Key Takeaway
Appellate Term finds insufficient excuse for late no-fault claim submission despite provider's proof of mailing to MVAIC first when insurer identity unclear.
Leica Supply, Inc. v American Tr. Ins. Co., 2013 NY Slip Op 50711(U)(App. Term 2d Dept. 2013)
“plaintiff had submitted its claims to defendant more than 45 days after the date the services had been rendered to plaintiff’s assignor (see Insurance Department Regulations § 65-1.1). Defendant’s denial of claim form adequately advised plaintiff of the basis for the denial, and it further advised plaintiff that the late submission of the claim would be excused if plaintiff provided a reasonable justification for the lateness (see Insurance Department Regulations § 65-3.3 ). We find that the reason proffered by plaintiff was insufficient.”
Since this is my case, here is the insufficiently proffered reason.
The bill here is for services on 2/14/08-3/7/08. Plaintiff provided proof that it mailed the bill to MVAIC on 3/24/08. This was through a letter with a mailing ledger and an affidavit from the billing manager. What was the reason the bill was sent to MVAIC? ” TIC was not known or indicated on the documents to be the insurer. “Only MVAIC advised that ATIC was, indeed, the insurer. Copes are attached. We never heard again from the examiner” The bill was then mailed to Defendant on 6/25/08 with explanation of tardiness.
Appellate Term found this to be an insufficient excuse. Interesting.
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- 45-day rule cases involving insufficiency of justification
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Legal Update (February 2026): Since this 2013 decision, the Insurance Department regulations governing no-fault billing submissions and excuse provisions under §§ 65-1.1 and 65-3.3 may have been amended, and the standards for evaluating “reasonable justification” for late submissions could have evolved through subsequent regulatory updates or case law interpretations. Practitioners should verify current regulatory provisions and recent appellate decisions when assessing acceptable excuses for untimely claim submissions.
