Did a party’s evidence establish that it mailed a no-fault claim, denial, verification request or examination notice?

Deciding this question means ruling on whether the evidence offered by a party proves that a specific no-fault document was mailed (and, where it matters, on what date and to the proper address), so that the presumption of receipt arises. The rule applied everywhere is that the presumption may be created by proof of actual mailing (an affiant with personal knowledge of the mailing, certified-mail receipts tied to the item, affidavits of service, postal-stamped mailing logs or certificates) or by an affidavit of someone with knowledge of a standard office practice or procedure designed to ensure that items are properly addressed and mailed; a bare denial of receipt does not rebut it. It covers any document in the no-fault claim process, whoever mailed it: the insurer's denials of claim, verification and follow-up requests, IME and EUO scheduling letters, and the provider's or claimant's claim forms (NF-3/NF-5 bills, NF-2) and verification responses, together with the opposing party's evidence of non-receipt offered to rebut the presumption. The categories record both the mailing party (insurer or provider/claimant) and the outcome.

Settled statewide by the Court of Appeals. The rule is the Court of Appeals' presumption-of-receipt rule (Nassau Ins. Co. v Murray, 46 NY2d 828 [1978]: office practice must be geared to ensure the item is always properly addressed and mailed; denial of receipt alone does not rebut), restated for no-fault by the Second Department (Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [2001]; New York & Presbyt. Hosp. v Allstate Ins. Co., 29 AD3d 547 [2006]; St. Vincent's, 2008) and applied in the same words by the First and Third Departments. In the database the Court of Appeals applies it to a provider's proof of mailing claim forms (Viviane Etienne, 2015: affidavit of a billing company president who described its mailing practices and mailed the forms himself was sufficient). No department disagrees on the rule; decisions differ only on how much detail an affidavit must give. Two disagreements below the Appellate Division ended: the Appellate Term, 2d Dept, in Contemp. Med. Diag. (2005) had required the affiant to state a duty to ensure compliance or personal knowledge of compliance, which Delta Diagnostic v Chubb (2007) disavowed; and the Nassau County District Court (Carle Place Chiropractic, Acupuncture Prima Care, 2007-2008) rejected bare 'place it in an envelope and mail it' procedures until it held itself bound by St. Vincent's (Uniondale Chiropractic, 2008). The same rule governs insurers' and providers' mailings.

Leading authorities · Authority map · Decisions by court · Plain-text version (Markdown)

Leading authorities

Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co. (2015 NY Slip Op 04787) Court of Appeals, 2015Provider's proof of mailing claim forms; billing-company affidavit sufficesA provider must submit admissible proof that the claim forms were mailed to and received by the insurer; an affidavit of the third-party billing company's president who described its mailing practices and mailed the forms himself was sufficient.
Such proof may include the verification of treatment form and/or an affidavit from a person or entity (1) with knowledge of the claim and how it was sent to the insurer or (2) who has relied upon the forms in the performance of their business.
Later history: Affirms Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 114 AD3d 33 (2d Dept 2013), post 6516
St. Vincent's Hosp. of Richmond v Government Empls. Ins. Co. (2008 NY Slip Op 04072) Appellate Division, Second Department, 2008Second Department: standard-office-practice affidavit proves insurer's mailingAn affidavit of an employee with knowledge of the insurer's standard office practices or procedures designed to ensure that items are properly addressed and mailed, attesting that a proper denial was issued on its date, was admissible evidence of timely mailing and raised a triable issue defeating the provider's summary judgment motion.
the defendant submitted admissible evidence in the form of an affidavit of an employee with knowledge of the defendant’s standard office practices or procedures designed to ensure that items were properly addressed and mailed
New York & Presbyt. Hosp. v Allstate Ins. Co. (2006 NY Slip Op 03558) Appellate Division, Second Department, 2006Second Department: same test applied to provider's mailing of billNo presumption arose where the provider's billing representative neither stated that he mailed the claim nor described the office's mailing practice; a certified-mail receipt and USPS tracking printout not tied to the claim, without a signed return receipt, did not prove receipt.
the certified mail receipt and the United States Postal Service “Track and Confirm” printout do not prove that the particular claim alleged in the second cause of action was actually received where, as here, there is no evidence that this claim was mailed to Allstate under that certified mail receipt number
American Tr. Ins. Co. v Lucas (2013 NY Slip Op 07273) Appellate Division, First Department, 2013First Department: affidavits establish mailing of IME noticesSworn affidavits of the examining physician and his employee were competent evidence that IME scheduling notices were mailed; a properly executed affidavit of service raises a presumption of mailing that a mere denial of receipt does not rebut.
Plaintiff submitted competent evidence that the notices scheduling the claimant’s medical examinations were mailed, as well as the failure to appear, based on the sworn affidavits of the scheduled examining physician and his employee
Progressive Cas. Ins. Co. v Infinite Ortho Prods., Inc. (2015 NY Slip Op 03340) Appellate Division, Second Department, 2015Second Department: affidavit must explain addressing and Postal Service hand-offAn affidavit describing an automated mailing system was insufficient because it did not say how envelopes were addressed to ensure a correct address or how and when the sealed envelopes reached the Postal Service; the insurer did not prove timely and proper mailing of its denials.
Andre did not state, in his affidavit, how the envelopes were addressed so as to ensure that the address was correct or whether the envelope was addressed by the automated system or by an employee.
Delta Diagnostic Radiology, P.C. v Chubb Group of Ins. (2007 NY Slip Op 27345) Appellate Term, Second Department, 2007Appellate Term: personal knowledge of mailing or practice description sufficesThe insurer showed timely mailing of its denials through its standard office practice; the affiant need not state a duty to ensure compliance with the practice or personal knowledge of compliance (clarifying Contemp. Med. Diag., 2005): personal knowledge of the mailing or a description of the standard practice suffices.
it is sufficient for the affiant to set forth that he or she possessed personal knowledge that the mailing occurred or describe the standard office practice or procedure used to ensure that items were properly addressed and mailed
Nassau Ins. Co. v Murray 46 NY2d 828Source of the presumption rule as quoted in the database: office practice must be geared to ensure the likelihood that the item is always properly addressed and mailed; denial of receipt standing alone does not rebut the presumption.Not in our database.
Matter of Gonzalez (Ross) 47 NY2d 922Cited with Nassau v Murray for when proof of office practice creates a presumption of receipt.Not in our database.
News Syndicate Co. v Gatti Paper Stock Corp. 256 NY 211A properly mailed letter is presumed received (cited by trial courts).Not in our database.
Preferred Mut. Ins. Co. v Donnelly 22 NY3d 1169Cited by the Third Department for the point that the presumption arises only after proper mailing is shown.Not in our database.
Residential Holding Corp. v Scottsdale Ins. Co. 286 AD2d 679The quoted formulation: presumption created by proof of actual mailing or of a standard office practice or procedure designed to ensure that items are properly addressed and mailed (cited by about 300 decisions in the database).Not in our database.
Hospital for Joint Diseases v Nationwide Mut. Ins. Co. 284 AD2d 374No presumption where the affiant neither mailed the item nor described the office's mailing practice.Not in our database.
Matter of Rodriguez v Wing 251 AD2d 335Proof of proper mailing gives rise to a rebuttable presumption of receipt.Not in our database.
Badio v Liberty Mut. Fire Ins. Co. 12 AD3d 229First Department: denial of receipt standing alone is insufficient to rebut the presumption (IME notices).Not in our database.

