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Presbyterian Hospital v. Gen. Acc. Ins. Co.

Appellate Division of the Supreme Court of New York, Second Department
Jul 15, 1996
229 A.D.2d 479 (N.Y. App. Div. 1996)

Opinion

July 15, 1996

Appeal from the Supreme Court, Nassau County (Davis, J.).


Ordered that the judgment is reversed, on the law, with costs, and the plaintiff's motion for summary judgment is denied.

The plaintiff, as assignee of an insured, made a timely demand for unpaid no-fault insurance benefits from the defendant insurance company. The defendant issued an untimely partial denial of claim, asserting that all but $9,608.88 of the $50,000.00 coverage limit of the subject policy had been exhausted. The plaintiff thereafter commenced this action seeking the balance of the claim. After issue had been joined, the plaintiff moved for summary judgment and the defendant cross-moved for summary judgment dismissing the complaint. The Supreme Court, holding that the defendant's untimely, partial denial of claim precluded it from denying or defending against the plaintiff's claim, directed entry of judgment in favor of the plaintiff. We now reverse.

An untimely denial of claim will not operate to preclude a defense that the coverage limits of the subject policy have been exhausted (see, Presbyterian Hosp. v. Liberty Mut. Ins. Co., 216 A.D.2d 448).

"[W]here, as here, an insurer has paid the full monetary limits set forth in the policy, its duties under the contract of insurance cease (see, Champagne v. State Farm Mut. Auto. Ins. Co., 185 A.D.2d 835, 837). The defendant's tardiness in issuing its denial of claim could not thereafter create a new policy or additional coverage in excess of the amount contracted for (see, e.g., Zappone v. Home Ins. Co., 55 N.Y.2d 131; Schiff Assocs. v Flack, 51 N.Y.2d 692; Employers Ins. v. County of Nassau, 141 A.D.2d 496)" (Presbyterian Hosp. v. Liberty Mut. Ins. Co., 216 A.D.2d 448, supra).

On the record before this Court, a question of fact is presented as to whether the policy limits have been exhausted. Thompson, J.P., Joy, Krausman and Florio, JJ., concur.


Summaries of

Presbyterian Hospital v. Gen. Acc. Ins. Co.

Appellate Division of the Supreme Court of New York, Second Department
Jul 15, 1996
229 A.D.2d 479 (N.Y. App. Div. 1996)
Case details for

Presbyterian Hospital v. Gen. Acc. Ins. Co.

Case Details

Full title:PRESBYTERIAN HOSPITAL IN THE CITY OF NEW YORK, Respondent, v. GENERAL…

Court:Appellate Division of the Supreme Court of New York, Second Department

Date published: Jul 15, 1996

Citations

229 A.D.2d 479 (N.Y. App. Div. 1996)
645 N.Y.S.2d 516

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