Key Takeaway
Jason Tenenbaum critiques Appellate Term's flawed reasoning in Compas Med. v Praetorian, where court accepted insufficient verification affidavit evidence in no-fault case.
Court Accepts Questionable Verification Affidavit Despite Missing Evidence
In New York’s no-fault insurance system, verification requirements play a crucial role in claim processing. When insurance carriers request additional verification from healthcare providers, the proper handling of these requests can make or break a case. The Appellate Term’s recent decision in Compas Med., P.C. v Praetorian Ins. Co. demonstrates how courts sometimes accept questionable evidence regarding verification non-receipt without proper scrutiny.
The case highlights ongoing issues with how courts evaluate evidence in no-fault disputes, particularly when providers claim they never received verification requests or assert they responded to such requests without producing the actual documentation.
Jason Tenenbaum’s Analysis:
Compas Med., P.C. v Praetorian Ins. Co., 2015 NY Slip Op 51776(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 (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”
Let’s ask the scrivener of the Compas affidavit: (1) Where is the requested verification because it was not in the papers; (2) The affidavit never stated the date the verification responses were mailed because they never were mailed. Alas, the Appellate Term screwed up again.
Key Takeaway
This decision illustrates problematic judicial reasoning where courts create “triable issues of fact” based on insufficient affidavit evidence. When healthcare providers cannot produce actual verification responses or specify mailing dates, courts should not presume compliance with no-fault insurance requirements. Such flawed analysis undermines the verification process’s integrity and creates uncertainty in additional verification procedures.
