Reasonable Justification for late submission

MVAIC Late Submissions: Why “Reasonable Justification” Requires More Than Just an Excuse

In the world of New York no-fault insurance claims, timing is everything. But what happens when you submit a claim late to MVAIC (Motor Vehicle Accident Indemnification Corporation)? A recent case, Stand-Up MRI of the Bronx, P.C. v MVAIC Ins. Co., 2022 NY Slip Op 50789(U)(App. Term 2d Dept. 2022), provides a critical lesson that could save your claim from being denied.

The Stand-Up MRI Case: A Costly Oversight

The facts seemed straightforward: Stand-Up MRI had initially submitted claims to an insurance company, but when they learned that company wouldn’t cover the claims, they resubmitted them to MVAIC. Sounds reasonable, right? The court didn’t think so.

“In opposition to MVAIC’s motion, plaintiff demonstrated that it had initially sent the claims at issue to an insurance company, but after plaintiff learned that the insurance company would not cover the claims, plaintiff sent the claims to MVAIC. However, plaintiff did not establish that it had provided MVAIC with a reasonable justification as to why it had initially submitted the claims to the insurance company. As a result, plaintiff did not establish that it had provided MVAIC with a reasonable justification for its untimely submission to MVAIC of the claim forms.”

The Critical Missing Element: The “Why”

As Jason Tenenbaum notes in his analysis: “Stand up left out the ‘Why’. Harkens back to a motion to conditionally certify a class on an FLSA case and my papers failed to satisfy (according to the Magistrate) the ‘why’ element in my party declaration. Let this be a lesson – ‘why’ did you sent to the wrong carrier?”

This observation cuts to the heart of the problem. It’s not enough to simply explain what you did (sent claims to the wrong carrier first). You must explain why you made that initial decision.

What This Means For You: The Reasonable Justification Standard

If you’re dealing with late submissions to MVAIC, understanding the reasonable justification standard is crucial for protecting your personal injury claim. The Stand-Up MRI case establishes that you must provide more than a basic timeline of events.

What Constitutes Reasonable Justification?

Based on this ruling and similar cases, reasonable justification for late MVAIC submission typically requires:

• A legitimate reason for the initial carrier selection – Why did you reasonably believe the first carrier should handle the claim?
• Good faith efforts to obtain coverage – Did you make reasonable attempts to get the claim covered?
• Prompt action upon discovery – How quickly did you resubmit to MVAIC once you learned the first carrier wouldn’t cover it?
• Documentation of the decision-making process – Can you show your reasoning was sound at the time?

What’s NOT Sufficient

The Stand-Up MRI case makes clear that simply stating you sent the claim elsewhere first is insufficient. The court rejected this approach because:

• No explanation was provided for the initial carrier choice
• The reasoning behind the original submission wasn’t documented
• There was no demonstration that the initial decision was reasonable under the circumstances

Understanding MVAIC: When It Applies

MVAIC (Motor Vehicle Accident Indemnification Corporation) serves as New York’s safety net for certain motor vehicle accident claims. It typically becomes relevant in situations involving:

Uninsured Motorist Claims

When the at-fault driver has no insurance, MVAIC may step in to provide coverage for no-fault benefits. However, timing requirements are strict, and reasonable justification for any delays is essential.

Hit-and-Run Accidents

In cases where the responsible party cannot be identified, MVAIC may provide coverage. But again, proper and timely submission is critical.

Coverage Gaps

When there are disputes about which carrier is responsible, MVAIC may become involved. This is often where timing issues arise, as in the Stand-Up MRI case.

Common Scenarios Where the “Why” Matters

Multiple Insurance Policies

When dealing with motor vehicle accidents involving multiple vehicles or complex insurance situations, providers might reasonably submit to what appears to be the primary carrier based on available information.

Good “Why” Example: “Based on the police report and initial information from the accident scene, we reasonably believed Carrier A was the responsible party’s insurer. We submitted the claim within the required timeframe to Carrier A. Only after receiving their denial letter stating they didn’t cover this vehicle did we learn that MVAIC was the appropriate recipient.”

Insurance Information Discrepancies

Sometimes the insurance information provided at the accident scene turns out to be incorrect or outdated.