Authority map

Each circle is a decision on this question, placed by court and date; its colour is the position it took. Lines are citations between them. Select a circle (or find a decision by name) to see its links and summary. The same decisions are listed by court below the map.

The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeThe insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeThe provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseThe provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseThe mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedDifferent mailing results for different documents or claims in one decisionRing: rules on the question, but another ground decided the caseContrasted, distinguished or limitedDeclined to follow, questioned, overruled or reversedCited Show ordinary citations

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How the rule was applied, by court

Court	Insurer proved mailing	Insurer failed to prove	Provider proved mailing	Provider failed to prove	Triable issue on mailing	Mixed rulings	Total
Court of Appeals	0	0	1	0	0	0	1
Appellate Division, First Department	15	3	0	0	0	0	18
Appellate Division, Second Department	10	13	8	1	1	1	34
Appellate Division, Third Department	0	1	1	0	0	0	2
Appellate Term, First Department	53	13	6	7	1	0	80
Appellate Term, Second Department	740	205	52	41	88	47	1173
Trial courts in the First Department	20	4	5	2	2	1	34
Trial courts in the Second Department	48	38	29	9	3	6	133
Trial courts in the Fourth Department	0	1	0	0	0	0	1

Decisions (1,476)

Every decision in our database that rules on this question: highest court first, then by department, newest first. 829 turn on it; the others rule on it alongside a different main ground (marked "also decides"). The one-sentence summaries describe what each court said on this question.

Court of Appeals (1 decision)

Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co. (2015 NY Slip Op 04787) Leading case Court of Appeals, June 10, 2015The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the billing company president's affidavit, describing the office mailing practice and stating he personally mailed the claim forms, sufficed to prove mailing and raise a presumption of receipt by the insurer.

Appellate Division, First Department (18 decisions)

State Farm Mut. Auto. Ins. Co. v Equinox Physical Therapy, P.C. (2024 NY Slip Op 05193) Appellate Division, First Department, October 22, 2024The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Accepted the claim specialist's affidavit and affidavits of service as proof that the EUO notices were sent to the claimants' residences.
Nationwide Gen. Ins. Co. v South (2024 NY Slip Op 00028) Appellate Division, First Department, January 4, 2024The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the attorney's affirmation describing the office procedure for mailing EUO notices, and the agent's operations manager's affidavit, sufficient to show the EUO notices and denials were timely sent.
State Farm Mut. Auto. Ins. Co. v AK Global Supply Corp. (2022 NY Slip Op 01890) Appellate Division, First Department, March 17, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the EUO attorney's affirmation describing his office's standard addressing and mailing practices, and stating he personally supervised the mailing, demonstrated timely mailing of the EUO scheduling letters.
Unitrin Advantage Ins. Co. v Cohen & Kramer M.D., P.C. (2020 NY Slip Op 06474) Appellate Division, First Department, November 12, 2020The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld office-practice affidavits plus postal-stamped mailing ledgers created a presumption of receipt of the IME notices; an erroneous '1st Floor' did not defeat it absent evidence of nonreceipt.
Global Liberty Ins. Co. v Evans (2019 NY Slip Op 07716) Appellate Division, First Department, October 29, 2019The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof insufficient to show timely mailing of the EUO letters because the claims adjuster's affidavits conflicted and the application bore inconsistent dates.
Hertz Vehs. LLC v Significant Care, PT, P.C. (2018 NY Slip Op 00456) Appellate Division, First Department, January 25, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held an affidavit of service by the person who mailed the EUO notices by regular mail to the claimant's address and attorney established proof of mailing.
Liberty Mut. Ins. Co. v K.O. Med., P.C. (2016 NY Slip Op 06166) Appellate Division, First Department, September 27, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Held that although counsel's affirmation might prove the EUO requests were mailed, nothing in the record showed they were mailed within the regulatory time frames, so the insurer failed to show the EUOs were properly noticed.
Mapfre Ins. Co. of N.Y. v Manoo (2016 NY Slip Op 04446) Appellate Division, First Department, June 9, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it timely and properly mailed the EUO notices to the insured, whose receipt of the first letter was also shown.

Show all 18 decisions

American Tr. Ins. Co. v Vance (2015 NY Slip Op 06762) Appellate Division, First Department, September 15, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that the notices of the scheduled IMEs were properly mailed.
American Tr. Ins. Co. v Longevity Med. Supply, Inc. (2015 NY Slip Op 06761) Appellate Division, First Department, September 15, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that the notices of the scheduled IMEs were properly mailed.
American Tr. Ins. Co. v Clark (2015 NY Slip Op 06759) Appellate Division, First Department, September 15, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that the notices of the scheduled IMEs were properly mailed.
Liberty Mut. Ins. Co. v Five Boro Med. Equip., Inc. (2015 NY Slip Op 05891) Appellate Division, First Department, July 7, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld counsel's affirmation describing the mailing procedures and stating he personally verified each EUO letter's mailing was adequate proof that the EUO letters were mailed, warranting a default declaration.
Hertz Corp. v Active Care Med. Supply Corp. (2015 NY Slip Op 00212) Appellate Division, First Department, January 6, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld EUO notices proved mailed by objective proof, as their certified mail numbers matched the return receipts and USPS tracking report, though counsel neither mailed them personally nor described office practice.
Allstate Ins. Co. v Pierre (2014 NY Slip Op 08921) Appellate Division, First Department, December 23, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected, as unpreserved and in any event unavailing, the providers' argument that the insurer failed to show the EUO notices were mailed to the assignors' correct addresses.
Interboro Ins. Co. v Perez (2013 NY Slip Op 08347) Appellate Division, First Department, December 12, 2013The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit of service insufficient to show the EUO scheduling letters were mailed per the regulations, and found no objective proof they were mailed to the claimant.
American Tr. Ins. Co. v Leon (2013 NY Slip Op 08124) Appellate Division, First Department, December 5, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's competent evidence proved mailing of the IME notices and rejected the argument that notices had to go to the assignor's attorney absent proof the assignor had counsel on the claim.
American Tr. Ins. Co. v Marte-Rosario (2013 NY Slip Op 07416) Appellate Division, First Department, November 12, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the affidavit of service raised a presumption the IME notices were properly mailed to the claimant and counsel, unrebutted by a returned letter with an apparently misspelled street name.
American Tr. Ins. Co. v Lucas (2013 NY Slip Op 07273) Leading case Appellate Division, First Department, November 7, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the non-conclusory affidavits of the examining physician and his employee, showing personal knowledge of office procedures, were competent evidence that the IME scheduling notices were mailed.

