Key Takeaway
New York court case highlights importance of proper documentation when resubmitting no-fault insurance claims to avoid summary judgment dismissal.
Understanding Documentation Requirements in No-Fault Insurance Resubmissions
No-fault insurance disputes often hinge on proper documentation and adherence to procedural requirements. Healthcare providers must maintain detailed records not only of their initial claim submissions but also of any resubmissions to insurance carriers. The case of Milky Way Acupuncture demonstrates how inadequate documentation can lead to unfavorable court rulings, even when providers believe they have followed proper procedures.
When insurance carriers deny claims or seek additional information, providers frequently need to resubmit documentation. However, simply stating that bills were “resubmitted” without providing comprehensive details about the submission process can create triable issues of fact as to submission of claim that may not favor the healthcare provider in litigation.
Jason Tenenbaum’s Analysis:
Milky Way Acupuncture, P.C. v Nationwide Ins., 2019 NY Slip Op 51968(U)(App. Term 2d Dept. 2019)
Sounds like a deficiency due to the failure to adhere to one of the “who, what, when and why” rule.
“Plaintiff moved, insofar as is relevant, for leave to renew its opposition to defendant’s motion and, upon renewal, for an order denying defendant’s motion. Plaintiff supported its motion with a new affidavit by its owner, who stated that the bills at issue had been “resubmitted to insurance carrier” on June 7, 2010. Defendant opposed the motion. Plaintiff appeals from so much of an order of the Civil Court entered February 13, 2018, as, upon renewal, adhered to its prior [*2]determination granting defendant’s motion for summary judgment dismissing the complaint.”
Key Takeaway
Healthcare providers must document the complete details of claim submissions and resubmissions, including who received the documentation, what was submitted, when it was sent, and how it was transmitted. Vague statements about resubmission, as demonstrated in this case, may not satisfy court requirements and can result in summary judgment against the provider. Proper documentation practices are essential for successful no-fault insurance litigation.
