Key Takeaway
NY court ruling establishes strong presumption for proper mailing in no-fault insurance cases, making it difficult for providers to deny receipt of verification requests.
Understanding the “Mailing Presumption” in No-Fault Insurance Cases
No-fault insurance disputes often hinge on seemingly mundane procedural issues that can have significant financial consequences. One of the most important—and frequently litigated—issues involves proving that an insurance company properly mailed verification requests to healthcare providers. The Appellate Term’s decision in Pomona Med. Diagnostics, P.C. v Travelers Ins. Co. demonstrates how courts apply the legal presumption of proper mailing, and why this presumption heavily favors insurance companies when they follow established procedures.
Under New York’s no-fault insurance regulations, insurers must request verification of medical services within specific timeframes. When providers claim they never received these requests, courts must determine whether proper mailing occurred. This case illustrates the high burden providers face in overcoming the presumption that mail was properly sent, particularly when mailing procedures are well-documented and consistently followed.
Jason Tenenbaum’s Analysis:
Pomona Med. Diagnostics, P.C. v Travelers Ins. Co., 2011 NY Slip Op 50447(U)(App. Term 2d Dept. 2011)
“The affidavit of defendant’s litigation claims examiner established that defendant had timely mailed its request and follow-up request for verification to plaintiff (see Insurance Department Regulations § 65-3.5 ; § 65-3.6 ) in accordance with defendant’s standard office practices and procedures (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 ; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 ). The mere denial by plaintiff’s medical biller of receipt of the verification requests did not overcome the presumption that proper mailing had occurred and that plaintiff had received the verification requests.”
There is nothing I like reading more than when the Plaintiff cannot prove lack of receipt after a prima case of mailing has occurred. It is vindication after the years of being trapped by the Contemporary precedent, which at the time was anything but contemporary – more or less antiquated.
Key Takeaway
The court’s ruling reinforces that insurance companies can establish proper mailing through standardized office procedures and sworn affidavits. Healthcare providers cannot defeat this presumption merely by denying receipt—they must present compelling evidence that proper mailing procedures were not followed. This decision strengthens insurers’ positions in no-fault verification disputes.
Legal Update (February 2026): Since this 2011 post, New York’s no-fault insurance regulations sections 65-3.5 and 65-3.6 have undergone multiple amendments affecting mailing procedures, verification request timeframes, and documentation requirements. Practitioners should verify current regulatory provisions and recent Appellate Term decisions, as both procedural requirements and judicial interpretations of the mailing presumption may have evolved significantly.
