Key Takeaway
Court clarifies that failure to mail no-fault denial forms in duplicate is not automatically fatal to insurance company's defense, reinforcing procedural flexibility.
Understanding No-Fault Insurance Denial Requirements
In New York’s no-fault insurance system, insurance companies must follow specific procedural requirements when denying claims. One area that has generated confusion involves whether denial forms must be mailed in duplicate to healthcare providers. This procedural question might seem minor, but it can significantly impact whether an insurance company preserves its right to contest a claim.
The Court of Appeals has established that insurance companies have three opportunities to raise defenses against no-fault claims, making proper procedural compliance crucial. However, not every technical violation results in a waived defense. Courts must balance the need for procedural compliance with practical realities of insurance administration.
When evaluating denial forms, courts examine both the substance and procedural aspects of the denial. While some procedural errors can be fatal to an insurance company’s defense, others are considered harmless technical violations that don’t prejudice the healthcare provider’s rights.
Jason Tenenbaum’s Analysis:
Performance Plus Med., P.C. v Utica Mut. Ins. Co., 2015 NY Slip Op 50399(U)(App. Term 2d Dept. 2015)
“We note that, contrary to plaintiff’s argument on appeal, the mailing affidavit submitted by defendant alleged that two copies of each denial of claim form were mailed to plaintiff. In any event, the failure to send a denial in duplicate is not, on its own, a fatal error (Mollo Chiropractic, PLLC v American Commerce Ins. Co., 42 Misc 3d 66, 69 ).”
Key Takeaway
The court reinforced that technical violations of mailing requirements don’t automatically invalidate an insurance company’s denial. This decision provides important guidance for practitioners handling no-fault disputes, distinguishing between procedural errors that affect substantive rights and those that constitute harmless technical violations.
