Sunday, June 21, 2009

Late Denial (Envelope)

- To issue a timely denial of a claim under the No-Fault Law, insurer must generate its denial and mail it to plaintiff within 30 days. 11 NYCRR 65.15(g)(3).

- “[A]s defendant submitted an untimely denial, defendant can present no defense against plaintiff, thereby leaving no issues of fact in dispute.“ Damadian MRI in Canarsie, P.C. v. Countrywide Ins. Co. 194 Misc.2d 708, 755 N.Y.S.2d 585.


- “Upon reviewing the Insurance Regulations, legislative history and case law, it must be inferred that the issuance of a denial included the generation and mailing of the denial. While there is no law defining “issue” in this matter, it is clear that the generation of a denial form and its mailing are separate and distinct aspect of “issuing” a denial. Hospital for Joint Diseases, et.al. v. Nationwide Mutual Insurance Co., 284 A.D.2d 347, 726 N.Y.S.2d 443 [2nd Dept. 2001][defendant insurance company presented evidence regarding whether denial of claim forms were mailed on the date issued].) While defendant may consider the generation of a denial form to be its issuance, there is no authority to its conclusion that the mere generation of a denial is sufficient to comply with statutory regulations.” Damadian MRI in Canarsie, P.C. v. Countrywide Ins. Co. 194 Misc.2d 708, 755 N.Y.S.2d 585.

- “Therefore, to issue a timely denial, defendant must generate its denial and mail it to plaintiff within thirty days. Any other interpretation of the statute would render the time limit meaningless, as defendant could backdate its denial and mail it days or weeks later, and still have issued a timely denial. The purpose of having the time requirement is to foster the expeditious processing of claims by the insurance carrier, a purpose that would be thwarted is defendant’s position were accepted. By finding that defendant issue a timely denial simply by generating the document belies logic and any reasonable interpretation of the law.” Damadian MRI in Canarsie, P.C. v. Countrywide Ins. Co. 194 Misc.2d 708, 755 N.Y.S.2d 585.

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