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Insurance Company’s Failure to Submit Second Request for Verification of No-Fault Claim Precluded Tolling of 30-Day Payment Period

The Second Department determined that defendant insurance company’s failure to issue a second request for verification to the hospital which had submitted a no-fault claim precluded the insurance company from asserting the hospital’s failure to reply to the request for verification as a basis for not paying the claim within 30 days:

Upon the hospital’s failure to timely comply with the defendant’s initial request for verification within “30 calendar days after the original request [for verification]” (11 NYCRR 65-3.6[b]), the defendant was under a regulatory duty to issue a second request for verification within 10 days after the expiration of that 30-day period (see 11 NYCRR 65-3.6[b]…). In the absence of any such second request for verification, there is no merit to the defendant’s contention that the 30-day period within which it had to pay, deny, or request verification of the claim had been extended. The defendant “failed to submit any evidence that it mailed a second or follow-up request for verification at the end of the 30-day period subsequent to [its] mailing [of] the initial request for verification”… . Westchester Med Ctr v Allstate Ins Co, 2013 NY Slip Op 08616, 2nd Dept 12-26-13

 

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