South Nassau Orthopedic Surgery v Auto One Ins. Co., 2011 NY Slip Op 51300(U)(App. Term 2d Dept. 2011)
Where have we seen this before?
“Defendant did not raise a triable issue of fact in opposition to plaintiff’s motion or establish its entitlement to summary judgment on its cross motion. In her affidavit, defendant’s litigation manager stated that she had begun working for defendant after the claim denial forms at issue had allegedly been mailed by defendant. As defendant did not establish actual mailing of [*2]the claim denial forms or defendant’s standard office practice and procedure for the mailing of the claim denial forms during the pertinent time period, defendant failed to show that its claim denial forms were timely mailed”
Oh by the way, I am sure Plaintiff received the denial. Yet, the difference between fact and fiction can sometimes be indistinguishable in this practice.
One Response
Oh by the way I bet the insurer got the bills but the provider still had to prove mailing. Oh by the way I bet the insurer did not pay but the provider had to prove that too.
Hmmm … where is the concept of prompt payment. Unless there is a real issue receipt of bills and denials should not be litigated. In fact it violates law when an insurer who received a bill makes the provider prove mailing.