Appellate Division, Second Department (34 decisions)

American Tr. Ins. Co. v Beach Med. Rehabilitation, P.C. (2026 NY Slip Op 03771) Appellate Division, Second Department, June 17, 2026The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to raise a triable issue of timely denial because its two employees' affidavits showed no personal knowledge of a standard office procedure for addressing and mailing denials or of actual mailing.
Quality Health Supply Corp. v Nationwide Ins. (2023 NY Slip Op 02689) Appellate Division, Second Department, May 17, 2023The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer showed its EUO scheduling letters were timely and properly mailed, as part of its prima facie no-show defense.
Nationwide Affinity Ins. Co. of Am. v George (2020 NY Slip Op 02801) Appellate Division, Second Department, May 13, 2020The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld affidavits on standard office practice proved mailing of the EUO letters and the denials; a mere denial of receipt and affidavits not contradicting the practice did not rebut the presumption.
Progressive Cas. Ins. Co. v Metro Psychological Servs., P.C. (2016 NY Slip Op 03485) Appellate Division, Second Department, May 4, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's counsel's affirmation insufficient to raise the presumption of mailing of the EUO letters because it was conclusory and did not show a practice designed to ensure proper addressing and mailing.
Progressive Advanced Ins. Co. v McAdam (2016 NY Slip Op 03484) Appellate Division, Second Department, May 4, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer submitted no proof of mailing or evidence from anyone with personal knowledge of the mailing of the EUO requests.
AutoOne Ins./Gen. Assur. v Eastern Is. Med. Care, P.C. (2016 NY Slip Op 00916) Appellate Division, Second Department, February 10, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the branch manager's affidavit established prima facie that the denials were timely mailed under the insurer's standard office mailing practices, and the provider raised no triable issue on timeliness.
Nationwide Gen. Ins. Co. v Bates (2015 NY Slip Op 06122) Appellate Division, Second Department, July 15, 2015The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove mailing of the deposition (examination) requests because it submitted no evidence from anyone with personal knowledge of the mailings, defeating its breach-of-condition argument.
Progressive Cas. Ins. Co. v Infinite Ortho Prods., Inc. (2015 NY Slip Op 03340) Leading case Appellate Division, Second Department, April 22, 2015The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld an affidavit describing an automated mailing system insufficient because it did not explain how envelopes were addressed to ensure correctness or how and when they reached the Postal Service.

Show all 34 decisions

Westchester Med. Ctr. v A Cent. Ins. Co. (2014 NY Slip Op 01319) Appellate Division, Second Department, February 26, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's opposition raised a triable issue whether it mailed a proper denial 22 days after receiving requested verification, which defeated the provider's summary judgment motion.
Wyckoff Hgts. Med. Ctr. v Government Empls. Ins. Co. (2014 NY Slip Op 01166) Appellate Division, Second Department, February 19, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's evidence that it mailed the NF-10 denial within 30 days raised a triable issue as to timely denial, defeating the hospital's summary judgment motion.
New York Hosp. Med. Ctr. of Queens v Allstate Ins. Co. (2014 NY Slip Op 00640) Appellate Division, Second Department, February 5, 2014The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held a postal receipt showing the insurer's receipt of the NF-5 and related documents, with the mailer's affidavit, sufficient proof of submission of the claim.
Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co. (2013 NY Slip Op 08430) Appellate Division, Second Department, December 18, 2013The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the billing company president's affidavit, stating he personally mailed the bills and describing the procedure for addressing and mailing them, together with a postal-stamped mailing ledger, raised a presumption that the insurer received the claim forms.
Westchester Med. Ctr. v Hereford Ins. Co. (2012 NY Slip Op 04156) Appellate Division, Second Department, May 30, 2012The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the certified mail receipt and signed return receipt card created a presumption of receipt of the provider's bill that the insurer's mere denial of receipt did not rebut.
Mount Sinai Hosp. v Government Empls. Ins. Co. (2011 NY Slip Op 05679) Appellate Division, Second Department, June 28, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's opposition proof raised a triable issue as to whether it issued a denial of claim form, which defeated the hospital's summary judgment motion despite its prima facie showing.
NYU-Hospital for Joint Diseases v Esurance Ins. Co. (2011 NY Slip Op 04436) Appellate Division, Second Department, May 24, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld an employee's affidavit describing standard office practices designed to ensure proper addressing and mailing, attesting that the denial was timely issued, raised a triable issue defeating the hospital's motion.
NYU Hosp. for Joint Diseases v Country Wide Ins. Co. (2011 NY Slip Op 04219) Appellate Division, Second Department, May 17, 2011The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the third-party biller's affidavit, certified mail receipt and signed return-receipt card referencing the patient and forms showed the bill was mailed to and received by the insurer.
New York Hosp. Med. Ctr. of Queens v Country Wide Ins. Co. (2011 NY Slip Op 01628) Appellate Division, Second Department, March 1, 2011The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the certified mail receipts and signed return-receipt card referencing the patient and forms, with the biller's affidavits, showed the hospital mailed the bills and the insurer received them.
Westchester Med. Ctr. v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 01458) Appellate Division, Second Department, February 22, 2011The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to submit sufficient evidence that it mailed its second denial form within the 30-day period, so it raised no triable issue on timely denial.
Westchester Med. Ctr. v Philadelphia Indem. Ins. Co. (2010 NY Slip Op 00138) Appellate Division, Second Department, January 5, 2010The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the biller's affidavit showed the claim forms were mailed and signed for, and the insurer's no-record affidavit failed to rebut receipt because the affiant lacked knowledge of the receiving office's procedures.
Westchester Med. Ctr. v Progressive Cas. Ins. Co. (2008 NY Slip Op 04867) Appellate Division, Second Department, May 27, 2008The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's evidence that its intoxication verification request was timely and properly sent to the first-treating hospital raised a triable issue as to the timeliness of its denial.
St. Vincent's Hosp. of Richmond v Government Empls. Ins. Co. (2008 NY Slip Op 04072) Leading case Appellate Division, Second Department, April 29, 2008The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld an employee's affidavit describing the insurer's standard office practices designed to ensure items are properly addressed and mailed, attesting that a complete denial was timely issued, was admissible proof that raised a triable issue defeating the provider's motion.
Westchester Med. Ctr. v Progressive Cas. Ins. Co. (2007 NY Slip Op 09770) Appellate Division, Second Department, December 11, 2007The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's evidence that its intoxication verification request was timely and properly sent to the first-treating hospital raised a triable issue as to the timeliness of its denial.
Westchester Med. Ctr. v Countrywide Ins. Co. (2007 NY Slip Op 09024) Appellate Division, Second Department, November 13, 2007The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's supervisor lacked personal knowledge of the mailings and gave only conclusory statements of office practice not shown to ensure proper addressing and mailing, so no presumption of receipt arose.
New York & Presbyt. Hosp. v Countrywide Ins. Co. (2007 NY Slip Op 07675) Appellate Division, Second Department, October 9, 2007Different mailing results for different documents or claims in one decisionFound triable issues on when the hospital mailed one set of claims, but held certified-mail and signed return receipts proved mailing of the verification material on the other claim, which a bare denial of receipt did not rebut.
Westchester Med. Ctr. v Liberty Mut. Ins. Co. (2007 NY Slip Op 04483) Appellate Division, Second Department, May 22, 2007The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld certified-mail receipts, signed return receipts or a matching Track & Confirm printout and annotated cover letter proved the hospital mailed the requested medical records, so the insurer's denial of receipt raised no triable issue.
New York & Presbyt. Hosp. v Travelers Prop. Cas. Ins. Co. (2007 NY Slip Op 01537) Appellate Division, Second Department, February 20, 2007The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the hospital's certified mail receipt, signed return receipt card referencing the patient and billing forms, and third-party biller's affidavit proved that the insurer received the bill.
Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co. (2006 NY Slip Op 09604) Appellate Division, Second Department, December 19, 2006The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove mailing of the IME notices because it submitted no evidence from anyone with personal knowledge of the mailings.
New York & Presbyterian Hospital v Allstate Insurance Company (2006 NY Slip Op 04815) Appellate Division, Second Department, June 13, 2006The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld a denial form dated within 30 days insufficient because the insurer offered no evidence it was timely transmitted to the provider, so no triable issue was raised.
New York & Presbyt. Hosp. v Allstate Ins. Co. (2006 NY Slip Op 03558) Leading case Appellate Division, Second Department, May 2, 2006The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld no presumption arose because the billing representative neither stated he mailed the claim nor described office mailing practice, and an untied certified-mail receipt and tracking printout without a return card did not prove receipt.
Hospital for Joint Diseases v Allstate Ins. Co. (2005 NY Slip Op 06192) Appellate Division, Second Department, August 1, 2005The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's denial form did not establish mailing within 30 days because no affidavit of service showed it was mailed, though the lack-of-coverage defense survived preclusion anyway.
Nyack Hosp. v Metropolitan Prop. & Cas. Ins. Co. (2005 NY Slip Op 02235) Appellate Division, Second Department, March 21, 2005The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer failed to prove its denial was mailed because it submitted no proper affidavit of service.
Hospital for Joint Diseases v Countrywide Ins. Co. (2004 NY Slip Op 06513) Appellate Division, Second Department, September 13, 2004The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld that the insurer's affidavit and documents raised triable issues as to when the provider mailed the claims and whether timely denials had been mailed, defeating the provider's summary judgment motion.
Hospital for Joint Diseases v Hertz Corp. (2004 NY Slip Op 06025) Appellate Division, Second Department, July 12, 2004The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurers' assertion that they timely denied the claim failed because they offered no evidentiary support for it.
New York Hosp. Med. Ctr. of Queens v New York Cent. Mut. Fire Ins. Co. (2004 NY Slip Op 05626) Appellate Division, Second Department, June 28, 2004The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits failed to establish that it mailed its requests for verification of the assignments, so its objections based on lack of proof of assignment failed.

