Key Takeaway
Court finds triable issue of fact exists when insurance company claims non-receipt of claim form but provider has proof of mailing. Untimely submission alone doesn't warrant dismissal.
No-fault insurance disputes often center on whether required documentation was properly submitted to insurance carriers. When carriers claim they never received claim forms, the burden shifts between parties depending on the evidence presented. The case of Lenox Hill Radiology v Great Northern Insurance Co. illustrates how courts handle these non receipt scenarios and why procedural defenses may not always succeed.
This appellate decision demonstrates that insurance companies cannot simply deny receipt without considering contrary evidence from healthcare providers. The court’s analysis reveals important principles about burden of proof and the limitations of certain procedural defenses in no-fault litigation.
Jason Tenenbaum’s Analysis:
Lenox Hill Radiology v Great N. Ins. Co., 2016 NY Slip Op 50206(U)(App. Term 2d Dept. 2016)
(1) “While defendant made a prima facie showing that it had not received plaintiff’s claim form, the affidavit of the mailing supervisor in plaintiff’s attorneys’ offices established that the claim at issue had been mailed to defendant. Thus, a triable issue of fact exists as to the submission of the claim form”
(2) “Moreover, contrary to defendant’s contention, even if plaintiff failed to submit the claim form in a timely manner, untimely submission, in and of itself does not entitle defendant to summary judgment dismissing the complaint”
I am confused as to why this was appealed, or why an insurance carrier paid money to appeal this? Could someone enlighten me here?
Key Takeaway
When insurance carriers claim non-receipt of claim forms, they can establish a prima facie case, but providers can counter with evidence of proper mailing. Courts will find triable issues of fact exist when both sides present credible evidence. Additionally, even late submission alone doesn’t guarantee dismissal of a provider’s complaint, contrary to what some carriers may argue.
