Key Takeaway
Court denied excuse for late written notice when attorney failed to explain why claim was initially submitted to wrong carrier, establishing prima facie case for summary judgment.
In New York’s no-fault insurance system, timing requirements are strictly enforced. Healthcare providers must submit claims within specific deadlines, and when they miss these deadlines, they face an uphill battle to excuse their late submissions. The courts consistently require clear explanations for delays, and vague or incomplete justifications rarely suffice.
One area where providers frequently stumble involves the 45-day rule and the requirement to demonstrate that their late notice deserves due consideration. When attempting to excuse late submissions, providers must offer detailed explanations for what went wrong and why the delay occurred.
Jason Tenenbaum’s Analysis:
Norman Y. Schoenberg, M.D., P.C. v N.Y.C. Tr. Auth., 2013 NY Slip Op 50421(U)(App. Term 2d Dept. 2013)
“Defendant annexed to its motion papers a letter from plaintiff’s attorney, who stated that, initially, the claim had been inadvertently submitted to a different carrier, but he failed to proffer any explanation as to why that had happened. Under the circumstances, defendant’s moving papers properly established its prima facie entitlement to summary judgment, and, therefore, its unopposed motion should have been granted”
And then had the circumstances been explained, it is a toss up as to whether claim would have been saved. There is a lot of case law on the “what happened” issue.
Key Takeaway
Simply stating that a claim was “inadvertently” submitted to the wrong carrier is insufficient to excuse late notice. Courts require detailed explanations of how and why delays occurred. Even with a complete explanation, success is not guaranteed, as extensive case law demonstrates the difficulty of overcoming timing violations in no-fault claims.
