First sighting of 120-day ruleOctober 3, 2017

TAM Med. Supply Corp. v Tri State Consumers Ins. Co., 2017 NY Slip Op 51247(U)(App. Term 2d Dept. 2017)

“In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court which granted defendant’s motion for summary judgment dismissing the complaint on the ground that defendant had timely and properly denied the claim at issue based upon plaintiff’s failure to provide requested verification within 120 days of the initial verification request (see 11 NYCRR 65-3.5 [o]). ”

The case was followed the usual rubric where the Court found a non-specific affidavit sufficient to raise an issue of fact.  What is more interesting, however, is the Court held that the a 120-day denial had to be timely issued.  This begs the question: When is a 120-day denial “timely” denied?  Good question.

2 Responses

  1. Sun Tzu says:

    Yup. First appeal shows that this new rule won’t work well from a policy standpoint. It will be very easy for insurers to allege non receipt of veri request. It dovetails with the follow up provision. Send two letters, pretend not to receive a response within 120 days. Insurer has meet all its obligations regarding notification with only two letters.

  2. Sun Tzu says:

    Also, now the insurers have a huge incentive to maintain horrible protocols regarding receipt and routing of incoming mail yet to hide that fact. The 120 day rule is going to further drive no-fault insurer conduct into the ground. It is beyond belief as it stands in 2017.

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