Interesting discussion on NF-10s

Understanding NF-10 Denial Forms in No-Fault Insurance Cases

The Appellate Term’s decision in Sheepshead Bay Med. Supply, Inc. v Erie Ins. Co. of N.Y. provides important guidance on two critical issues in New York no-fault insurance law: the sufficiency of NF-10 denial forms and the burden of proof for proper mailing. This case illustrates the ongoing challenges healthcare providers face when insurance companies deny claims and the strict evidentiary standards courts apply.

NF-10 forms are standardized denial notices that insurance companies must use when rejecting no-fault claims. The regulatory requirements for these forms are designed to ensure that claimants receive adequate notice of the reasons for denial. However, as this case demonstrates, courts will accept forms that contain “substantially the same, pertinent information” as the prescribed form, even if they’re not the most current version.

The decision also reinforces the fundamental principle that attorneys cannot simply submit affirmations without personal knowledge to create factual disputes in summary judgment motions.

Jason Tenenbaum’s Analysis:

Sheepshead Bay Med. Supply, Inc. v Erie Ins. Co. of N.Y., 2021 NY Slip Op 50491(U)(App. Term 2d Dept. 2021)

“Contrary to plaintiff’s assertion, defendant established that it had mailed the NF-10 denial of claim forms at issue in duplicate. The affirmation of plaintiff’s counsel in opposition to defendant’s motion for summary judgment was insufficient to raise a triable issue of fact, as counsel did not demonstrate that he had personal knowledge of the facts (see Zuckerman v City of New York, 49 NY2d 557 ). To the extent that plaintiff contends that it was prejudiced by defendant’s improper use of “outdated” denial of claim forms, the denial forms at issue are not fatally defective, as they contain substantially the same, pertinent information as the prescribed form (see 11 NYCRR 65-3.8 ; NYU-Hospital for Joint Diseases v Allstate Ins. Co., 123 AD3d 781 ; see also 11 NYCRR 65-3.8 ). Plaintiff’s remaining contention was improperly raised for the first time on appeal and, in any event, lacks merit.”

Key Takeaway

Insurance companies can successfully defend no-fault cases by proving proper mailing of NF-10 forms and demonstrating that even “outdated” forms meet regulatory requirements if they contain substantially similar information. Healthcare providers must present evidence with personal knowledge to create genuine factual disputes in litigation.

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