St. Vincent’s Hospital & Medical Center v Government Employees Insurance Company, 2008 NY Slip Op 33319(U) (Sup Ct, Nassau County)
Although plaintiff claims that it would be entitled to the full amount of $71 ,492.13 if its bill were received by the defendant prior to the other bills, and that GEICO’s verification requests were defective because the first request for verification preceded plaintiffs March 20, 2008 bill, based upon the record before it, the Court is unable to find that plaintiff is entitled to summary judgment awarding attorneys fees and interest as a matter of law.In opposition to the motion, the Affidavit of Greer Vargas, a GEICO employee who is the Custodian of the File at its Claims Division with personal knowledge of the claim procedures, represents that the records kept in the regular course of business reflect that GEICO initially received a bil from ST. VINCENT’S in the sum of $354,759.34, on March 8, 2008, for services provided to Mr. FUENTES. Thereafter, it appears that GEICO received an amended NF-5 Form from ST. VINCENT’S billng service, Hospital Receivables Inc., in the sum of $190,920.84 , dated March 11 2008 and another amended NF-5 Form in the sum of $71,492.13, dated March 17, 2008. In response to the March 8 bill, Ms. Vargas states that GEICO sent out requests for additional verification, on March 12, 2008 and April 12, 2008, and that GEICO received the requested information on April 15, 2008. It is GEICO’s position that timely payment of the bill on May 1, 2008, in the amount of $49,336.89 , exhausted the relevant policy limit of $75,000.00 , and that no further monies are due and owing. Ms. Vargas states that a denial of benefis for the balance of the bill was issued on May 5, 2008. Counsel for GECIO states that the payment record reflects that other bils were paid and received before the subject bill was paid because the proof of claim was received prior to the April 15, 2008 completion of ST. VINCENT’S claim and, as such, a priority was created for those entities. Moreover counsel states that the payment to ST. VINCENT in the sum of $53752.55 reflects the surcharge to the State. Counsel urges that GEICO’s legal obligation ceases at the outer limits of the policy and that coverage cannot materialize out of thin air, citing Central General Hospital v Chubb 90 NY2d 195, 659 NYS2d 246, 681 NE2d 413 (C.A 1997).