30 + 10 + 5 = timely

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Triangle R Inc. v Praetorian Ins. Co., 2010 NY Slip Op 52294(U)(App. Term 1st Dept. 2010)

The Appellate Term, in exercising what appears to be its interest in justice jurisdiction, has found that a follow-up verification that is 5-days late is sufficient to toll the 30-day pay or deny clock.  Borrowing from the logic that a premature follow-up verification should not, in the interest of justice, estop an insurance carrier from demanding the sought after verification, the Appellate Term held that an untimely follow-up verification should have the same effect.

The logic to arrive at this result is interesting.  In principle, I agree with the court that a provider or injured person should not be rewarded for its stubborn recalcitrance.  Either provide the information or object to it similarly to what happened in Omega Diagnostic Imaging, P.C. v MVAIC, 2010 NY Slip Op 51779(U)(App. Term 1st Dept. 2010) and litigate the underlying issue.  In reality, the court is probably disregarding Presbyterian.  But what I see is a back lash against the form over substance jurisprudence, common to our practice, which appears to be bothering the Appellate Term, First Department bench.  This cuts both ways, mind you.  The carriers’ attorneys are upset that a provider can walk into court with an NF-10 and say, prove your defense.  I have no problem with this because Dan Medical is a contrived legal fiction at best.  The providers’ are unhappy that “mailing” has been deconstructed and strict adherence to time lines, except for a true 30-day pay or deny issue, has been obviated.

I am just puzzled.

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7 Responses

  1. The regs dictate that an insurer runs down the pay or deny clock if it fails to send a timely request for additional verification. I dont see why it follow ups wouldnt be counted against the same clock.

  2. Because to quote an excellent Judge — now Justice — this is “No Fault … the fairyland where the law does not apply.”

  3. I would be interested to hear what Lawrence Rogak has to say about this decision. There should be a handy way to link to his blog.

    1. When is the Pit coming back? The Pit should be linked to everything, no-fault and Rico related as well as to the happenings of what goes on at Herbert Street in Sunny Kings County.

    1. Ray Zuppa: man of the people. Are you working today? There is no one in my whole office building, and we had three inches of snow? I wonder what my Fourth Department friends would think of all of this….

  4. 103 fever Wednesday; Thursday and Friday. Doctor cannot see me until Tuesday “if you holdout that long.” Why do I represent these miscreants.

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