Key Takeaway
New York appellate court clarifies when insurance companies can prove they properly mailed denial of claim forms through affidavit testimony from litigation examiners.
No-fault insurance disputes often hinge on seemingly mundane procedural requirements, but these details can determine whether a healthcare provider receives payment for services rendered. One critical issue that frequently arises is whether insurance companies can prove they properly mailed denial of claim forms to providers within required timeframes.
Under New York’s no-fault insurance regulations, insurers must follow strict procedures when denying claims, including proper mailing of denial forms. When providers challenge these denials in court, insurance companies must demonstrate they followed their established mailing procedures. This burden of proof becomes particularly important when mailing procedures are scrutinized in litigation.
The Longevity Medical Supply case illustrates how courts evaluate evidence of proper mailing procedures. The Civil Court initially found the insurance company’s proof insufficient, but the appellate court disagreed. This type of procedural requirement affects countless no-fault insurance disputes throughout New York.
Jason Tenenbaum’s Analysis:
Longevity Med. Supply, Inc. v IDS Prop. & Cas. Ins. Co., 2014 NY Slip Op 51244(U)(App. Term 2d Dept. 2014)
Civil Court of the City of New York, Kings County (Carol Ruth Feinman, J.)
“The Civil Court denied defendant’s motion on the ground that defendant had not established that its procedure for mailing denial of claim forms had been followed. This appeal by defendant ensued.”
…
“Contrary to the determination of the Civil Court, the affidavit by defendant’s litigation examiner established, based upon her personal knowledge, that defendant’s procedures for mailing “
Key Takeaway
The appellate court reversed the Civil Court’s decision, finding that the insurance company’s litigation examiner’s affidavit was sufficient to establish proper mailing procedures. This demonstrates that personal knowledge testimony about standard office procedures can satisfy the burden of proof for timely mailing, even when the Civil Court initially found such evidence inadequate.
