Key Takeaway
Court finds insurance carrier failed to prove proper mailing of denial forms, highlighting critical documentation requirements in no-fault cases.
Proper Mailing Requirements in No-fault Insurance Claims
In New York’s no-fault insurance system, carriers must follow strict procedural requirements when denying claims. One of the most fundamental requirements is properly mailing denial forms to healthcare providers. When carriers fail to establish proper mailing procedures, even seemingly straightforward denials can be overturned on appeal.
The case of Exultant Med. Diagnostics, P.C. v American Commerce Ins. Co. demonstrates how inadequate documentation of mailing procedures can derail an insurance company’s defense. This appellate decision reinforces that carriers must maintain detailed records not just of what they mail, but how they ensure accurate addressing and proper postage. The court’s scrutiny of these seemingly mundane details reflects the importance of procedural compliance in no-fault litigation.
For healthcare providers dealing with certified mail and regular mail issues, this case offers valuable insight into how courts evaluate mailing evidence.
Jason Tenenbaum’s Analysis:
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”
Key Takeaway
Insurance carriers must provide detailed affidavits documenting their mailing procedures, including how they obtain correct addresses and ensure proper postage. Generic statements about mailing practices are insufficient to establish proper service of denial forms in no-fault cases.
