Why Trust This Analysis
This article is part of our ongoing timely submissions of bills coverage, with 17 published articles analyzing timely submissions of bills issues across New York State. Attorney Jason Tenenbaum brings 24+ years of hands-on experience to this analysis, drawing from his work on more than 1,000 appeals, over 100,000 no-fault cases, and recovery of over $100 million for clients throughout Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx. For personalized legal advice about how these principles apply to your specific situation, contact our Long Island office at (516) 750-0595 for a free consultation.
New York’s no-fault insurance system operates under strict deadlines designed to ensure prompt processing of claims and prevent fraud. One of the most fundamental requirements is the 45-day rule under 11 NYCRR 65-2.4(c), which mandates that healthcare providers submit their claims to insurance carriers within 45 days of rendering services. This regulation serves as a cornerstone of the no-fault system’s efficiency.
When providers fail to meet this deadline, their claims face denial unless they can demonstrate a reasonable justification that warrants due consideration for late notice. However, as the Masigla case demonstrates, some appeals lack merit from the outset.
The Decision
Masigla v ELRAC, Inc., 2017 NY Slip Op 51712(U)(App. Term 2d Dept. 2017)
“With regard to the claims that were denied based upon plaintiff’s failure to submit them to defendant within the time frame required by 11 NYCRR 65—2.4 (c), contrary to plaintiff’s argument on appeal, its own papers demonstrate that the claims were submitted more than 45 days after the dates on which the services had been rendered.”
This was funny.
How the 45-Day Rule Works
A short refresher for readers outside the no-fault bar. The mandatory personal injury protection endorsement — the standard policy language every New York auto insurer must use — conditions payment of health service bills on the provider submitting proof of claim within 45 days after the date services are rendered. The clock runs from each date of service, not from the end of a course of treatment, so a provider treating a patient over several months must bill on a rolling basis.
A late bill is not automatically dead. The regulations require the carrier’s denial to advise the applicant that late submission will be excused where the applicant provides a reasonable justification for the delay, and the carrier must then actually consider any excuse offered. That is the “due consideration” component that generates much of the litigation in this area: a denial that fails to invite an excuse, or a carrier that ignores one, can forfeit an otherwise solid timeliness defense. Conversely, where the carrier issues a proper, timely denial and the provider offers no justification, the defense is close to airtight.
Two proof battles dominate these cases. First, mailing: the carrier must establish when the bill was received, and the provider must establish when it was sent, which puts ordinary proof-of-mailing principles at center stage. Second, the denial itself must be timely and properly completed. When both pieces are in place, the only escape hatch left is the reasonable justification — and courts will not invent one for a provider who never offered it.
Why This Case Stands Out
Masigla is a reminder that appellate review begins with the appellant’s own record. The provider argued on appeal that its claims were timely, but its own motion papers showed submission more than 45 days after the dates of service. There was no dispute for the court to resolve — the appeal was self-refuting.
For medical providers and their billing services, the practical lessons are straightforward:
- Calendar from the date of service. Forty-five days passes quickly, especially for high-volume practices billing in batches.
- Keep proof of mailing. A contemporaneous mailing log or certificate-of-mailing practice converts a swearing contest into a documents case.
- If a bill is late, say why. A reasonable justification submitted in response to the denial preserves the claim; silence forfeits it.
- Audit the file before appealing. If your own exhibits prove the carrier’s defense, the appeal is wasted money — and, as here, the court may say so bluntly.
For carriers, the case confirms that a clean 45-day denial, supported by proof of the receipt date, remains one of the most efficient defenses in the no-fault toolbox.
Key Takeaway
Healthcare providers must carefully review their own documentation before appealing 45-day rule denials. In Masigla, the provider’s appeal was doomed because its own submitted papers proved the claims were filed late. The case highlights the importance of thorough preparation and honest assessment of claim timing before pursuing costly appeals that lack factual support.
Related Resources
- Late notice defense sustained
- 45-day rule denial not sustianed
- Triable issue of fact on the 45-day rule
- Late written notice excused
- 45-days…and then what?
