Key Takeaway
NY appellate court rules that insurance company's late receipt of claim forms creates triable issue of fact regarding timely mailing under 45-day rule.
Understanding the 45-Day Rule and Burden of Proof in No-Fault Claims
New York’s no-fault insurance system operates under strict deadlines, including the critical 45-day rule that governs claim submissions. When disputes arise over whether documents were timely mailed, courts must carefully examine the evidence to determine if proper procedures were followed. The recent case of Irina Acupuncture, P.C. v Auto One Ins. Co. demonstrates how insurance companies can challenge the presumption of timely mailing by presenting evidence of late receipt.
The case highlights an important principle: while healthcare providers benefit from a rebuttable presumption that properly mailed documents are received, this presumption isn’t absolute. Insurance carriers retain the right to present evidence that calls into question the timing and effectiveness of a provider’s mailing procedures. This creates a more balanced approach to resolving timing disputes, which is particularly significant given that late notice issues can have serious consequences for both parties in no-fault litigation.
Jason Tenenbaum’s Analysis:
Irina Acupuncture, P.C. v Auto One Ins. Co., 2018 NY Slip Op 50781(U)(App. Term 2d Dept. 2018)
“Proof that documents are mailed in accordance with a standard mailing practice and procedure gives rise to a rebuttable presumption that the documents have been received (see Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 ). Contrary to the Civil Court’s finding, by demonstrating that it had received the claim forms at issue long after plaintiff claims to have mailed them, defendant raised a triable issue of fact as to whether plaintiff’s practices and procedures resulted in the timely mailing of the claim forms to defendant (see Healing Health Prods., Inc. v New York Cent. Mut. Fire Ins. Co., 44 Misc 3d 59 ). Thus, plaintiff is not entitled to summary judgment on the second through fourth causes of action”
Key Takeaway
This decision emphasizes that the presumption of proper mailing can be rebutted when an insurance company demonstrates significantly delayed receipt of claim forms. Healthcare providers must maintain reliable mailing procedures and be prepared to defend their practices when timing disputes arise, as summary judgment may not be available when genuine factual disputes exist about mailing effectiveness.
