and some other stuff
Starting with the “other stuff”…
In the instant matter, defendant suggests that an insurer is entitled to receive verification of a claim even if the request for such verification is untimely. We decline to adopt defendant’s proposed interpretation of 11 NYCRR 65-3.8(f) because it conflicts with the basic purpose of the regulatory scheme. Rather, we interpret the language of section 65-3.8(f) to mean only that an insurer must, within 30 calendar days after the insurer receives the initial proof of claim, either: a) pay the claim; b) deny the claim; or, c) make a timely request for verification. Under 11 NYCRR 65-3.8(c), the insurer is required to either pay or deny the claim in whole or in part within 30 calendar days after proof of claim is received. In other words, section 65-3.8(f) means simply that the 30-day rule to pay or deny a claim does not preclude an insurer from making a proper and timely request for verification of a claim.We decline to adopt the defendant’s interpretation of the regulations because the suggested interpretation would render the clearly delineated time frames specified in the statute virtually meaningless. Furthermore, the proposed interpretation could lead to significant delays in the processing of claims for no-fault benefits. Such a result would clearly be at odds with the basic purpose of the regulatory scheme. Therefore, we find defendant’s contentions to be without merit.
The fact that the regulations contain specific deadlines implies that an untimely [*4]verification request does not toll the 30-day period to pay or deny a claim. In fact, the caselaw clearly supports such a conclusion.
“Upon receipt of a no-fault claim, the regulations shift the burden to the carrier to obtain further verification or deny or pay the claim” (Hospital for Joint Diseases v. Travelers Property Cas. Ins. Co., 9 NY3d 312, 319 [2007]). It is well settled that an insurer is not obligated to pay or deny a claim until it has received verification of all relevant information requested (Central Suffolk Hosp. V. New York Cent. Mut. Fire Ins. Co., 24 AD2d 492, 493 [2d Dept 2005]; Hospital for Joint Diseases v. State Farm Mut. Auto. Ins. Co., 8 AD3d 533, 535 [2d Dept 2004]).
Here, the affidavit of defendant’s employee, claims examiner Edward Baillie, establishes that defendant received plaintiff’s claim and, further, that defendant failed to pay or deny the claim within the statutory 30-day time frame. Furthermore, said affidavit fails to demonstrate that defendant requested verification in a timely manner. Accordingly, the defendant has not shown a triable issue of fact regarding whether payment of no-fault benefits was overdue.
For the above reasons, defendant’s motion for summary judgment is hereby denied, and plaintiff’s cross-motion for summary judgment is granted.
Surely the defendant in this case knew when they received the bills; why would they want to leave that information out of their papers?
Now for the Appellate Term….
Bromer Med., P.C. v Chubb Indem. Ins. Co., 2008 NYSlipOp 50298(U) (App. Term, 1st Dept)
Defendant’s documentary submissions in support of its motion to strike the notice of trial and compel discovery sufficed to demonstrate“good cause” (State Farm Mut. Auto. Ins. Co. v Mallela, 4 NY3d 313, 322 [2005]) with regard to its defense that plaintiff is fraudulently incorporated in violation of Business Corporation Law ยงยง 1507 and 1508. Defendant is therefore entitled to outstanding disclosure pertaining to that defense, including the depositions of plaintiff’s alleged owner and the assignor’s treating physician (see Continental Med. Acupuncture Servs., P.C. v Travelers Ins. Co., 13 Misc 3d 132[A], 2006 NY Slip Op 51890[U] [2006]).
Several cases came out from the Appellate Term, Second Dept., but they aren’t worth noting. To view those cases, click here.
And one that I forgot about. I was reminded by a comment:
Travelers v. Glenwood (AD 1st Dept)
http://www.courts.state.ny.us/re…/ 2008_01598.htm
Big case of the day – 6 yr SOL upheld by First Dept. It really should be three years
notoriously anonymous