Key Takeaway
New York court accepts inadequate verification compliance affidavit despite lack of specific details about mailing dates and contents in no-fault insurance case.
New York’s no-fault insurance system requires healthcare providers to submit verification responses when insurance carriers request additional documentation to support claims. When disputes arise over whether these verifications were properly sent, courts must determine whether the evidence presented is sufficient to establish compliance. The case of Compas Med., P.C. v Praetorian Ins. Co. illustrates ongoing challenges in the standards applied to verification compliance affidavits.
This decision highlights a recurring pattern where appellate courts accept verification compliance affidavits that contain only generic language without specific details about what was actually mailed or when. The case demonstrates the tension between practical litigation needs and evidentiary standards in New York No-Fault Insurance Law disputes.
Jason Tenenbaum’s Analysis:
Compas Med., P.C. v Praetorian Ins. Co.,2015 NY Slip Op 51699(U)(App. Term 2d Dept. 2015)
However, in opposition to the cross motion, plaintiff submitted an affidavit from plaintiff’s owner, which affidavit was sufficient to give rise to a presumption that the requested verification had been mailed to, and received by, defendant (see Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 ). In light of the foregoing, there is a triable issue of fact as to whether this cause of action is premature (see Healing Health Prods., Inc. v New York Cent. Mut. Fire Ins. Co., 44 Misc 3d 59 ).
I read the affidavit. There is nothing except boilerplate about submitting verification responses to the carrier. Noteworthy, there is nothing provided showing wen the verification was mailed and what was mailed. Why? It never happened. I would hope after seeing the same affidavit, this Court would wake up and ask themselves why they are reversing close to 100 matters where judges found the plaintiff affidavit to be deficient. One day someone on the 15th floor will get it.
Key Takeaway
This case exemplifies a troubling trend where appellate courts accept boilerplate verification affidavits lacking specific details about mailing dates and contents. Despite the absence of concrete evidence that verification responses were actually sent, the court found sufficient grounds to create a triable issue of fact, potentially setting a low bar for verification compliance documentation.
