The actionable violation of 3.2(b)February 2, 2017

Integral Assist Med., P.C. v Tri-State Consumer Ins. Co., 2017 NY Slip Op 50103(U)(App. Term 2d Dept. 2017)

“There is no merit to plaintiff’s argument on appeal that defendant “clearly took an adversarial position” during claims processing in violation of 11 NYCRR 65-3.2 (b).”

Assume that Defendant did take an adversarial role in the claims processing.  What would happen at that point?  The case on point states that a violation of 3.8(b)(4) is an administrative issue, not one that leads to preclusion due to its violation.  Does a violation of 3.2(b) lead to the same result?  Or, does this violation allow (under the right circumstance) an extra-contractual claim or a GBL 349 claim?  The case law will have to be further developed.

My thinking is that a violation of 3.2(b) is not enough to impact a first-party no-contractual claim.  But, this falls into the gambit of 349 and under certain extreme circumstances, bad faith.

One Response

  1. Sun says:

    No-fault insurers are not immune to GBL 349. Even assuming 3.2 did not exist, No-fault insurers are responsible for their deceptive conduct. We have about 30 lawsuits now pending in queens civil on this very issue. We will push this through for the plaintiff’s bar.