Key Takeaway
Maya Insurance Co. loses three no-fault cases due to claims adjuster's contradictory testimony about mailing denial forms before her employment start date.
In no-fault insurance litigation, proving that denial forms were properly mailed is crucial for insurance companies defending against claims. The burden of proof lies with the insurer to demonstrate they sent timely denials to healthcare providers. When this proof fails, insurers face significant legal consequences.
Three recent cases against Maya Assurance Company highlight a fundamental problem in insurance defense: inconsistent witness testimony that undermines the entire defense strategy. These decisions demonstrate how even seemingly minor discrepancies in an affidavit can completely destroy an insurer’s case, particularly when dealing with mailing requirements that courts scrutinize heavily.
The core issue in these cases involves a claims adjuster who claimed to have personally mailed denial forms in May 2012, but then revealed she didn’t begin working for the company until July 2012. This contradiction rendered her testimony worthless and left Maya unable to prove proper mailing occurred.
Jason Tenenbaum’s Analysis:
Great Health Care Chiropractic, P.C. v Maya Assur. Co., 2016 NY Slip Op 50308(U)(App. Term 2d Dept 2016)
Gl Acupuncture, P.C. v Maya Assur. Co., 2016 NY Slip Op 50310(U)(App. Term 2d Dept. 2016)
Atlantic Radiology, P.C. v Maya Assur. Co., 2016 NY Slip Op 50316(U)(App. Term 2d Dept. 2016)
“Although the claims adjuster stated that, in May 2012, she had personally generated the denial of claim form and placed it in an envelope, affixed proper postage and placed the envelope in an outgoing mailbox, she also stated that she began working for defendant as a claims adjuster in July 2012. Consequently, her affidavit was of no probative value (see Points of Health Acupuncture, P.C. v GEICO Ins. Co., 25 Misc 3d 140, 2009 NY Slip Op 52445 ).”
Key Takeaway
Insurance companies must ensure their witnesses provide consistent, accurate testimony when proving mailing of denial forms. Even minor contradictions about employment dates can render entire affidavits worthless, leaving insurers unable to meet their burden of proof. This case series underscores the importance of proper documentation and verification procedures in no-fault insurance claims handling.
