Another Mailing Again

The landscape of New York no-fault insurance litigation continues to evolve, particularly regarding the standards courts apply when evaluating whether insurance companies have properly mailed denial forms. This shift has significant implications for both healthcare providers seeking reimbursement and insurance carriers defending claims.

In no-fault insurance disputes, timing is everything. Insurance companies must send denial forms within specific timeframes, and proving timely mailing is crucial to their defense. Historically, courts have imposed varying standards on insurance companies regarding their obligation to ensure proper mailing procedures. The burden of proof for establishing timely mailing has been a contentious issue, with some courts requiring insurance companies to demonstrate strict oversight and control over their mailing operations.

Recent developments in New York No-Fault Insurance Law show courts taking a more practical approach to these evidentiary requirements, moving away from overly rigid standards that may have been difficult for insurance companies to meet in practice.

Jason Tenenbaum’s Analysis:

JCC Med., P.C. v Lancer Ins. Co., 2021 NY Slip Op 50485(U)(App. Term 2d Dept. 2021)

“In addition, the testimony of defendant’s no-fault claims examiner was sufficient to establish that the denial of claim forms were timely mailed (see St. Vincent’s Hosp. of Richmond [*2]v Government Empls. Ins. Co., 50 AD3d 1123 ) to plaintiff notwithstanding that the no-fault claims examiner did not have direct supervisory authority over defendant’s mail personnel”

It is nice to see this line. What a far trip from “duty to ensure compliance” to “did not have direct supervisory authority”

Key Takeaway

This ruling represents a notable shift in judicial thinking about mailing requirements in no-fault cases. The court’s acceptance that a claims examiner can establish timely mailing without having “direct supervisory authority” over mail personnel suggests a more flexible, realistic approach to proof standards. This evolution benefits insurance companies by reducing the burden of establishing complex chains of custody and supervision for routine mailing procedures.

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• When partial compliance with no-fault verification requirements fails
• Key regulatory amendments affecting no-fault insurance practices
• New York No-Fault Insurance Law