Key Takeaway
Court ruling clarifies that insurance carriers must submit IME scheduling letters to toll the 30-day payment period in NY no-fault cases - key practice tip.
PR Med., P.C. v Praetorian Ins. Co., 2016 NY Slip Op 50338(U)(App. Term 1st Dept. 2016)
(1) Prima facie case: “Turning to the merits, plaintiff established prima facie that its no-fault claims in the amount of $2,005.25 were overdue, since they were not “denied or paid” within the prescribed 30-day period”
(2)”Contrary to Civil Court’s determination, defendant’s letter stating, in essence, that payment was delayed pending independent medical examinations (IMEs) of plaintiff’s assignor did not serve to toll the 30-day statutory period (id.). Nor has defendant otherwise raised a triable issue as to whether the 30-day period was tolled by verification requests that preceded its receipt of the underlying claims”
If you are trying to decipher this one, I think I might have the answer here. In order to toll the time to pay or deny when a bill is delayed for an IME or EUO, the carrier besides putting in the bill delay must also put in the submissions the EUO or IME scheduling letters. That was not done here. For may of us, just keep an eye on this – I just instructed my office to keep an eye on this subtle issue. It has happened to all of us at some point.
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