Key Takeaway
New York court ruling shows insurance companies must provide detailed affidavits about mail handling procedures to successfully invoke the 45-day rule defense in no-fault cases.
Insurance companies in New York no-fault cases often attempt to deny claims by arguing they never received medical bills within the required 45-day period. However, as this recent Appellate Term decision demonstrates, insurers cannot simply make bare assertions about non-receipt — they must provide comprehensive documentation of their mail handling procedures.
Under New York No-Fault Insurance Law, insurance carriers have 30 days to pay or deny claims after receiving proper bills. The law provides an additional 15-day grace period, creating the critical 45-day window. When insurers claim they never received bills within this timeframe, courts require detailed proof of their internal processes for handling mail and maintaining claim files.
The burden on insurance companies is substantial. They must demonstrate not just that they didn’t receive specific bills, but that their entire mail retrieval, opening, indexing, and filing systems are reliable enough to support such a conclusion. This protection ensures that healthcare providers aren’t unfairly denied payment due to inadequate insurance company record-keeping.
Jason Tenenbaum’s Analysis:
Utopia Equip. Inc. v Chubb Indem. Ins. Co., 2017 NY Slip Op 50540(U)(App. Term 1st Dept. 2017)
“The affidavit of defendant’s claims adjuster failed to describe defendant’s “regular practices and procedures in retrieving, opening, and indexing its mail and in maintaining its files on existing claims” (Liriano v Eveready Ins. Co., 65 AD3d 524, 525 ), and was inadequate to demonstrate that plaintiff’s bills were not timely received within the 45—day period (see SMB Med. P.C. v Chubb Indem. Ins. Co., 47 Misc 3d 146, 2015 NY Slip Op 50719 )“
Key Takeaway
This decision reinforces that insurance companies cannot rely on conclusory statements when asserting the 45-day rule defense. Courts require detailed affidavits explaining mail handling procedures, filing systems, and claim management practices. Without this comprehensive documentation, insurers cannot successfully argue they never received bills within the statutory timeframe, protecting healthcare providers from unfair claim denials.
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Common Questions
Frequently Asked Questions
What is New York's no-fault insurance system?
New York's no-fault insurance system requires all drivers to carry Personal Injury Protection (PIP) coverage. This pays for medical expenses and lost wages regardless of who caused the accident, up to policy limits. However, you can only sue for additional damages if you meet the 'serious injury' threshold.
