What went wrong here?October 8, 2010

Aminov v Travelers Prop. Cas. Ins. Co., 2010 NY Slip Op 51723(U)(App. Term 2d Dept. 2010)

“While the complaint listed the total amount allegedly owed to plaintiff, it did not list the dates that the subject medical services were provided, and the subject claim forms were not annexed to the complaint. Therefore, while defendant asserted that it had never received the claim forms, such assertion appears to be belied by the fact that defendant was aware of the dates the medical services were rendered, and it is unclear from what source defendant acquired this knowledge if not from the claim forms. In light of the foregoing, upon the instant motion, defendant failed to establish as a matter of law that plaintiff had failed to submit the subject claim forms within 45 days of the date that the services were provided (see Insurance Department Regulations [11 NYCRR] § 65-1.1).”

As a practitioner, nothing bothers me more than a party’s failure to specify the date(s) and amount(s) of the transactions.  One could even say that the CPLR requires this and the complaint should have been thrown out on this ground.  CPLR 3016(f); 3211(a)(7).

In any event, the carrier should have sought discovery as to the bills and moved accordingly.  Also, how did the 180 and 45 day rule come about here insofar as these are precludable defenses.  Were any denials issued?  Very strange.

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