Performance Plus Med., P.C. v. Nationwide Ins.
This case involves an appeal by Performance Plus Medical, P.C., acting as an assignee, against Nationwide Ins. The plaintiff sought to recover assigned first-party no-fault benefits. The Civil Court had previously granted the defendant's motion for summary judgment, leading to the dismissal of the complaint. The Appellate Term affirmed this order, ruling that the defendant's timely verification request tolled the insurer's time to pay or deny the claim, thus rendering the plaintiff's action premature due to a failure to respond to the request. Additionally, the court found that the defendant had successfully demonstrated a prima facie case for denying claims related to the first cause of action based on the workers' compensation fee schedule, which the plaintiff failed to rebut.