Key Takeaway
Court case demonstrates how mailing discrepancies can undermine no-fault insurance claims when dates don't align with alleged service dates.
Medical providers pursuing no-fault insurance claims face strict procedural requirements, including proper service of claim forms within statutory deadlines. When insurers deny receiving these forms, courts must weigh competing evidence about mailing practices and office procedures. A recent appellate decision illustrates how seemingly minor discrepancies in documentation can significantly impact a provider’s ability to prove proper service.
The challenge becomes particularly acute when claim forms contain internal inconsistencies that contradict sworn testimony about mailing dates. These situations require careful analysis of both the provider’s mailing procedures and the insurer’s receipt protocols, as mailing disputes remain a common battleground in no-fault litigation.
Jason Tenenbaum’s Analysis:
Vincent Med. Servs., P.C. v Clarendon Natl. Ins. Co., 2012 NY Slip Op 50431(U)(App. Term 2d Dept. 2012).
“the affidavit of plaintiff’s billing manager stated that he had personally mailed the claim to defendant on June 15, 2006. However, we note that plaintiff’s claim form is dated June 22, 2006 and seeks to recover for services rendered to the assignor after June 15, 2006. In opposition to plaintiff’s motion and in support of the branch of its cross motion seeking summary judgment dismissing the fifth cause of action insofar as it pertained to this claim, the affidavit of defendant’s examiner contained a detailed recitation of defendant’s office practices and procedures pertaining to its receipt, filing and/or storage of claim forms, which was sufficient to show that defendant had never received the $608.40 claim form from plaintiff.”
Key Takeaway
This case demonstrates that when proving service of no-fault claims, internal consistency matters. A billing manager’s sworn statement about personally mailing a claim was undermined by the claim form’s later date and references to subsequent services. Combined with the insurer’s detailed office procedures affidavit, these discrepancies proved fatal to the provider’s case. Proper documentation alignment is crucial when certified mail versus regular mail disputes arise.
