Key Takeaway
Court rejects mailing affidavit from employee who started after the denial was sent, highlighting importance of personal knowledge in proving proper mailing procedures.
No-fault insurance disputes often hinge on whether an insurance company can prove it properly mailed a denial or other correspondence to a healthcare provider. Courts scrutinize these proof-of-mailing affidavits carefully, requiring that the person making the sworn statement have actual personal knowledge of the mailing procedures during the relevant time period.
The Healthy Way Acupuncture case demonstrates a common pitfall that insurance companies face when trying to establish their mailing procedures. When an employee who wasn’t even working at the company during the time in question attempts to swear to the company’s mailing practices, courts will reject such evidence as lacking probative value.
This ruling is part of a broader pattern where courts demand strict compliance with procedural requirements in no-fault cases, similar to issues we’ve seen in other mailing disputes.
Jason Tenenbaum’s Analysis:
Healthy Way Acupuncture, P.C. v One Beacon Ins. Co., 2015 NY Slip Op 50537(U)(App. Term 1st Dept. 2015)
This time, the Court does not focus so much on the jural relationship between the parties, but the court is focusing on when the person commenced employment with the entity at issue.
“The affidavit submitted by defendant to establish proof of mailing, identifying the affiant as an employee of nonparty Tower Insurance Group (“Tower”), an entity remotely related to defendant, lacked probative value, since it failed to set forth the basis of affiant’s personal knowledge of the internal mailing practices and procedures of defendant during the pertinent period (see Gogos v Modell’s Sporting Goods, Inc., 87 AD3d 248, 253-254 ), especially given that affiant began his employment with Tower after the denial at issue was allegedly mailed by defendant”
Key Takeaway
The court’s decision emphasizes that proof-of-mailing affidavits must be made by someone with actual personal knowledge of the company’s mailing procedures during the specific time period when the document was allegedly sent. An employee who started working after the mailing occurred cannot provide valid testimony about procedures they never witnessed or participated in.
