Key Takeaway
Court ruling shows affidavit alone can create triable issue on verification receipt despite 120-day rule, prompting questions about documentary evidence standards.
Court Challenges Traditional Evidence Standards in No-Fault Verification Disputes
In New York’s no-fault insurance system, the verification process plays a crucial role in claim processing. Insurance companies routinely request additional verification from healthcare providers, and failure to respond within specified timeframes can result in claim denials under the 120-day rule. However, disputes frequently arise over whether verification requests were actually received by providers, creating complex evidentiary battles in court.
A recent Appellate Term decision highlights an interesting development in how courts evaluate evidence in these verification non-receipt cases. The ruling suggests that a simple affidavit, without supporting documentation, may be sufficient to create a disputed question of fact - a position that raises important questions about evidence standards in no-fault litigation.
Jason Tenenbaum’s Analysis:
Solution Bridge, Inc. v State Farm Mut. Auto. Ins. Co., 2018 NY Slip Op 51648(U)(App. Term 2d Dept. 2018)
“Contrary to plaintiff’s contentions, defendant’s proof was sufficient to demonstrate prima facie that it had timely mailed initial and follow-up verification requests (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 ); that it had not received the requested verification; and that it had timely denied the claim on that ground. However, as plaintiff further argues, the affidavit submitted by plaintiff in opposition to defendant’s motion was sufficient to give rise to a presumption that the requested verification had been mailed to, and received by, defendant (see id.). In light of the foregoing, there is a triable issue of fact as to whether plaintiff provided the requested verification.”
Has anyone sought to ask the Second Department to review these cases? i am hard-pressed to imagine that an affidavit without documentary support is sufficient to raise an issue of fact. Or, are we all sheep?
Key Takeaway
This decision demonstrates how courts may accept minimal evidence to create factual disputes in verification cases, potentially undermining the efficiency of summary judgment motions. The ruling suggests that a healthcare provider’s sworn statement alone can counter an insurance company’s documentation, raising questions about how courts determine when verification was actually received.