Appellate Division, Third Department (2 decisions)

Matter of Mercury Cas. Co. (Patient Care Assoc.) (2015 NY Slip Op 08891) Appellate Division, Third Department, December 3, 2015The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld no presumption of receipt arose for the IME notices because none of the insurer's mailing evidence listed the insured's correct address, and the arbitrator rationally found the mailing improper.
LMK Psychological Servs., P.C. v Liberty Mut. Ins. Co. (2006 NY Slip Op 04486) Appellate Division, Third Department, June 8, 2006The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld signed and stamped mailing certificates plus an officer's affidavit of mailing proved actual mailing, raising an unrebutted presumption of receipt corroborated by the insurer's own receipt dates.

Appellate Term, First Department (80 decisions)

RVA Leasing Corp. v Nationwide Mut. Ins. Co. (2026 NY Slip Op 51527(U)) Appellate Term, First Department, September 22, 2026The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's attorney adequately proved mailing of the EUO letters by describing his office's standard mailing practice and attesting from personal knowledge that it was followed.
Town RX Inc. v Nationwide Mut. Ins. Co. (2025 NY Slip Op 51853(U)) Appellate Term, First Department, November 24, 2025The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's attorney adequately proved mailing of the EUO letters by describing his office's standard mailing practice and attesting from personal knowledge that it was followed.
One RX Chemist, Inc. v Nationwide Mut. Ins. Co. (2025 NY Slip Op 51848(U)) Appellate Term, First Department, November 21, 2025The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's attorney adequately proved mailing of the EUO letters by describing his office's standard mailing practice and attesting from personal knowledge that it was followed.
Straight Up Chiropractic, PC v MVAIC (2020 NY Slip Op 51243(U)) Appellate Term, First Department, October 23, 2020The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's proof raised no presumption of receipt because the IME scheduling letters were sent to an address with an incorrect zip code.
Bright Med. Supply Co. v Nationwide Ins. Co. of Am. (2017 NY Slip Op 51700(U)) Appellate Term, First Department, December 18, 2017The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the insurer's conclusory no-record affidavit, lacking any description of its mail-handling practices or proof the post office box was its address, insufficient to show the claim was not properly and timely submitted.
J.O.V. Acupuncture, P.C. v Amex Assur. Co. (2017 NY Slip Op 50347(U)) Appellate Term, First Department, March 24, 2017The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove proper and timely mailing of its denial because the affiant, employed by a nonparty company, showed no relationship to the insurer or personal knowledge of its mailing practices.
Easy Care Acupuncture, P.C. v ELRAC, Inc. (2017 NY Slip Op 50234(U)) Appellate Term, First Department, February 22, 2017The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer failed to show it timely and properly mailed its denial of claim form to the assignee provider, so it could not assert the excessive-fees defense.
Karina K. Acupuncture, P.C. v Hartford Ins. Co. (2016 NY Slip Op 51382(U)) Appellate Term, First Department, September 28, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely and proper mailing of the IME notices to the assignor, and the provider raised no triable issue as to their mailing.

