Hernandez v. Merchants Mut. Ins. Co.

Summary

The New York Supreme Court, Appellate Division, Second Department affirmed a judgment awarding Mario Hernandez $44,573.86 in first-party no-fault benefits against Merchants Mutual Insurance Company. The court held that Hernandez established that the claims were mailed and received and that the insurer failed to pay or validly deny them within the statutory period. The court rejected the insurer's lack-of-medical-necessity defense and concluded that Hernandez had standing to pursue the claims.

Holdings

1. The direct appeal from the order granting summary judgment must be dismissed because the right to direct appeal from the order terminated upon entry of the judgment; the issues raised on the order were reviewable on the appeal from the judgment.
2. A plaintiff establishes prima facie entitlement to summary judgment on a no-fault claim by submitting evidence that the prescribed statutory billing forms were mailed and received and that payment of the benefits was overdue.
3. The defendant failed to raise a triable issue of fact as to whether the claimed benefits were properly denied for lack of medical justification.
4. The plaintiff had standing to pursue his claims for first-party no-fault benefits.

Questions Presented

1. Whether the appeal from the interlocutory order granting summary judgment had to be dismissed after entry of the final judgment.
2. Whether the plaintiff established prima facie entitlement to summary judgment on his claim for first-party no-fault benefits.
3. Whether the defendant raised a triable issue of fact concerning the medical necessity or medical justification for the claimed benefits.
4. Whether the plaintiff had standing to pursue the no-fault benefit claims.

Disposition

affirmed