TIMELY MAILING OF DENIAL – DEFENDANT’S AFFIDAVIT

TIMELY MAILING OF DENIAL – DEFENDANT’S AFFIDAVIT

Atlantic Radiology, P.C. v Maya Assur. Co.2016 NY Slip Op 50316(U), http://www.nycourts.gov/reporter/3dseries/2016/2016_50316.htm.  Here is one that begs the question of; who reviewed this before it went out?

Contrary to defendant’s contention, the affidavit of defendant’s claims adjuster was insufficient to establish that its denial of claim form had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). Although the claims adjuster stated that, in May 2012, she had personally generated the denial of claim form and placed it in an envelope, affixed proper postage and placed the envelope in an outgoing mailbox, she also stated that she began working for defendant as a claims adjuster in July 2012. Consequently, her affidavit was of no probative value (see Points of Health Acupuncture, P.C. v GEICO Ins. Co., 25 Misc 3d 140[A], 2009 NY Slip Op 52445[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2009]). Defendant thus failed to demonstrate that it was not precluded from interposing its defense of lack of medical necessity (see Presbyterian Hosp. in City of NY v Maryland Cas. Co., 90 NY2d 274, 282 [1997]). As defendant raises no issue on appeal with respect to plaintiff’s prima facie case, we do not pass upon the propriety of the Civil Court’s determination with respect thereto.

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