Mailing and denial issues

Urban Well Acupuncture, P.C. v American Commerce Ins. Co., 2014 NY Slip Op 51520(U)

“The action, seeking recovery of first-party no-fault benefits, is not ripe for summary dismissal since defendant “failed to … establish that the denial of claim form was in fact mailed to the plaintiff” (Nyack Hosp. v Metropolitan Prop. & Cas. Ins. Co., 16 AD3d 564, 564-565 ; see Mercury Cas. Co. v Encare, Inc., 90 AD3d 475 ). The affidavit submitted by the defendant insurer to establish proof of mailing – identifying the affiant as a “mailroom representative” of a nonparty to this action, State-Wide Insurance Company (“State-Wide”) – neither stated that the affiant actually mailed the claim denial to plaintiff nor, so far as appears, described defendant’s mailing office practice and procedures (see New York and Presbyterian Hospital v Allstate Ins. Co., 29 AD3d 547 ), as opposed to those generally followed by State-Wide. Conspicuously absent from defendant’s moving submission was any allegation or showing that a jural relationship existed between defendant and State-Wide. Given these shortcomings in defendant’s proof, we have no occasion to consider whether defendant’s purported mailing of the claim denial to the individual treating acupuncturist rather than the employing professional corporation was proper (see 11 NYCRR 65-3.8)”

Nyack v. Metropolitan is best known as one of the first defective denial cases.  There is a line in this case (nobody paid attention to it) stating that an affidavit of mailing to the plaintiff was not presented.  I guess somebody forgot to link “state wide” and “american commerce” in the mailing affidavit.  It happens, and I am sure this mistake will not happen again.

I like how the court ducked the main issue here: Can a denial be sent to the treating acupuncturist as opposed to the P.C.  If the court follows Judge Ciaffa’s agency theory case and pertinent precedent regarding the duty to communicate, then the answer to the question should be an unconditional “yes”.

Related Articles

• Understanding No-Fault Insurance Mailing Requirements: Lessons from the First Department’s “Venom” Decision
• How Claim Representative Affidavits Can Cure NF-10 Form Inaccuracies in New York No-Fault Law
• Understanding Medical Necessity Denials: Escaping the Four Corners Rule in Long Island No-Fault Cases
• DWI defense non-upheld: mailing, denials and affidavits gone awry
• New York No-Fault Insurance Law

Legal Update (February 2026): The mailing and denial requirements referenced in this 2014 post, particularly under 11 NYCRR 65-3.8, may have been subject to regulatory amendments or clarifications since publication. Practitioners should verify current mailing procedures, proof of service requirements, and denial form protocols, as the Department of Financial Services has periodically updated no-fault regulations affecting insurer notice obligations and documentation standards.