New York State Court of Claims

New York State Court of Claims

MARAN v. THE STATE OF NEW YORK, #2000-016-074, Claim No. 96178, Motion No. M-56594


Synopsis


Pro se claim of physician alleging nonpayment by State Insurance Fund for treatment rendered to two patients by physician was dismissed on the grounds that the claim failed to comply with the particularity requirements of §11 of the Court of Claims Act.

Case Information

UID:
2000-016-074
Claimant(s):
ANDREW MARAN
Claimant short name:
MARAN
Footnote (claimant name) :

Defendant(s):
THE STATE OF NEW YORK
Footnote (defendant name) :

Third-party claimant(s):

Third-party defendant(s):

Claim number(s):
96178
Motion number(s):
M-56594
Cross-motion number(s):

Judge:
Alan C. Marin
Claimant's attorney:
No appearance
Defendant's attorney:
Eliot Spitzer, Attorney GeneralBy: Ellen Matowik, AAG
Third-party defendant's attorney:

Signature date:
September 11, 2000
City:
New York
Comments:

Official citation:

Appellate results:

See also (multicaptioned case)



Decision

Pro se claimant Andrew Maran, a physician, alleges that the "State Insurance Fund refuses to pay for professional services" rendered to two patients in the total amount of $1,515. This is defendant's motion to dismiss on the grounds that: the claim was untimely, claimant failed to exhaust his administrative remedies, and upon exhaustion, his sole route of appeal is to the Appellate Division, Third Department. Workers' Compensation Law §13-f provides in relevant part that a physician who provides treatment to a workers' compensation claimant may not collect a fee from such person, but rather "shall have recourse for payment of services rendered only to the employer . . ." Section 13-g sets forth the procedure for payment of medical bills, providing in relevant part that within 45 days of a physician's submission of a bill to an employer, the employer must either pay the bill or notify the physician in writing that the bill is not being paid and provide an explanation. If the employer fails to either pay or provide notice of refusal within such 45-day period, the physician may notify the chair of the Workers' Compensation Board and request that the Board make payment. If the employer has provided notice of refusal to pay and the parties cannot agree on an amount, §13-g provides that the issue be arbitrated.

Aside from his one-sentence description and submission of three insurance claim forms[1], Maran has provided no details concerning his claim. For instance, did he submit bills to his patients' employers and when? (The services were rendered in 1995, but the billing forms are not dated until 1997.) Did the employers refuse payment? What were the explanations? Did he seek compensation from the Workers' Compensation Board? Was the amount claimed at issue?

Section 11(b) of the Act provides that a "claim shall state the time when and place where such claim arose, the nature of same, and the items of damage or injuries claimed to have been sustained and the total sum claimed." "The claim must plead the facts relied upon to sustain a recovery. In addition it must set forth a valid cause of action . . ." Cannon v State of New York, 163 Misc 2d 623, 625, 622 NYS2d 177, 178 (Ct Cl 1994) (citation omitted). The purpose of §11 of the Act "is to give the State prompt notice of an occurrence and an opportunity to investigate the facts . . ." Id., 163 Misc 2d at 626, 622 NYS2d at 179. Maran's claim is devoid of any information which would shed light on the foregoing questions and he has thus failed to comply with §11 of the Act, warranting dismissal of his claim. The issues of timeliness and exhaustion of administrative remedies need not be reached.

For the foregoing reasons, having reviewed the parties' submissions[2], IT IS ORDERED that motion M-56594 is granted and the claim of Andrew Maran is dismissed.


September 11, 2000
New York, New York

HON. ALAN C. MARIN
Judge of the Court of Claims




  1. [1] One is for a patient who was treated on April 25 and 26, 1995; the form is dated May 9, 1997. The other two are for a patient who was treated on October 9-12, 1995; those forms are also dated May 9, 1997. These appear to be generic claim forms that can be used for a variety of insurance types; they contain a section where the appropriate box is to be checked for "MEDICARE," "MEDICAID," "CHAMPUS," "CHAMPVA," "GROUP HEALTH PLAN," "FECA BLK LUNG," OR "OTHER."
  2. [2]Along with the claim, the Court reviewed defendant's notice of motion with affirmation in support and Exhibits A-C. Claimant submitted no opposition papers.