Show all 80 decisions

Urban Well Acupuncture, P.C. v Erie Ins. Co. of N.Y. (2016 NY Slip Op 51302(U)) Appellate Term, First Department, September 19, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits established timely denial and the provider raised no triable issue as to the efficacy of the insurer's mailing of the denial.
Urban Well Acupuncture, P.C. v Erie Ins. Co. of N.Y. (2016 NY Slip Op 51300(U)) Appellate Term, First Department, September 19, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits established timely denial of the 97813 and 97814 claims and the provider raised no triable issue as to the efficacy of the mailing.
Urban Well Acupuncture, P.C. v Nationwide Gen. Ins. Co. (2016 NY Slip Op 50906(U)) Appellate Term, First Department, June 15, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely and proper mailing of the IME notices to the assignor and the assignor's attorney, and the provider raised no triable issue as to mailing.
Metro 8 Med. Equip., Inc. v Esurance Ins. Co. (2016 NY Slip Op 50904(U)) Appellate Term, First Department, June 15, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely and proper mailing of the EUO notices to the assignor and his attorney, and the provider raised no triable issue on mailing.
Urban Well Acupuncture, P.C. v Hereford Ins. Co. (2016 NY Slip Op 50606(U)) Appellate Term, First Department, April 18, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely denial and the provider failed to raise a triable issue as to the efficacy of the insurer's mailing of the denials.
MDJ Med. PC v Delos Ins. Co. (2016 NY Slip Op 50604(U)) Appellate Term, First Department, April 18, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely and proper mailing of the EUO notices to the assignor, and the provider raised no triable issue as to mailing.
Karina K. Acupuncture, P.C. v AIG Centennial Ins. Co. (2016 NY Slip Op 50415(U)) Appellate Term, First Department, March 28, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer showed timely and proper denial through affidavits of its claims administrators' employees detailing their office mailing procedures; the provider's specific challenge was unpreserved.
Life Tree Acupuncture P.C. v Republic W. Ins. Co. (2016 NY Slip Op 50023(U)) Appellate Term, First Department, January 13, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it timely and properly mailed the IME notices to the assignor, and the provider raised no triable issue as to their mailing.
Easy Care Acupuncture, PC v 21st Century Indem. Ins. Co. (2015 NY Slip Op 51850(U)) Appellate Term, First Department, December 18, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the affidavits of the mailing center and claims administrator sufficiently detailed office procedures placing the NF-10 with payment checks in window envelopes, and the provider conceded receiving the checks.
Easy Care Acupuncture, P.C. v Nationwide Gen. Ins. Co. (2015 NY Slip Op 51849(U)) Appellate Term, First Department, December 18, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits established timely denial of the acupuncture code claims and the provider raised no triable issue as to the efficacy of the mailing.
Alfa Med. Supplies, Inc. v Praetorian Ins. Co. (2015 NY Slip Op 51847(U)) Appellate Term, First Department, December 18, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established proper mailing of the IME notices to the assignor and her attorney, and the provider raised no triable issue as to their mailing.
Healthy Way Acupuncture, P.C. v Amica Mut. Ins. Co. (2015 NY Slip Op 51623(U)) Appellate Term, First Department, November 12, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits established timely denial, disregarding a year error in the notary's jurat, and the provider raised no triable issue as to the efficacy of the mailing.
EMA Acupuncture v Statewide Ins. Co. (2015 NY Slip Op 51622(U)) Appellate Term, First Department, November 12, 2015The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's supervisor's affidavit insufficient to show mailing of verification letters because she lacked personal knowledge of mailing and described office mailing practices only in the most general terms.
Easy Care Acupuncture P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51524(U)) Appellate Term, First Department, October 20, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established proper mailing of the IME notices to the assignor, and the provider raised no triable issue as to their mailing.
Acupuncture Pain Mgt., P.C. v Kemper Cas. Ins. Co. (2015 NY Slip Op 51522(U)) Appellate Term, First Department, October 20, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely and proper mailing of the IME notices to the assignor, and the provider raised no triable issue as to their mailing.
MRJA Radiology, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51381(U)) Appellate Term, First Department, September 29, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it timely and properly mailed the IME notices to the assignor and his attorney.
S.A. Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 50953(U)) Appellate Term, First Department, June 25, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it timely and properly mailed the IME notices to the assignor.
Tutto Anesthesia v American Country Ins. Co. (2015 NY Slip Op 50738(U)) Appellate Term, First Department, May 18, 2015The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the insurer's own submissions, including the providers' claim forms date-stamped as received, established the insurer's receipt of the claims.
Harmonic Physical Therapy v Encompass Home & Auto Ins. Co. (2015 NY Slip Op 50733(U)) Appellate Term, First Department, May 18, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it timely and properly mailed the IME notices to the assignor and his counsel.
Orthopedic Specialist of Greater NY v Chubb Indem. Ins. Co. (2015 NY Slip Op 50565(U)) Appellate Term, First Department, April 21, 2015The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseDismissed the $212.37 claim because the provider's office manager neither alleged personally mailing it within 45 days nor described a regular office mailing practice, so no triable issue on timely submission arose.
Priority Med. Diagnostics, P.C. v New York Cent. Mut. Fire, Ins. Co. (2015 NY Slip Op 50538(U)) Appellate Term, First Department, April 16, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the third-party IME scheduler's affidavit, based on personal knowledge of the office's standard mailing practices, sufficiently established mailing of the IME notices.
Healthy Way Acupuncture, P.C. v One Beacon Ins. Co. (2015 NY Slip Op 50537(U)) Appellate Term, First Department, April 16, 2015The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove mailing of its denials because its affiant, employed by a related nonparty and hired after the mailing, showed no basis for personal knowledge of its mailing practices.
21st Century Acupuncture, P.C. v Allstate Ins. Co. (2015 NY Slip Op 50445(U)) Appellate Term, First Department, April 2, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it timely and properly mailed the IME notices to the assignor.
Acupuncture Solutions, P.C. v Lumbermans Mut. Cas. Co. (2015 NY Slip Op 50346(U)) Appellate Term, First Department, March 23, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it timely and properly mailed the IME notices to the assignor, and the provider raised no triable issue as to their mailing.
River Acupuncture, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 50271(U)) Appellate Term, First Department, March 4, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely and proper mailing of the IME notices to the assignor, and the provider raised no triable issue as to mailing.
VS Care Acupuncture v State Farm Mut. Auto. Ins. Co. (2015 NY Slip Op 50164(U)) Appellate Term, First Department, February 25, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's documentary submissions established timely and proper denial of the fee-schedule claims and the provider raised no triable issue as to the efficacy of the mailing of the denial forms.
Five Boro Med. Equip., Inc. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 51888(U)) Appellate Term, First Department, December 31, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established proper and timely mailing of its denial of claim forms for the June 2 and June 22 supplies, supporting summary judgment along with its peer review.
SMB Med., P.C. v State Farm Mut. Ins. Co. (2014 NY Slip Op 51853(U)) Appellate Term, First Department, December 30, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely and proper mailing of the IME notices to the assignor and his counsel, and the provider raised no triable issue on mailing.
Easy Care Acupuncture, P.C. v 21 Century Advantage Ins. Co. (2014 NY Slip Op 51766(U)) Appellate Term, First Department, December 17, 2014The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the claims administrator's affidavit insufficient because it only said mail-bin items were picked up by a vendor, without knowledge or description of the vendor's procedures, and a reply affidavit could not cure it.
Medcare Supply, Inc. v Farmers New Century Ins. Co. (2014 NY Slip Op 51752(U)) Appellate Term, First Department, December 15, 2014The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer's no-record affidavit insufficient for lack of knowledge of the designated claims office's practices, and the provider's stamped mailing certificate raised a triable issue whether the claim was timely mailed.
Urban Well Acupuncture, P.C. v American Commerce Ins. Co. (2014 NY Slip Op 51520(U)) Appellate Term, First Department, October 22, 2014The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove mailing of its denial because a nonparty's mailroom representative neither stated she mailed it nor described the insurer's own mailing practice, and no jural relationship was shown.
Karina K. Acupuncture P.C. v State-Wide Ins. Co. (2014 NY Slip Op 51518(U)) Appellate Term, First Department, October 22, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits established timely denial of the fee-schedule claim and the provider raised no triable issue as to the efficacy of the mailing of the denial form.
Alpha Acupuncture, P.C. v Hertz Claim Mgt. Corp. (2014 NY Slip Op 51515(U)) Appellate Term, First Department, October 22, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely and proper mailing of the IME notices to the assignor and his counsel, with no triable issue raised as to mailing.
Okslen Acupuncture P.C. v Travco Ins. Co. (2014 NY Slip Op 51209(U)) Appellate Term, First Department, August 11, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits established timely and proper denial and the provider raised no triable issue as to the efficacy of the mailing of the claim denial.
Healthy Way Acupuncture P.C. v Metropolitan Prop. & Cas. Ins. Co. (2014 NY Slip Op 51127(U)) Appellate Term, First Department, July 24, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits established timely denial of the claims and the provider raised no triable issue regarding the efficacy of the mailing of the denials.
Sunrise Acupuncture, P.C. v Encompass Auto & Home Ins. Co. (2014 NY Slip Op 51082(U)) Appellate Term, First Department, July 16, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely and proper mailing of the IME notices to the assignor and his counsel, and the provider raised no triable issue as to mailing.
MDJ Med., P.C. v Praetorian Ins. Co. (2014 NY Slip Op 50895(U)) Appellate Term, First Department, June 9, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer proved mailing of the EUO notices to the address on the claim form; their return as unclaimed, unexplained by the provider, did not defeat the showing.
Healthy Way Acupuncture, P.C. v Allstate Ins. Co. (2014 NY Slip Op 50841(U)) Appellate Term, First Department, May 30, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely and proper mailing of the IME notices to the assignor, and the provider raised no triable issue as to mailing.
