Key Takeaway
Court ruling shows employee affidavits can create legal presumptions about mailed verification documents, raising questions about premature insurance claims.
When Verification Goes Astray: The Presumption Game
In New York no-fault insurance disputes, the timing of verification requests and responses can make or break a case. Insurance companies routinely claim they never received required verification documents, while healthcare providers insist they sent them. This creates a classic “he said, she said” scenario that courts must resolve.
The recent appellate decision in EMC Health Products highlights how courts handle these verification disputes and the legal presumptions that can arise from employee testimony. Understanding these nuances is crucial for providers navigating the complex world of no-fault insurance claims and verification requirements.
Jason Tenenbaum’s Analysis:
EMC Health Prods., Inc. v National Liab. & Fire Ins. Co., 2016 NY Slip Op 50132(U)(App. Term 2d Dept, 2016)
“However, in opposition to the cross motion, plaintiff submitted an affidavit from plaintiff’s employee, 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 the first, second, third and fifth causes of action are premature (see Healing Health Prods., Inc. v New York Cent. Mut. Fire Ins. Co., 44 Misc 3d 59 ).”
Really?
Key Takeaway
Jason’s skeptical “Really?” speaks volumes about the practical challenges in verification disputes. While employee affidavits can create legal presumptions about mailed documents, the reality of proving actual receipt remains murky. This case demonstrates how procedural technicalities can keep insurance disputes alive even when the underlying facts seem questionable.
