Key Takeaway
Court ruling shows insurance companies must provide detailed affidavits about mail handling procedures to prove 45-day rule violations in no-fault claims disputes.
This article is part of our ongoing timely submissions of bills coverage, with 17 published articles analyzing timely submissions of bills issues across New York State. Attorney Jason Tenenbaum brings 24+ years of hands-on experience to this analysis, drawing from his work on more than 1,000 appeals, over 100,000 no-fault cases, and recovery of over $100 million for clients throughout Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx. For personalized legal advice about how these principles apply to your specific situation, contact our Long Island office at (516) 750-0595 for a free consultation.
Understanding the 45-Day Rule in No-Fault Insurance Claims
New York’s no-fault insurance system operates under strict timing requirements, with healthcare providers typically required to submit bills within 45 days of treatment. However, insurance companies cannot simply claim a bill was submitted late without proper documentation. A recent Appellate Term decision highlights the evidentiary standards required when insurers attempt to deny claims based on alleged late submissions.
The case demonstrates an important jurisdictional split between New York’s appellate departments regarding what constitutes sufficient proof of untimely billing submissions. While some courts have been more lenient with insurance company affidavits, this ruling establishes a higher bar for proving timing violations.
Jason Tenenbaum’s Analysis:
SMB Med. P.C. v Chubb Indem. Ins. Co., 2015 NY Slip Op 50719(U)(App. Term 1st Dept. 2015)
“Defendant failed to establish its entitlement to summary judgment dismissing the complaint based upon plaintiff’s alleged untimely submission of the claims beyond the applicable 45-day time limit (see 11 NYCRR 65-1.1). The affidavit of defendant’s claims adjuster failed to describe defendant’s “regular practices and procedures in retrieving, opening, and indexing its mail and in maintaining its files on existing claims”
The First Department (unlike Second Department precedent) requires some type of discussion in the affidavit to allow the affiant to reach the conclusion that the billing was untimely submitted. Just saying the billing was received on some day is insufficient.
Key Takeaway
Insurance companies cannot defeat no-fault claims simply by stating when they received billing documents. The First Department requires detailed affidavits explaining the insurer’s mail handling procedures and file maintenance practices. This procedural requirement protects healthcare providers from unfounded late notice claims and ensures proper due process in timing disputes.
Related Articles
Legal Context
Why This Matters for Your Case
New York law is among the most complex and nuanced in the country, with distinct procedural rules, substantive doctrines, and court systems that differ significantly from other jurisdictions. The Civil Practice Law and Rules (CPLR) governs every stage of civil litigation, from service of process through trial and appeal. The Appellate Division, Appellate Term, and Court of Appeals create a rich and ever-evolving body of case law that practitioners must follow.
Attorney Jason Tenenbaum has practiced across these areas for over 24 years, writing more than 1,000 appellate briefs and publishing over 2,353 legal articles that attorneys and clients rely on for guidance. The analysis in this article reflects real courtroom experience — from motion practice in Civil Court and Supreme Court to oral arguments before the Appellate Division — and a deep understanding of how New York courts actually apply the law in practice.
Keep Reading
More Timely submissions of Bills Analysis
Mastering Medical Expenses in Personal Injury Claims
Learn about medical expenses after personal injury in NYC & Long Island. Expert guidance on documenting costs and maximizing compensation.
Dec 10, 2024Triable issue of fact: 45-day rule
NY appellate court rules that insurance company's late receipt of claim forms creates triable issue of fact regarding timely mailing under 45-day rule.
Jun 3, 2018The conclusory statement of non receipt will not non-suit a 45-day case
Easy Care Acupuncture v MVAIC case shows conclusory non-receipt statements insufficient to dismiss 45-day no-fault billing cases without proper search evidence
Nov 26, 2014Summary judgment granted under the new interpretation of prima facie
Court grants summary judgment under new prima facie interpretation for no-fault billing manager affidavit establishing timely claim submission within 45 days.
Apr 25, 2012What went wrong here?
Aminov v Travelers case analysis: court finds insurer failed to prove non-receipt of claim forms despite provider's incomplete complaint documentation.
Oct 8, 201045-days…and then what?
Understanding New York no-fault 45-day rule violations and reasonable justifications. Expert legal guidance from Long Island attorney Jason Tenenbaum.
Apr 28, 2009Common Questions
Frequently Asked Questions
What is the deadline for submitting no-fault medical bills in New York?
Under 11 NYCRR §65-1.1, healthcare providers must submit no-fault billing within 45 days of the date of service. Late submissions can result in denial of the claim. The 45-day rule is strictly enforced, though providers may argue reasonable justification for late filing in limited circumstances.
What happens if a medical bill is submitted late?
If a no-fault bill is submitted more than 45 days after treatment, the insurer can deny the claim as untimely. This defense must be raised on the NF-10 denial form. If the provider can show a reasonable justification for the delay, the denial may be overturned, but this is a difficult burden to meet.
Does the 45-day rule apply to all no-fault claims?
The 45-day submission requirement applies specifically to healthcare providers submitting bills under no-fault. The injured person's application for benefits (NF-2) has a 30-day deadline from the accident. Different timelines apply to different types of claims within the no-fault system, so compliance with each deadline is critical.
Was this article helpful?
About the Author
Jason Tenenbaum, Esq.
Jason Tenenbaum is the founding attorney of the Law Office of Jason Tenenbaum, P.C., headquartered at 326 Walt Whitman Road, Suite C, Huntington Station, New York 11746. With over 24 years of experience since founding the firm in 2002, Jason has written more than 1,000 appeals, handled over 100,000 no-fault insurance cases, and recovered over $100 million for clients across Long Island, Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, the Bronx, and Staten Island. He is one of the few attorneys in the state who both writes his own appellate briefs and tries his own cases.
Jason is admitted to practice in New York, New Jersey, Florida, Texas, Georgia, and Michigan state courts, as well as multiple federal courts. His 2,353+ published legal articles analyzing New York case law, procedural developments, and litigation strategy make him one of the most prolific legal commentators in the state. He earned his Juris Doctor from Syracuse University College of Law.
Disclaimer: This article is published by the Law Office of Jason Tenenbaum, P.C. for informational and educational purposes only. It does not constitute legal advice, and no attorney-client relationship is formed by reading this content. The legal principles discussed may not apply to your specific situation, and the law may have changed since this article was last updated.
New York law varies by jurisdiction — court decisions in one Appellate Division department may not be followed in another, and local court rules in Nassau County Supreme Court differ from those in Suffolk County Supreme Court, Kings County Civil Court, or Queens County Supreme Court. The Appellate Division, Second Department (which covers Long Island, Brooklyn, Queens, and Staten Island) and the Appellate Term (which hears appeals from lower courts) each have distinct procedural requirements and precedents that affect litigation strategy.
If you need legal help with a timely submissions of bills matter, contact our office at (516) 750-0595 for a free consultation. We serve clients throughout Long Island (Huntington, Babylon, Islip, Brookhaven, Smithtown, Riverhead, Southampton, East Hampton), Nassau County (Hempstead, Garden City, Mineola, Great Neck, Manhasset, Freeport, Long Beach, Rockville Centre, Valley Stream, Westbury, Hicksville, Massapequa), Suffolk County (Hauppauge, Deer Park, Bay Shore, Central Islip, Patchogue, Brentwood), Queens, Brooklyn, Manhattan, the Bronx, Staten Island, and Westchester County. Prior results do not guarantee a similar outcome.