Stracar Med. Servs. v New York Cent. Mut. Ins. Co. (2014 NY Slip Op 50263(U)) Appellate Term, First Department, February 27, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the litigation examiner's affidavit demonstrated that the IME scheduling notices were timely and properly mailed, and the provider raised no triable issue as to mailing.
Karina K. Acupuncture P.C. v MVAIC (2013 NY Slip Op 52127(U)) Appellate Term, First Department, December 13, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held MVAIC's affidavits established timely mailing of its fee-schedule denial, and the provider raised no triable issue as to the efficacy of that mailing.
Lotus Acupuncture, P.C. v MVAIC (2013 NY Slip Op 51925(U)) Appellate Term, First Department, November 20, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits established timely denial of the claim, and the provider raised no triable issue as to the efficacy of the insurer's mailing of the denial.
Pomona Med. Diagnostic P.C. v Praetorian Ins. Co. (2013 NY Slip Op 51798(U)) Appellate Term, First Department, October 28, 2013The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the third-party biller's affidavit insufficient to show the provider mailed its verification compliance letter, because the affiant lacked personal knowledge of the mailing date and described office practice only generally.
MDJ Med., P.C. v New York Cent. Mut. Ins. Co. (2013 NY Slip Op 51797(U)) Appellate Term, First Department, October 28, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it timely and properly mailed the IME notices to the assignor, and the provider raised no triable issue as to the mailing.
Acupuncture Approach PC v MVAIC (2013 NY Slip Op 51676(U)) Appellate Term, First Department, October 15, 2013The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the IME scheduler's affidavit insufficient because the affiant lacked personal knowledge of mailing dates and described mailing practices only generally, not showing a procedure ensuring proper addressing and mailing.
City Care Acupuncture, PC v New York Cent. Mut. Fire Ins. Co. (2013 NY Slip Op 50430(U)) Appellate Term, First Department, March 27, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer established timely and proper mailing of the IME notices, and the assignor's denial of receipt, standing alone, was insufficient to rebut it.
Magenta Med. P.C. v Clarendon Natl. Ins. Co. (2012 NY Slip Op 52236(U)) Appellate Term, First Department, December 11, 2012The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the provider failed to raise a triable issue on timely claim submission because its employee lacked personal knowledge of the mailing date and described office practice only generally, and the certified-mail receipt bore two postmarks and a non-matching file number.
GNK Med. Supply, Inc. v Tri-State Consumer Ins. Co. (2012 NY Slip Op 52195(U)) Appellate Term, First Department, November 30, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof established timely and proper mailing of initial and follow-up verification letters to the provider's attorney, and counsel's conclusory denial of receipt did not raise a triable issue.
SK Prime Med. Supply, Inc. v Hertz Claim Mgt. Corp. (2012 NY Slip Op 52192(U)) Appellate Term, First Department, November 28, 2012The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the IME scheduler's affidavit insufficient because the affiant lacked personal knowledge of the mailing dates and described the office's mailing practices only in general terms.
Diagnostic Chiropractic Specialities, P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 52114(U)) Appellate Term, First Department, November 15, 2012The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the provider's assertion that it mailed the claim earlier failed to raise a triable issue because the earlier claim covered services on a different date than the claim sued on.
Orthotech Express Corp. v MVAIC (2012 NY Slip Op 51913(U)) Appellate Term, First Department, October 5, 2012The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the IME scheduler's affidavit insufficient because the affiant lacked personal knowledge of the mailing dates and described office practice only generally, without explaining address checks or pickup for mailing.
Muhammad Tahir, M.D., P.C. v Travelers Prop. Cas. Ins. Co. (2012 NY Slip Op 51802(U)) Appellate Term, First Department, September 19, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld after trial that the litigation examiner's testimony about counsel's representation letter and the standard office mailing procedure established proper mailing of verification requests to the provider's attorney, creating an unrebutted presumption of receipt.
Darlington Med. Diagnostic, P.C. v Praetorian Ins. Co. (2012 NY Slip Op 51757(U)) Appellate Term, First Department, September 11, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer properly mailed verification demands to the provider's claim-form address, and the third-party biller's conclusory denial of receipt, without showing the missing suite number caused non-receipt, raised no triable issue.
Searay Med., P.C. v Praetorian Ins. Co. (2012 NY Slip Op 51383(U)) Appellate Term, First Department, July 26, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it timely and properly mailed the IME notices to the assignor.
Comprehensive Neurological Servs., PA v Tri-State Consumer Ins. Co. (2012 NY Slip Op 50950(U)) Appellate Term, First Department, May 29, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the billing supervisor's general description of logging received requests, without showing anyone checked the system for these letters, did not rebut the presumption of receipt from the insurer's proof of mailing.
Diagnostic Medicine, P.C. v Clarendon Natl. Ins. Co. (2012 NY Slip Op 50102(U)) Appellate Term, First Department, January 25, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established proper and timely mailing of the denial of claim forms as part of its prima facie showing.
Socrates Med. Health, P.C. v Praetorian Ins. Co. (2011 NY Slip Op 52174(U)) Appellate Term, First Department, December 6, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's submissions established prima facie proper mailing of the IME notices.
Darlington Med. Diagnostics, P.C. v Praetorian Ins. Co. (2011 NY Slip Op 51634(U)) Appellate Term, First Department, August 31, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer established timely mailing of its initial and follow-up verification letters, and the provider's conclusory denial of receipt did not raise a triable issue.
Excel Radiology Serv., P.C. v Utica Mut. Ins. Co. (2011 NY Slip Op 50751(U)) Appellate Term, First Department, April 28, 2011The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to establish prima facie that the IME notices were properly mailed to the assignor.
Center for Orthopedic Surgery, LLP v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 50473(U)) Appellate Term, First Department, March 29, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's submissions established mailing of the IME notices to the assignor and rejected the claim that notices also had to go to an attorney absent proof of representation.
Lenox Hill Radiology, P.C. v Tri-State Consumer Ins. Co. (2010 NY Slip Op 20530) Appellate Term, First Department, December 30, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld trial testimony of a claims examiner who prepared the requests and knew the standard mailing practice, including mail pickup and handling of returned mail, established mailing and presumed receipt of the verification requests, unrebutted by any denial of receipt.
Devonshire Surgical Facility, L.L.C. v Hereford Ins. Co. (2010 NY Slip Op 52297(U)) Appellate Term, First Department, December 7, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the lower court properly found the insurer established that its denials were timely mailed within the 30-day period, contrary to the providers' contention.
Socrates Med. Health, P.C. v Motor Veh. Acc. Indem. Corp. (2010 NY Slip Op 51606(U)) Appellate Term, First Department, September 17, 2010The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the provider employee's affidavit describing standard office mailing procedures created a presumption that the claim was mailed, and in any event the insurer acknowledged receiving it.
Gotham Acupuncture, P.C. v Country Wide Ins. Co. (2008 NY Slip Op 51615(U)) Appellate Term, First Department, July 28, 2008The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to submit competent proof that it mailed its denials within 30 days, so its excessive-fee and medical-necessity defenses were precluded.
Beta Supply, Inc. v Government Employees Insurance Co. (2008 NY Slip Op 51406(U)) Appellate Term, First Department, July 16, 2008The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's documentary submissions sufficient to raise a presumption that its verification requests were timely mailed and received.
P.L.P. Acupuncture, P.C. v Travelers Indem. Co. (2008 NY Slip Op 50484(U)) Appellate Term, First Department, March 14, 2008The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the insurer's admission of receipt foreclosed its challenge to the provider's proof that the claims were mailed and received.
Westmed Physician, P.C. v State Farm Auto Ins. Co. (2007 NY Slip Op 52113(U)) Appellate Term, First Department, October 31, 2007The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the billing entity employee's affidavit insufficient to raise a presumption that the bill was mailed within 180 days because it neither described the office mailing practice nor explained her recollection of the mailing three years later.
East Coast Psychological, P.C. v Allstate Ins. Co. (2006 NY Slip Op 52000(U)) Appellate Term, First Department, October 20, 2006The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the provider sufficiently described a standard office procedure designed to ensure that the claim forms were properly addressed and mailed.
Response Med. Equip. v General Assur. Co. (2006 NY Slip Op 51765(U)) Appellate Term, First Department, September 20, 2006The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification response (also decides)Held the provider's principal's affidavit failed to prove mailing of several claims because he neither stated he mailed them nor described office mailing practice; the insurer's IME-letter mailing proof only raised a fact issue.
Mid Atl. Med., P.C. v Travelers Indem. Co. (2006 NY Slip Op 51579(U)) Appellate Term, First Department, August 15, 2006The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer did not prove timely denial of the late claim because its claims representative neither stated she mailed the denial nor described the office's mailing practice and procedures.
Bronx Expert Radiology, P.C. v Travelers Ins. Co. (2006 NY Slip Op 51227(U)) Appellate Term, First Department, June 29, 2006The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld no presumption arose that the provider mailed its verification responses because its representative neither stated she mailed them nor described the office's mailing practice and procedures.
Inwood Hill Med., P.C. v General Assur. Co. (2005 NY Slip Op 25437) Appellate Term, First Department, October 20, 2005The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge to the proof of mailing, holding the insurer proved the IME scheduling letters were mailed to both addresses the assignor provided.
North N.Y. Med. Care, P.C. v New York Cent. Mut. Fire Ins. Co. (2004 NY Slip Op 51453(U)) Appellate Term, First Department, November 24, 2004The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the billing manager's uncontradicted sworn statement that the claim forms were mailed to the insurer on the date each was signed sufficiently established mailing.

