Jesa Med. Supply, Inc. v. Am. Transit Ins. Co.

• Decision Date: 29 May 2010
• Citation: 28 Misc.3d 827,905 N.Y.S.2d 842
• Parties: JESA MEDICAL SUPPLY, INC., a/a/o Ketty Molina, Plaintiff, v. AMERICAN TRANSIT INSURANCE CO., Defendant.
• Court: New York Civil Court

905 N.Y.S.2d 842
28 Misc.3d 827

JESA MEDICAL SUPPLY, INC., a/a/o Ketty Molina, Plaintiff,
v.
AMERICAN TRANSIT INSURANCE CO., Defendant.

Civil Court, City of New York,
Kings County.

May 29, 2010.

905 N.Y.S.2d 842

Aaron Cargain, Esq., of the Law Offices of Melissa Betancourt, P.C., Brooklyn, for Plaintiff.

Peter Coates, Esq., of the Law Offices of Daniel J. Tucker, New York, for Defendant.

SYLVIA G. ASH, J.

28 Misc.3d 828

In an action seeking payment of first party no-fault benefits, Defendant moves to reargue the Court's decision dated October 9, 2009, wherein the Court found that Defendant's denial of Plaintiff's claim was untimely.

The Court found that Defendant's follow up verification request was 2 days late, thus reducing its denial time to 28 days (see Nyack Hosp. v. General Motors, 8 N.Y.3d 294, 832 N.Y.S.2d 880, 864 N.E.2d 1279), which made its denial in this case late by one day. Defendant contends that the Court erred in its finding that its follow up verification request was sent 2 days late rather than 1 day late. Defendant argues that President's Day is a legal holiday and should not have been included in computing the timeliness of Defendant's denial.

In an action to obtain payment of first party no-fault benefits, 11 NYCRR § 65-3.5 provides that a no-fault insurance carrier has 30 days from the date of receipt of the claim to pay or deny a claim in whole or in part. However, the insurance carrier's time to pay or deny a claim is extended by making a timely demand for verification. (see Infinity Health Products, Ltd. v. Eveready Ins. Co., 67 A.D.3d 862, 890 N.Y.S.2d 545 (2nd Dept.2009)). A claim does not have to be paid or denied until

905 N.Y.S.2d 843

the insurance carrier has been provided with all timely demanded verification. (see New York Presbyterian Hosp. v. Progressive Casu. Ins. Co., 5 A.D.3d 568, 774 N.Y.S.2d 72 (2nd Dept.2004); Mount Sinai Hosp. v. Chubb Group of Insurance Companies, 43 A.D.3d 889, 843 N.Y.S.2d 634 (2nd Dept.2007)). Pursuant to 11 NYCRR § 65-3.5(b) the insurance company must request additional verification within 15 business days of the receipt of the prescribed verification forms. However, an untimely verification request will reduce the 30 calendar days wherein a claim must be denied or paid upon receipt of the requested information., 11 NYCRR § 65-3.8(j).

The Court notes that the rule specifically states business days rather than calendar days. However, the statute does not define either term. Traditionally...