Progressive sent another “Verification Request: Follow-up Notice” seeking that which was sought in the 26 November 2010 verification request.
On 10 January 2011, Progressive acknowledged receipt of the hospital records but further requested from the Hospital the results of blood alcohol testing or a certified letter from the Hospital indicating that the testing was never performed.
By letter dated 4 February 2011, PK, a biller and account representative for Hospital Receivable Systems, an entity which represents the Hospital, informed Progressive that it had mailed the complete medical records and that the Hospital did not test for blood alcohol and drugs and, thus, did not have any serum toxicology test results. This letter was not certified.
To Be Cont…
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