Good “Why” Example: “The at-fault driver provided an insurance card showing coverage with Company B. We verified this information through available databases and submitted the claim accordingly. We later discovered the policy had lapsed three days before the accident, making MVAIC the appropriate carrier.”

Coverage Disputes

When multiple carriers might have coverage obligations, the initial choice must be reasonable and well-documented.

Best Practices for MVAIC Submissions

Document Your Decision-Making Process

From the moment you receive a case, document why you’re submitting claims to specific carriers. This contemporaneous documentation can be invaluable if you later need to justify your decisions.

Act Promptly Upon Discovery

The moment you learn that your initial carrier choice was incorrect, immediately begin the process of submitting to MVAIC. Delays after discovery can undermine your reasonable justification defense.

Maintain Detailed Records

Keep copies of all communications, denials, and coverage determinations. This paper trail helps establish the reasonableness of your actions.

Consult with Experienced Counsel

Given the complexity of MVAIC claims and the strict requirements for reasonable justification, professional legal guidance is often essential.

The Bigger Picture: Procedural Requirements Matter

The Stand-Up MRI case reflects a broader principle in New York law: procedural requirements must be taken seriously, and courts expect thorough, well-reasoned explanations for deviations from standard timelines.

This principle extends beyond MVAIC claims to many areas of personal injury law, where timing requirements and justification standards can make or break a case.

Frequently Asked Questions

Q: What if I genuinely didn’t know MVAIC was the correct carrier initially?

A: Lack of knowledge alone isn’t sufficient. You must show that your initial carrier choice was reasonable based on the information available to you at the time, and explain your decision-making process.

Q: How long do I have to submit to MVAIC after discovering the first carrier won’t cover the claim?

A: While there’s no specific grace period, courts expect prompt action. The longer you wait after discovery, the harder it becomes to maintain that your delay was reasonable.

Q: Can I appeal an MVAIC denial based on late submission?

A: Yes, but you’ll need to demonstrate reasonable justification for the delay. The Stand-Up MRI case shows how important it is to have a well-documented explanation for your actions.

Q: What should I do if I’m facing a similar situation now?

A: Document everything immediately. Write down why you initially chose the first carrier, what steps you took to verify coverage, and when/how you discovered the need to submit to MVAIC.

Q: Does this rule apply to all no-fault claims or just MVAIC?

A: While this case specifically addressed MVAIC, the principle of providing adequate justification for procedural decisions applies broadly to no-fault insurance claims in New York.

Lessons from Jason’s Experience

Jason Tenenbaum’s candid reflection on his own experience with the “why” element in an FLSA case demonstrates an important truth: even experienced attorneys can miss critical procedural requirements. The key is learning from these experiences and ensuring that future submissions include all necessary elements.

This transparency about legal challenges helps clients understand that the law requires precision and attention to detail – qualities that are essential when dealing with insurance companies and court proceedings.

Protecting Your Rights: Next Steps

If you’re dealing with MVAIC claims or facing challenges with late submissions, time is of the essence. The requirements established in Stand-Up MRI and similar cases make it clear that procedural compliance is not optional.

For Current MVAIC Issues:

• Gather all documentation related to your initial carrier choice
• Prepare a detailed timeline of events and decision-making
• Identify any reasonable justifications for your actions
• Act quickly to minimize additional delays

For Future Claims:

• Develop systems for documenting carrier selection decisions
• Create checklists for MVAIC eligibility verification
• Establish protocols for prompt action when coverage issues arise
• Consider professional legal guidance for complex cases

The Bottom Line: Details Matter

The Stand-Up MRI case serves as a crucial reminder that in no-fault insurance law, the devil truly is in the details. It’s not enough to have a generally reasonable explanation for your actions – you must be able to articulate specific justifications for each decision you made.

Whether you’re dealing with MVAIC claims, other no-fault issues, or broader personal injury matters, the principle remains the same: thorough documentation and clear reasoning are essential for protecting your legal rights.

Don’t let a lack of detailed justification derail your claim. If you’re facing MVAIC submission issues or need guidance on no-fault insurance claims, professional legal assistance can help ensure you meet all procedural requirements and protect your right to compensation.

Call 516-750-0595 for a free consultation to discuss your MVAIC claim or any no-fault insurance issues. Don’t let procedural technicalities prevent you from getting the coverage you deserve.