Jesa Med. Supply, Inc. v Progressive Ins. Co., 2011 NY Slip Op 51603(U)(App. Term 2d Dept. 2011)
Nothing new here, but I liked the language from the Court regarding the non-receipt of the verification:
“Defendant demonstrated that it had not received the requested verification, and plaintiff did not show that the verification had been provided to defendant prior to the commencement of the action. Consequently, the 30-day period within which defendant was required to pay the $1,205.50 and $1,675 claims did not begin to run (see Insurance Department Regulations [11 NYCRR] § 65-3.8 [a]; Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492 [2005]; Hospital for Joint Diseases v State Farm Mut. Auto. Ins. Co., 8 AD3d 533 [2004]), and, thus, plaintiff’s action with respect to the $1,205.50 and $1,675 claims is premature.”
The lack of medical necessity of the portion of the opinion was unremarkable.
I do not often see the portion of an additional verification non-receipt opinion discussing the non-receipt of the requested items prior to the commencement of litigation or arbitration. In Mount Sinai Hosp. v Chubb Group of Ins. Cos., 43 AD3d 889 (2d Dept 2007), the Appellate Division explicitly laid this rule out.
