Key Takeaway
New York court highlights importance of proper proof of mailing in no-fault insurance denials, showing how inadequate affidavits can undermine insurer defenses.
Proper Proof of Mailing Requirements in No-Fault Insurance Cases
In New York No-Fault Insurance Law cases, insurance companies must follow strict procedural requirements when denying claims. One critical requirement is providing proper proof that denial letters were actually mailed to healthcare providers. A recent appellate court decision demonstrates how inadequate documentation can derail an insurer’s defense, even when represented by experienced counsel.
The case of J.O.V. Acupuncture, P.C. v Amex Assur. Co. illustrates a fundamental principle: insurers cannot simply submit any affidavit claiming proper mailing occurred. The court requires specific, credible evidence that demonstrates the affiant has personal knowledge of the insurer’s actual mailing procedures. This requirement becomes particularly important in cases involving IME no-shows where proper notice is essential.
Jason Tenenbaum’s Analysis:
J.O.V. Acupuncture, P.C. v Amex Assur. Co., 2017 NY Slip Op 50347(U)(App. Term 1st Dept. 2017)
“This action, seeking recovery of first-party no-fault benefits, is not ripe for summary dismissal, since defendant-insurer failed to establish the proper and timely mailing of the denial of claim form at issue (see Nyack Hosp. v Metropolitan Prop. & Cas. Ins. Co., 16 AD3d 564, 564—565 , lv denied 5 NY3d 713 ; Hospital for Joint Diseases v Nationwide Mut. Ins. Co., 284 AD2d 374 ). The affidavit submitted by defendant to establish proof of mailing of the denial, identifying the affiant as an employee of nonparty Ameriprise Auto & Home , lacked probative value, since affiant failed to show any relationship between Ameriprise and defendant, or any personal knowledge of the internal mailing practices and procedures of defendant during the pertinent period”
I always thought when a firm billed by the hour, the work product was supposed to be better. #Alternativefacts not by Sean Spicer.
Key Takeaway
This decision reinforces that insurers must provide competent proof of mailing through affidavits from individuals with actual knowledge of the company’s mailing procedures. Generic affidavits from third-party employees without demonstrated connections to the insurer will not satisfy court requirements, potentially allowing providers to recover benefits despite claim denials.
