A 30-day notice case that went to trial

When dealing with New York’s no-fault insurance system, understanding notice requirements is crucial for both healthcare providers and accident victims. The Law Office of Jason Tenenbaum has extensive experience navigating these complex regulations, particularly in cases involving timely notice of claims. Our recent analysis of a significant Nassau County District Court case demonstrates the importance of proper notice procedures and insurance company compliance with regulatory requirements.

The Case: Medical Select, P.C. v Allstate Ins. Co.

Medical Select, P.C. v Allstate Ins. Co., 2013 NY Slip Op 23446 (District Ct. Nassau Co. 2013)

“According to the proof adduced at trial, Allstate initially received notice of the accident from its insured within one week of the accident date. It was apparently advised, at that time, that three other individuals (plaintiff’s assignors) had been injured in the accident.”

…

“Following receipt of the signed NF-2’s, Allstate took no immediate steps to advise plaintiff’s assignors that their NF-2’s had been submitted too late, nor did it advise them that a late submission could be excused. Instead, it was not until Allstate began receiving assigned claims from the plaintiff provider that it first asserted, in its timely denials of the provider’s claims, that it was refusing to pay for necessary treatments due to the assignors’ failure to give written notice to defendant within 30 days of the accident.”

“Each of the denials includes the following explanation: “Claim denied for failure to comply with written notice requirement. Notice must be given as soon as reasonably practicable, but in no event more than 30 days after the accident date, unless the eligible injured person submits written proof providing clear and reasonable justification for failure to comply with such time limitation…” Using almost identical language, the denials added: “reasonable justification not proven, for proof of claim. herefore claim is denied.”

..

“Unlike the circumstances presented in SZ Med. PC v County-Wide Ins. Co., the insurer’s denials include language which partially tracks the language of 11 NYCRR 65-3.3(e). However, on balance, the Court concludes that the language employed fails to substantially satisfy the requirements of this section. At the very least, a valid denial must include some language indicating that the claimant “may submit additional information (such as justification for delay) and that reconsideration is possible.” Hempstead Pain & Med. Servs., PC v General Assur. Co., supra. The denials, here, fail to do so.”

…

“Instead of containing the required advisory, the denials simply present a fait accompli conclusion that “reasonable justification” was “not proven.” Although plaintiff’s assignors were copied on the denials, they were never specifically advised, in the denials or otherwise, that they could or should submit additional information explaining why the NF-2 forms were submitted more than 30 days after the accident.”

…

“In the case at bar, such “explicit notice” is lacking. Moreover, defendant’s trial proof did not demonstrate that it had established “standards for review” of late claims, or that it had established “procedures, based upon objective criteria, to ensure due consideration of denial of claims based upon late notice or late submission of proof of claim … (11 NYCRR 65-3.5).”

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This case absolutely begs the question: why didn’t Allstate move for summary judgment? First, the “prefatory language” part of the opinion would have been controlled in a pro-forma affidavit that on balance would have made a better record on appeal. And make no mistake, the failure of the Assignor or the medical provider to seek reconsideration pre-suit renders this opinion wrong on the law. The recent precedent suggests that to be the case, In addition, 65-3.5(l) does not form a basis for evaluating these types of case, in accordance with the most recent pronouncements on the 30-day rule.

But to appeal these cases in the trial postulate, where uncontrolled testimony or “trial stips” can muddy the record is a dangerous game to play.

Understanding New York’s 30-Day Notice Rule in Context

The Legal Framework in Long Island and New York City

The 30-day notice requirement under New York’s no-fault law represents one of the most critical deadlines in personal injury cases. For residents across Long Island, including Nassau and Suffolk Counties, and throughout New York City’s five boroughs, understanding this requirement can mean the difference between receiving coverage and facing denial of essential medical benefits.

The regulation at 11 NYCRR 65-3.3(e) establishes specific procedures that insurance companies must follow when denying claims based on late notice. This isn’t merely a procedural formality – it’s a consumer protection mechanism designed to ensure fairness in the claims process.

Key Issues Identified in the Medical Select Case

1. Insurance Company Obligations Upon Receipt of Late Notice

When an insurance carrier receives an NF-2 form after the 30-day deadline, they cannot simply deny the claim without following proper procedures. The Medical Select case demonstrates that insurers must:

• Immediately advise the claimant that their submission was late
• Inform them that late submissions can potentially be excused with proper justification
• Establish clear standards and procedures for reviewing late claims
• Provide explicit notice of reconsideration options

2. The Problem with “Fait Accompli” Denials

The court criticized Allstate’s approach of presenting a conclusive denial without offering the opportunity for reconsideration. This practice violates regulatory requirements and denies claimants their procedural rights under New York law.

