Key Takeaway
NY court ruling emphasizes that healthcare providers must actively use regulatory safety valves when facing late notice denials in no-fault insurance claims.
Understanding the NF-10 Safety Valve: When Communication is Critical
In New York’s no-fault insurance system, healthcare providers face strict deadlines for notifying insurers about accidents and treatments. When these deadlines are missed, providers often look to regulatory safety valves that allow for late submissions under certain circumstances. However, as a recent Appellate Term decision demonstrates, simply having access to these opportunities isn’t enough—providers must actively use them.
The case of Healthway Med. Care, P.C. v Country Wide Ins. Co serves as a crucial reminder about the importance of responding to denial notices and utilizing available procedural protections. This ruling highlights a common pitfall: failing to take advantage of opportunities explicitly provided by insurance carriers after a late notice denial.
Jason Tenenbaum’s Analysis:
Healthway Med. Care, P.C. v Country Wide Ins. Co., 2015 NY Slip Op 51654(U)(App. Term 2d Dept. 2015)
“As defendant established its prima facie entitlement to judgment as a matter of law, the burden shifted to plaintiff. Despite being informed by the denial of claim forms that it had the opportunity to “submit[] written proof providing clear and reasonable justification for the failure” to timely advise defendant of the accident (11 NYCRR 65-1.1; 65-2.4), plaintiff did not present any evidence that it had availed itself of the opportunity or that it had given timely notice.”
The Court again stressed that if you wish to seek refuge within the regulation’s safety valve, communication with the carrier is key.
Key Takeaway
When insurance carriers provide specific opportunities to justify late notice through denial forms, healthcare providers must actively respond with written proof. Simply receiving the opportunity isn’t sufficient—providers must demonstrate they attempted to use the regulatory safety valve. This case underscores that communication with carriers is essential when seeking to overcome procedural defenses in no-fault insurance disputes.
