Ambrister v Integon Natl. Ins. Co., 2010 NY Slip Op 50489(U)(App. Term 2d Dept. 2010)
“Defendant’s claims examiner explained that when a provider fails to comply with a verification request, defendant’s regular course of business is to stamp the original request with the words “second notice” and insert the date of the second notice. The verification request annexed as an exhibit was dated December 24, 2007 and bore a stamp of the words “second notice” and the date, January 28, 2008. Therefore, without reaching the question of whether defendant was even required in the first instance to annex its verification requests to its cross motion papers, we reject plaintiff’s argument that defendant failed to annex a copy of its initial verification request. Accordingly, the judgment is affirmed.”
1. Do you think it is proper for an insurance carrier to move for summary judgment without annexing the bills, which correspond to the denials?
2. Is it proper for an insurance carrier to move for summary judgment without annexing the denials?
3. Is it proper for a provider to move for summary judgment, without annexing the bills to its motion?
4. Is it proper for a provider to meet its prima facie case through an insurance carriers denials, which are first disclosed in answering papers, thereby obviating the rule that the failure to make a prima facie case precludes resort to the opposing papers?
5. Is it proper for an insurance carrier to move for summary judgment on a medical necessity defense, and not to include the medical records the peer reviewer relies on to come to his conclusion that a service is not medically appropriate?
