Key Takeaway
Court ruling highlights the critical difference between claiming you mailed documents and proving proper mailing procedures in no-fault insurance claims.
New York no-fault insurance disputes often hinge on seemingly technical procedural requirements that can make or break a healthcare provider’s claim. One of the most contentious areas involves the 45-day deadline for submitting claims and the burden of proving timely mailing when an insurance company denies receiving documentation.
The recent decision in Orthopedic Specialist of Greater NY v Chubb Indemnity Insurance Co. illustrates how courts scrutinize both the substantive medical necessity of treatments and the procedural compliance with filing deadlines. This case demonstrates that even when medical evidence supports the necessity of treatment, mailing disputes can derail otherwise valid claims.
The tension between what providers claim they mailed versus what insurers say they received creates a recurring battleground in no-fault litigation. Understanding the specific proof requirements for establishing timely mailing becomes crucial for healthcare providers seeking reimbursement.
Jason Tenenbaum’s Analysis:
Orthopedic Specialist of Greater NY v Chubb Indem. Ins. Co., 2015 NY Slip Op 50565(U)
(1) “We agree that the conflicting medical expert opinions adduced by the parties sufficed to raise a triable issue as to the medical necessity of the orthopedic surgery underlying plaintiff’s first-party no-fault claim in the sum of $3,408.11. However, defendant made a prima facie showing of entitlement to summary judgment dismissing plaintiff’s no-fault claim in the sum of $212.37, by the affidavit of its claims adjuster demonstrating that plaintiff submitted the claim beyond the 45-day time limit for submission of claims”
(2) “The affidavit of plaintiff’s office manager did not allege a personal mailing of the claim within the 45-day period or describe plaintiff’s regular office mailing practice and procedure”
It is always interesting watching the “mailing v. non-receipt” battles.
Key Takeaway
This case underscores a fundamental principle in no-fault insurance litigation: proving you sent something requires more than just claiming you did. Healthcare providers must establish either personal knowledge of mailing or demonstrate their standard office procedures for handling certified mail and regular mail. Without proper documentation of mailing practices, even valid medical claims can be dismissed on procedural grounds.
