Jonathan Laul was allegedly a passenger in a motor vehicle owned by Crescencio Canela Company on October 11, 2000, the date of loss. On January 17, 2006 this action was commenced to recover $3,602 in unpaid medical bills. Plaintiff alleged that it rendered services to Laul on various dates in October, November, and December of 2000, and January and February of 2001, and that it timely submitted bills and claims to MVAIC, and those claims were neither timely paid nor denied.

MVAIC alleged a lack of coverage on the grounds that Laul failed to qualify for MVAIC no-fault benefits, in particular because Laul failed to provide proof of New York residency. Moreover, MVAIC argued that the statute of limitations to become qualified expired.

MVAIC stated that on June 27, 2001, a letter was sent to Lauls attorney stating that MVAIC was unable to process the Notice of Intent to make a claim because he failed to prove residency, or to provide a Social Security Number. In addition, MVAIC noted that a telephone conversation ensued between its claim representative and Lauls attorney regarding the deficiencies of his application.

Accordingly, held the court, the defendant has made out a prima facie showing of its entitlement to summary judgment as a matter of law.

In opposition, the plaintiff, in an effort to meet its burden of raising a triable issue of fact, asserts that it filed a Notice of Intention to make a claim with MVAIC within 180 days. The plaintiff applies the standard generally applied in Insurance Law Article 51 actions. In a no-fault insurance action, a medical provider must submit evidentiary proof that the appropriate claim forms were mailed, that the forms were received by the insurer, and that the payment of no-fault benefits was overdue. However, here, prior to a review pursuant to Article 51, the plaintiff must first comply with Article 52, and the Notice of Claim requirement. The plaintiff does not address the issue of the failure of the assignee to provide MVAIC with proof of residency.

In the instant case, the [plaintiffs] claims interposed on or about October, November, and December, 2000, and January 6, 13, [and] 19, [of] 2001 are dismissed as untimely. The remaining claims dated January 27, 2001 and February 10, 2001, although not denied for statute of limitation purposes as MVAIC concedes, are nonetheless dismissed on summary judgment.

In order to recover MVAIC benefits, the injured party must be eligible for MVAIC benefits, which requires that the party not have any other available insurance covering its claim and that the accident is of the nature contemplated by MVAIC. Upon proving that the claimants accident was of a type contemplated by MVAIC, the injured party must then be a qualified person, defined by MVAIC, as someone other than (1) an insured, or (2) the owner of an uninsured motor vehicle and his/her spouse when a passenger in such vehicle.

In the instant case, the plaintiff has failed to meet his burden in establishing the condition precedent, of qualifying as a covered person. Accordingly, MVAICs failure to timely deny plaintiffs claims does not preclude the dismissal of the plaintiffs causes of action based upon lack of coverage.

Accordingly, the defendants motion for summary judgment is granted and the plaintiffs complaint is dismissed.

Comment: This is the second recent Nassau County case to hold that being a qualified person is a condition precedent to MVAIC having to pay or deny a claim. There is a recent Suffolk County case holding the opposite.

Universal Acupuncture Pain Servs. P.C. a/a/o Jonathan Laul v. MVAIC, 2006 NY Slip Op 52343(U) (District Court, Nassau Co.) (Marber, j)