Key Takeaway
Court ruling shows how healthcare providers can overcome insurance company claims of non-receipt of verification documents through proper affidavits and evidence.
In New York no-fault insurance cases, disputes over verification requests and responses create significant litigation challenges for healthcare providers. When insurance companies claim they never received required verification documents, providers must navigate complex evidentiary requirements to prove their compliance and avoid having their lawsuits dismissed as premature.
The Great Health Care Chiropractic case demonstrates the intricate legal framework governing these verification non-receipt disputes. This decision illustrates how the burden of proof shifts between parties and what evidence courts require to establish whether verification documents were properly exchanged. Understanding these dynamics is crucial for providers operating under New York No-Fault Insurance Law, where procedural missteps can derail otherwise valid reimbursement claims.
The case also highlights the ongoing challenges providers face when insurers assert they never received requested verification documents, creating factual disputes that must be resolved through litigation.
Jason Tenenbaum’s Analysis:
Great Health Care Chiropractic, P.C. v Hereford Ins. Co., 2016 NY Slip Op 50910(U)(App. Term 2d Dept. 2016)
“In support of the cross motion, defendant established that it had timely mailed its verification request and follow-up verification request (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 ). Defendant also demonstrated prima facie that it had not received the requested verification and, thus, that plaintiff’s action is premature (see Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492 ). 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 (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 this action is premature (see Healing Health Prods., Inc. v New York Cent. Mut. Fire Ins. Co., 44 Misc 3d 59 ).”
No further comment.
Key Takeaway
This decision shows that while insurance companies can establish a prima facie case for non-receipt of verification documents, healthcare providers can successfully counter with owner affidavits asserting proper mailing. When both parties present competing evidence about document transmission, courts will typically find triable issues of fact, allowing cases to proceed to trial rather than dismissing them as premature.