Appellate Term, Second Department (1,173 decisions)

One RX Chemist, Inc. v Nationwide Mut. Ins. Co. (2026 NY Slip Op 51309(U)) Appellate Term, Second Department, June 17, 2026The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Found it undisputed that the insurer established timely mailing of its initial and follow-up EUO scheduling letters.
Big Apple Delivery Supply Corp. v Plymouth Rock Assur. Corp. of N.Y. (2026 NY Slip Op 50794(U)) Appellate Term, Second Department, May 15, 2026The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove timely mailing of its denials because its litigation specialist's description of office practice omitted how postage was affixed and how and when envelopes reached the Postal Service.
Big Apple Delivery Supply Corp. v Plymouth Rock Assur. Corp. of N.Y. (2026 NY Slip Op 50795(U)) Appellate Term, Second Department, May 15, 2026The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's litigation specialist's description of office mailing practices insufficient because it omitted how postage was affixed and how and when envelopes reached the Postal Service, so timely mailing of the denial was not shown.
Prompt Med. Group, Inc. v Erie Ins. Co. of N.Y. (2026 NY Slip Op 50796(U)) Appellate Term, Second Department, May 15, 2026The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer did not prove mailing because counsel's affirmation that he directed an assistant to send the verification requests was the only proof, and the specialist's affirmation did not show the denial was mailed on its date.
Healthway Med. Care, P.C. v MVAIC (2026 NY Slip Op 50200(U)) Appellate Term, Second Department, January 23, 2026The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or received (also decides)Held the provider's billing clerk's affidavit raised a presumption that the claim form was timely mailed and received, which against the insurer's non-receipt showing left an issue of fact on timely submission.
Healthway Med. Care, P.C. v MVAIC (2026 NY Slip Op 50198(U)) Appellate Term, Second Department, January 23, 2026The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer showed non-receipt of the claim, but the provider's billing clerk affidavit describing a standard mailing practice raised a triable issue whether the claim was mailed, defeating summary judgment for either side.
Bridgeview Supply Corp. v Nationwide Mut. Ins. Co. (2026 NY Slip Op 50190(U)) Appellate Term, Second Department, January 16, 2026The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits were prima facie evidence that the denial form was timely mailed under its standard office practices, unrefuted by the provider.
John A. Nasrinpay 2 v State Farm Mut. Auto. Ins. Co. (2025 NY Slip Op 51833(U)) Appellate Term, Second Department, November 7, 2025The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's employee affidavits sufficed to raise a presumption that the EUO scheduling letters and denial forms were timely mailed, rejecting the provider's contrary contention.

