It was not mailed

Exultant Med. Diagnostics, P.C. v American Commerce Ins. Co., 2017 NY Slip Op 50496(U)(App. Term 2d Dept. 2017)

Jesus.  I get it, it is a volume business and we all make mistakes.  I am raising my hand here.  Guilty as charged.  Saw two on my desk.  We had a group discussion and it will not happen again.  What did we not do?  Appeal.

But now you appealed a sloppy loss?  And how come the carrier has not filed a malpractice lawsuit for this among others?

“Upon a review of the record, we find that defendant failed to establish that the denial of claim forms, which denied plaintiff’s claims on the ground of lack of medical necessity, had been properly and timely mailed. The affidavit of defendant’s claims adjuster did not state how defendant obtains the mailing address for the denial of claim forms, so as to ensure that the address is correct, or that the envelopes are affixed with postage”