Key Takeaway
Court ruling demonstrates that insurance companies must timely deny claims to preserve fee schedule defenses in New York no-fault litigation.
The timing of insurance company denials plays a crucial role in New York no-fault insurance litigation, particularly when it comes to preserving defenses related to fee schedule limitations. Under New York’s no-fault insurance regulations, insurers have specific timeframes within which they must assert certain defenses, or risk waiving them entirely. This principle becomes especially important in fee schedule disputes, where the amount of reimbursement for medical services is at stake.
The Mercury Casualty Co. v. Encare case from 2011 illustrates a fundamental procedural requirement in no-fault insurance law: the preservation of defenses through timely action. When insurance companies fail to raise fee schedule objections within the required timeframes, they may find themselves unable to rely on those defenses later in litigation. This timing requirement is part of the broader framework of New York no-fault insurance law, which seeks to streamline the claims process while protecting the rights of all parties involved.
The case serves as a reminder that procedural compliance is often just as important as the underlying merits of a dispute. Insurance companies must be vigilant about meeting denial deadlines, whether dealing with standard medical treatments or more specialized procedures like those involving CPT codes for acupuncture or other therapeutic services. The consequences of missing these deadlines can be significant, potentially resulting in the loss of otherwise valid defenses and forcing insurers to pay claims they might have successfully contested if proper procedures had been followed.
Jason Tenenbaum’s Analysis:
Mercury Cas. Co. v Encare, Inc. 2011 NY Slip Op 32166(U)(Sup. Ct. NY Co. 2011)
Do you really think I believed I was going to win this one? To quote a relatively obscure country artist: “This ain’t my last goodbye”. See you on Madison Avenue.
Key Takeaway
This decision reinforces the critical importance of procedural compliance in no-fault insurance disputes. Insurance companies must adhere strictly to denial deadlines to preserve their right to assert fee schedule limitations and other defenses. Missing these deadlines can result in waiver of otherwise meritorious defenses, leaving insurers obligated to pay claims at rates higher than the fee schedule would normally allow. For healthcare providers and their legal representatives, understanding these timing requirements helps ensure proper case strategy and maximizes the likelihood of successful claim resolution.
Legal Update (February 2026): Since this 2011 post, New York’s no-fault regulations have undergone several amendments affecting denial timeframes and fee schedule defense preservation requirements. The Insurance Department has updated various procedural rules and fee schedule provisions that may impact how insurers must assert defenses within required timeframes. Practitioners should verify current regulatory provisions and recent case law developments when advising on denial timing and defense preservation strategies.