Implications for Healthcare Providers and Patients

For Medical Providers

Healthcare providers who treat accident victims must understand that insurance companies cannot arbitrarily deny claims based on late notice without following proper procedures. When insurers fail to comply with regulatory requirements, providers have legal recourse to challenge improper denials.

For Accident Victims

If you’ve been injured in a motor vehicle accident in New York, it’s crucial to understand:

• The 30-day notice deadline is strict but not absolute
• Late submissions can be excused with proper justification
• Insurance companies must follow specific procedures when handling late claims
• You have rights even if your initial notice was late

The Strategic Perspective: Why This Case Matters

From a litigation strategy standpoint, this case highlights several important considerations:

Summary Judgment vs. Trial Strategy

The opinion raises an interesting question about Allstate’s decision to proceed to trial rather than seeking summary judgment. As noted in the analysis, proceeding to trial in these cases can be “a dangerous game to play” because uncontrolled testimony and trial stipulations can muddy the record for appeal purposes.

Regulatory Compliance as a Defense Strategy

The case demonstrates that insurance companies’ failure to comply with regulatory procedures can provide strong grounds for challenging claim denials, even when the underlying notice was admittedly late.

The Importance of Proper Record Development

For both plaintiffs and defendants, developing a clear, controlled record is essential. The regulatory requirements under 11 NYCRR 65-3.5(l) regarding standards for review and objective criteria must be properly addressed.

Frequently Asked Questions About 30-Day Notice Requirements

Q: What happens if I miss the 30-day deadline for submitting my NF-2 form?

A: Missing the deadline doesn’t automatically disqualify you from coverage. Insurance companies must follow specific procedures when denying late claims, including giving you the opportunity to provide justification for the delay and offering reconsideration options.

Q: Can insurance companies deny my claim simply because my NF-2 was submitted after 30 days?

A: No. While late submission can be grounds for denial, insurers must comply with regulatory procedures, provide proper notice of your rights, and establish fair standards for reviewing late claims.

Q: What constitutes “reasonable justification” for late submission?

A: Reasonable justification can include factors like medical incapacitation, lack of knowledge about the requirement, or other circumstances beyond your control that prevented timely submission.

Q: How do I challenge an improper denial based on late notice?

A: Challenging improper denials requires understanding both the substantive law and procedural requirements. An experienced no-fault attorney can evaluate whether the insurance company followed proper procedures and help you pursue your claim.

Q: What are my options if the insurance company didn’t provide proper notice of reconsideration rights?

A: If an insurer fails to provide required advisories about reconsideration options, this procedural violation can be grounds for overturning the denial, even if the original submission was late.

Conclusion: The Importance of Experienced Legal Representation

The Medical Select case illustrates the complex interplay between substantive law and procedural requirements in New York no-fault cases. While the 30-day notice rule is well-established, insurance companies cannot simply ignore their regulatory obligations when handling late claims.

Whether you’re a healthcare provider seeking payment for treating accident victims, or an individual whose claim has been denied based on allegedly late notice, understanding these nuances is crucial. The regulatory framework provides important protections, but realizing those protections often requires experienced legal advocacy.

At the Law Office of Jason Tenenbaum, we have extensive experience handling no-fault cases throughout Long Island and New York City. Our deep understanding of both the substantive law and regulatory requirements positions us to effectively advocate for our clients’ rights.

Contact Our Experienced New York No-Fault Attorneys

If you’re facing a denial based on late notice, or if you’re a healthcare provider dealing with improper claim denials, don’t navigate these complex waters alone. Our team has the knowledge and experience to protect your interests and ensure that insurance companies comply with their legal obligations.

Call us today at 516-750-0595 for a consultation about your no-fault insurance case. We serve clients throughout Nassau County, Suffolk County, and the five boroughs of New York City, providing dedicated advocacy in personal injury and insurance law matters.

Related Articles

• Court of Appeals analysis of notice condition precedents
• Understanding when written proof of loss is considered timely
• How the prejudice rule applies in notice disputes
• Recent developments in timely notice requirements
• Due consideration requirements for late notice claims

Legal Update (February 2026): Since this 2014 post, 11 NYCRR Part 65 regulations governing no-fault insurance procedures may have been amended, particularly provisions related to notice requirements and insurer denial procedures under section 65-3.5. The regulatory framework for timely notice of claims and insurance company obligations has been subject to periodic updates and clarifications. Practitioners should verify current regulatory provisions and recent case law developments when advising clients on notice requirements and denial procedures.