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Requirements for Indefinite Tolling of 30-Day Period During Which a No-Fault Carrier Must Determine Whether to Pay or Deny a Claim Explained

The Second Department noted that a request for verification that precedes a no-fault insurer’s receipt of the N-F-5 claim form does not trigger the tolling of the 30-day period within which an insurer must determine whether to pay or deny the claim. Once the tolling of the 30-day period is triggered, the insurer has 10 days from the expiration of the 30-day period to send a follow-up request for verification inorder to invoke an indefinite tolling of its time to pay or deny:

….[T]his action is not premature[—] the 30-day period in which the defendant must pay or deny the claim has not been indefinitely tolled. “[A]; request for verification that precedes a no-fault insurer’s receipt of the prescribed N-F 5 claim form does not trigger the tolling of the 30-day period within which an insurer must determine whether to pay or deny such a claim” … . Here, the defendant sent two letters requesting verification, one dated March 15, 2010, and another dated April 15, 2010. The defendant’s verification request dated March 15, 2010, was sent after the defendant received an “interim bill” from the plaintiff, which was sent solely for the purpose of notifying the defendant of the claim, and preceded the defendant’s receipt of the N-F 5 form. Thus, the March 15, 2010, verification request did not trigger the tolling of the 30-day period within which an insurer must determine whether to pay or deny the claim. Consequently, the only effective request for verification was the one dated April 15, 2010, six days after the defendant’s receipt of the plaintiff’s N-F 5 form … .

The April 15, 2010, verification request resulted in an initial toll of the 30-day period within which to pay or deny the claim (see id.). The defendant then had 10 days from the expiration of that 30-day period to send a follow-up request for verification in order to invoke the protection of the indefinite tolling of its time to pay or deny the claim … . However, no follow-up request was issued. Since the initial toll of the 30-day period following the plaintiff’s submission of the N-F 5 form to the defendant had expired by the time this action was commenced, this action is not premature… . Mount Sinai Hosp v Dust Tr Inc, 2014 NY Slip Op 03667, 2nd Dept 5-21-14

 

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