The conclusory statement of non receipt will not non-suit a 45-day case

The Burden of Proving Non-Receipt in No-Fault Insurance Cases

New York’s no-fault insurance regulations impose strict timing requirements on healthcare providers submitting bills for accident-related services. Under 11 NYCRR 65-1.1, providers must generally submit claims within 45 days of rendering service. When insurance carriers assert that bills were never received, thereby claiming untimeliness, courts require more than conclusory statements to establish this defense.

The First Department Appellate Term’s decision in Easy Care Acupuncture PC v MVAIC addresses the quantum of proof necessary for insurance carriers to prevail on non-receipt defenses. This case demonstrates that bare assertions of non-receipt, without supporting documentation or testimony about search procedures, cannot support summary dismissal of provider claims.

The decision carries particular significance for Motor Vehicle Accident Indemnification Corporation (MVAIC) cases, where proof of timely submission becomes critical to establishing the provider’s right to payment. Understanding the evidentiary requirements for proving or disproving receipt protects both providers and carriers from unfair results based on insufficient documentation.

Case Background

Easy Care Acupuncture PC provided acupuncture services to an individual injured in a motor vehicle accident and sought reimbursement from MVAIC, the state fund that compensates victims when no insurance coverage exists. MVAIC moved for summary judgment dismissing the provider’s claims, asserting that the bills were not submitted within the mandatory 45-day window following service.

To support this defense, MVAIC’s claim representative submitted an affidavit stating that MVAIC “was not aware of plaintiff’s bills” prior to the commencement of the lawsuit. The carrier relied on this statement as prima facie proof that the provider failed to comply with the 45-day submission requirement.

The provider opposed the motion, challenging MVAIC’s proof of non-receipt. The trial court needed to determine whether the claim representative’s vague statement about lack of awareness constituted sufficient evidence to establish that bills were never received, or whether additional proof was necessary.

Jason Tenenbaum’s Analysis:

Easy Care Acupuncture PC v MVAIC, 2014 NY Slip Op 51645(U)(App. Term 1st Dept. 2014)

“The action, seeking recovery of assigned first-party no-fault benefits, is not ripe for summary dismissal. The vague and conclusory assertion by defendant MVAIC’s claim representative that defendant “was not aware of plaintiff’s bills” prior to the commencement of the action was insufficient, on this record, to make a prima facie showing that plaintiff’s claims were untimely submitted beyond the applicable 45-day time limit (see 11 NYCRR 65-1.1; cf. NY Arthroscopy & Sports Medicine PLLC v Motor Veh. Acc. Indem. Corp., 15 Misc 3d 89 ). Conspicuously absent from the claim’s representative’s moving affidavit was any indication that she or a colleague searched the assignor’s file — said to be under the affiant’s “custody and control” — to ascertain whether plaintiff’s bills and claims had been logged in by defendant as received.”

Like any other defense that germinates from a “non-receipt” of a item, the Courts have uniformly held that some type of search was made prior coming to the conclusion that an item was not received. The search does not need to be exhaustive (a prior case from the second department dispelled this notion), but the search must be somewhat detailed. Here, all that was presented was a boilerplate I did not receive the billing. That is not enough to win in this Court.

Legal Significance

This decision establishes important evidentiary principles for non-receipt defenses in no-fault litigation. The Appellate Term’s rejection of MVAIC’s conclusory assertion reflects a broader judicial recognition that bare denials of receipt, without supporting proof of search procedures, cannot satisfy the moving party’s burden on summary judgment.

The court’s emphasis on the absence of any indication that the claim representative or colleagues searched the assignor’s file demonstrates that carriers must affirmatively establish their search efforts. Simply stating lack of awareness or knowledge proves insufficient because it fails to address whether the bills might have been received but not properly logged, misfiled, or otherwise lost within the carrier’s systems.

This requirement serves important policy objectives in the no-fault system. Healthcare providers who timely mail submissions should not lose payment rights based on carrier recordkeeping failures or inadequate search procedures. By requiring carriers to demonstrate reasonable search efforts, courts ensure that non-receipt defenses rest on genuine factual foundations rather than convenient assertions.

The decision also reinforces that affidavits supporting summary judgment motions must contain factual specificity rather than legal conclusions. Statements about what the affiant “was not aware of” constitute conclusions about non-receipt rather than facts about search procedures undertaken, documents reviewed, or systems checked.

Practical Implications for Carriers and Providers

Insurance carriers defending against claims on non-receipt grounds must prepare detailed affidavits describing their search procedures. Effective affidavits should specify: (1) which files or databases were searched; (2) what search parameters or criteria were used; (3) who conducted the searches; (4) when the searches occurred; and (5) what results were obtained. Simply stating that the affiant has “custody and control” of files and “was not aware” of submissions will not suffice.

The search need not be exhaustive, but it must be reasonable and somewhat detailed. Carriers should document their search efforts contemporaneously, maintaining records of file reviews, database queries, and communications with staff members about missing documents. This documentation becomes critical if non-receipt defenses later become contested.

Healthcare providers confronting non-receipt defenses should carefully scrutinize carrier affidavits for the level of detail provided about search efforts. When affidavits contain only conclusory statements, providers should object and demand proof of actual searches conducted. Providers may also submit their own proof of mailing—such as certified mail receipts, mailing logs, or third-party vendor certifications—to create factual disputes precluding summary judgment.

For MVAIC cases specifically, the heightened scrutiny on non-receipt defenses reflects judicial awareness that MVAIC serves as the payor of last resort for accident victims. Courts will not permit technical timing defenses to defeat legitimate claims without substantial proof that submission deadlines were actually violated.

Related Articles

• TImely submissions and MVAIC – a real problem
• 45-days…and then what?
• The Provider is Under an Extremely Tight Leash to Explain Why a Bill Was Untimely Submitted: Essential Guide for Long Island and NYC Healthcare Providers
• The Court of Appeals discusses a condition precedent

Legal Update (February 2026): Since this 2014 decision, practitioners should verify current provisions of 11 NYCRR 65-1.1 regarding timely submission requirements, as no-fault regulations and procedural standards for establishing non-receipt defenses may have been amended. Additionally, evolving case law may have further refined the evidentiary standards required to demonstrate adequate searches of claim files when asserting non-receipt.