- Mailing and proof of service in no-fault cases — our cluster hub on mailing proof
- The firm’s Legal Encyclopedia of New York no-fault topics
- Our no-fault defense practice
Legal Context
Why This Matters for Your Case
New York law is among the most complex and nuanced in the country, with distinct procedural rules, substantive doctrines, and court systems that differ significantly from other jurisdictions. The Civil Practice Law and Rules (CPLR) governs every stage of civil litigation, from service of process through trial and appeal. The Appellate Division, Appellate Term, and Court of Appeals create a rich and ever-evolving body of case law that practitioners must follow.
Attorney Jason Tenenbaum has practiced across these areas for over 24 years, writing more than 1,000 appellate briefs and publishing over 2,353 legal articles that attorneys and clients rely on for guidance. The analysis in this article reflects real courtroom experience — from motion practice in Civil Court and Supreme Court to oral arguments before the Appellate Division — and a deep understanding of how New York courts actually apply the law in practice.
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Nov 26, 2014Frequently Asked Questions
Common Questions About This Topic
3 answers from the firm's New York personal-injury and employment-law practice. Click any question to expand.
What is the deadline for submitting no-fault medical bills in New York?
Under 11 NYCRR §65-1.1, healthcare providers must submit no-fault billing within 45 days of the date of service. Late submissions can result in denial of the claim. The 45-day rule is strictly enforced, though providers may argue reasonable justification for late filing in limited circumstances.
What happens if a medical bill is submitted late?
If a no-fault bill is submitted more than 45 days after treatment, the insurer can deny the claim as untimely. This defense must be raised on the NF-10 denial form. If the provider can show a reasonable justification for the delay, the denial may be overturned, but this is a difficult burden to meet.
Does the 45-day rule apply to all no-fault claims?
The 45-day submission requirement applies specifically to healthcare providers submitting bills under no-fault. The injured person's application for benefits (NF-2) has a 30-day deadline from the accident. Different timelines apply to different types of claims within the no-fault system, so compliance with each deadline is critical.
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About the Author
Jason Tenenbaum, Esq.
Jason Tenenbaum is the founding attorney of the Law Office of Jason Tenenbaum, P.C., headquartered at 326 Walt Whitman Road, Suite C, Huntington Station, New York 11746. With over 24 years of experience since founding the firm in 2002, Jason has written more than 1,000 appeals, handled over 100,000 no-fault insurance cases, and recovered over $100 million for clients across Long Island, Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, the Bronx, and Staten Island. He is one of the few attorneys in the state who both writes his own appellate briefs and tries his own cases.
Jason is admitted to practice in New York, New Jersey, Florida, Texas, Georgia, and Michigan state courts, as well as multiple federal courts. His 2,353+ published legal articles analyzing New York case law, procedural developments, and litigation strategy make him one of the most prolific legal commentators in the state. He earned his Juris Doctor from Syracuse University College of Law.
Disclaimer: This article is published by the Law Office of Jason Tenenbaum, P.C. for informational and educational purposes only. It does not constitute legal advice, and no attorney-client relationship is formed by reading this content. The legal principles discussed may not apply to your specific situation, and the law may have changed since this article was last updated.
New York law varies by jurisdiction — court decisions in one Appellate Division department may not be followed in another, and local court rules in Nassau County Supreme Court differ from those in Suffolk County Supreme Court, Kings County Civil Court, or Queens County Supreme Court. The Appellate Division, Second Department (which covers Long Island, Brooklyn, Queens, and Staten Island) and the Appellate Term (which hears appeals from lower courts) each have distinct procedural requirements and precedents that affect litigation strategy.
If you need legal help with a timely submissions of bills matter, contact our office at (516) 750-0595 for a free consultation. We serve clients throughout Long Island (Huntington, Babylon, Islip, Brookhaven, Smithtown, Riverhead, Southampton, East Hampton), Nassau County (Hempstead, Garden City, Mineola, Great Neck, Manhasset, Freeport, Long Beach, Rockville Centre, Valley Stream, Westbury, Hicksville, Massapequa), Suffolk County (Hauppauge, Deer Park, Bay Shore, Central Islip, Patchogue, Brentwood), Queens, Brooklyn, Manhattan, the Bronx, Staten Island, and Westchester County. Prior results do not guarantee a similar outcome.