Show all 1,173 decisions

MSB Physical Therapy, P.C. v Nationwide Ins. (2025 NY Slip Op 50830(U)) Appellate Term, Second Department, May 16, 2025The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Found the insurer showed the initial EUO scheduling letter was mailed before it received the claims and that follow-up requests were timely issued.
MSB Physical Therapy, P.C. v Nationwide Ins. (2025 NY Slip Op 50831(U)) Appellate Term, Second Department, May 16, 2025The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it timely mailed the initial and follow-up EUO scheduling letters.
Bronx Community Med., P.C. v MVAIC (2024 NY Slip Op 51538(U)) Appellate Term, Second Department, September 27, 2024The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the provider owner's affidavit insufficient to raise a presumption of mailing because it named neither the recipient nor the address, and the annexed claim forms postdated the alleged mailing date.
ZZ Acupuncture, P.C. v Kemper Ins. Co. (2024 NY Slip Op 51205(U)) Appellate Term, Second Department, August 30, 2024The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's claims representative's affidavit failed to establish when its denials were mailed to or received by the provider, so accrual could not be measured from the denials.
GPLW Acupuncture, P.C. v Nationwide Mut. Ins. Co. (2024 NY Slip Op 50395(U)) Appellate Term, Second Department, March 14, 2024The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it timely mailed the initial and follow-up EUO scheduling letters for each bill.
GPLW Acupuncture, P.C. v Nationwide Mut. Ins. Co. (2024 NY Slip Op 50397(U)) Appellate Term, Second Department, March 14, 2024The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit established timely mailing of the EUO scheduling letters and the denial forms under its standard office practices and procedures.
Shafai Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2023 NY Slip Op 50796(U)) Appellate Term, Second Department, July 21, 2023The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer employee's affidavit sufficient to raise a presumption that the EUO scheduling letters and denial of claim forms were timely mailed, which was the provider's only challenge.
Shafai Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2023 NY Slip Op 50795(U)) Appellate Term, Second Department, July 21, 2023The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer employee's affidavit sufficient to raise a presumption that the EUO scheduling letters and denial of claim forms were timely mailed, the provider's sole contention on appeal.
Burke Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. (2023 NY Slip Op 50794(U)) Appellate Term, Second Department, July 21, 2023The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's proof established timely mailing of its initial and follow-up verification requests and of its denial.
Horizon P.T. Care, P.C. v State Farm Mut. Auto. Ins. Co. (2023 NY Slip Op 50442(U)) Appellate Term, Second Department, April 14, 2023The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's contention and held the insurer's employee affidavits sufficient to presume timely mailing of the EUO scheduling letters and denial forms for the remaining causes of action.
New York Manual, P.T., P.C. v Nationwide Affinity Ins. Co. of Am. (2023 NY Slip Op 50281(U)) Appellate Term, Second Department, February 24, 2023The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer showed prima facie that it timely mailed its initial and follow-up verification requests.
Spring Rehab PT P.C. v Nationwide Affinity Ins. Co. (2022 NY Slip Op 51268(U)) Appellate Term, Second Department, December 2, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit established that the EUO scheduling letters and denial forms were timely mailed under its standard office practices and procedures.
American Kinetics Lab, Inc. v GEICO Gen. Ins. Co. (2022 NY Slip Op 51267(U)) Appellate Term, Second Department, December 2, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's proof established timely mailing of its initial and follow-up verification requests.
First Spine Chiropractic of NY, P.C. v Nationwide Affinity Ins. Co. of Am. (2022 NY Slip Op 51252(U)) Appellate Term, Second Department, December 2, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the claim specialist's and mailing manager's affidavits sufficient to establish prima facie that the denials were timely mailed, and the provider raised no triable issue.
Heal-Rite, P.T., P.C. v State Farm Mut. Auto. Ins. Co. (2022 NY Slip Op 51246(U)) Appellate Term, Second Department, December 2, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's standard-office-practice affidavit, supported by mailing logs showing delivery to the post office, established timely mailing of the EUO letters and denials.
Good Samaritan Hosp. v MVAIC Ins. Co. (2022 NY Slip Op 51100(U)) Appellate Term, Second Department, October 14, 2022The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification response (also decides)Held the provider did not prove it first mailed the claim to MVAIC on the earlier date, since it gave no affidavit of personal knowledge or mailing practices and its certificate of mailing could not fill the gaps.
Parisien v Travelers Ins. Co. (2022 NY Slip Op 51136(U)) Appellate Term, Second Department, September 30, 2022The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer proved timely mailing of its verification requests, but the provider's affidavit raised an issue of fact as to whether its verification response had been mailed to and received by the insurer.
Remedy Chiropractic, P.C. v Nationwide Ins. (2022 NY Slip Op 50935(U)) Appellate Term, Second Department, September 23, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer showed prima facie that it timely mailed its initial and follow-up verification requests.
Wellness Plaza Acupuncture, P.C. v Nationwide Ins. (2022 NY Slip Op 50934(U)) Appellate Term, Second Department, September 23, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof, contrary to the provider's contentions, raised a presumption of timely mailing of the EUO letters and denials, and the provider raised no triable issue on timeliness of the mailings.
Columbus Imaging Ctr., LLC v Erie Ins. Co. of N.Y. (2022 NY Slip Op 50929(U)) Appellate Term, Second Department, September 23, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer showed it properly scheduled the IMEs and timely denied the claim, citing the standard-office-practice mailing rule.
New Millennium Med. Imaging, P.C. v GEICO (2022 NY Slip Op 22300) Appellate Term, Second Department, September 23, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Accepted the insurer's prima facie proof that it mailed the denial on a given date, but held proper mailing presumes receipt only within a reasonable time, not on any exact date, so earlier receipt was not shown.
Nassau Chiropractic Servs., P.C. v Travelers Indem. Co. (2022 NY Slip Op 50933(U)) Appellate Term, Second Department, September 23, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits established timely mailing of the EUO scheduling letters and the denial under standard office practices and procedures.
Parisien v Tri State Consumers Ins. Co. (2022 NY Slip Op 50920(U)) Appellate Term, Second Department, September 16, 2022The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to show the IME scheduling letters were properly addressed and generated under its scheduling vendor's standard office practices and procedures.
Forest Park Acupuncture, P.C. v Nationwide Prop. & Cas. Ins. Co. (2022 NY Slip Op 50915(U)) Appellate Term, Second Department, September 9, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that the letter scheduling the EUO at issue was timely and properly mailed.
Wave Med. Servs., P.C. v Hertz Vehs., LLC (2022 NY Slip Op 50908(U)) Appellate Term, Second Department, August 26, 2022The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer's proof of non-receipt rebutted the presumption of receipt and called into question whether the claim forms were mailed, so mailing could not be deemed incontrovertible and remained for trial.
Hands On Physical Therapy Care v Nationwide Ins. (2022 NY Slip Op 50797(U)) Appellate Term, Second Department, August 12, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge to the insurer's mailing affidavits, holding the proof sufficient to presume the EUO scheduling letters and denial forms were properly mailed on the dates alleged for the remaining claims.
ACH Chiropractic, P.C. v Nationwide Ins. (2022 NY Slip Op 50795(U)) Appellate Term, Second Department, August 12, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's sole appellate contention and held the insurer established that the EUO scheduling letters were timely mailed under its standard office practices and procedures.
PFJ Med. Care, P.C. v Nationwide Ins. (2022 NY Slip Op 50783(U)) Appellate Term, Second Department, August 5, 2022The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the affidavit of the provider's owner insufficient to give rise to a presumption that the claim forms were timely mailed to and received by the insurer, so the provider's cross motion failed on those claims.
Gentlecare Ambulatory Anesthesia Servs. v MVAIC (2022 NY Slip Op 50785(U)) Appellate Term, Second Department, August 5, 2022The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer proved timely mailing of its verification requests, but the provider's affidavit raised a presumption that the verification was mailed and received, leaving a factual question.
First Care Med. Equip., LLC v MVAIC (2022 NY Slip Op 50778(U)) Appellate Term, Second Department, July 22, 2022The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the provider's opposing affidavit sufficient to give rise to a presumption that the requested verification was mailed to and received by MVAIC, which raised a triable issue on prematurity and defeated MVAIC's motion.
Warton Supplies, Inc. v GEICO Indem. Co. (2022 NY Slip Op 50770(U)) Appellate Term, Second Department, July 15, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof sufficient to give rise to a presumption that the denial of claim forms had been timely mailed.
Columbus Imaging Ctr., LLC v Nationwide Ins. (2022 NY Slip Op 50620(U)) Appellate Term, Second Department, July 1, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Found the insurer's affidavits showed prima facie that the IME scheduling letters were timely and properly mailed, though the defense failed on proof of nonappearance.
Citycare Chiropractic, P.C. v Repwest Ins. Co. (2022 NY Slip Op 50619(U)) Appellate Term, Second Department, July 1, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the IME scheduler's affidavit proved timely and proper mailing of the scheduling letters, and the assignor's bald conclusory denial of receipt did not rebut the presumption of receipt.
Ezra Supply, Inc. v State Farm Mut. Auto Ins. Co. (2022 NY Slip Op 50613(U)) Appellate Term, Second Department, June 17, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer proved timely and proper mailing of the initial and follow-up EUO letters under its office practices, as the assignor confirmed the address and receipt was undisputed.
New York Wellness PT, P.C. v State Farm Mut. Auto. Ins. Co. (2022 NY Slip Op 50608(U)) Appellate Term, Second Department, June 17, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Found the insurer established that the EUO scheduling letters were timely mailed, though its defense failed on nonappearance proof and the timeliness of its denial.
Hand By Hand PT, P.C. v Nationwide Prop. & Cas. Ins. Co. (2022 NY Slip Op 50607(U)) Appellate Term, Second Department, June 17, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's proof demonstrated that its initial and follow-up EUO scheduling letters were timely mailed and that the claims were timely denied, both under the St. Vincent's standard.
Metropolitan Surgical Servs., P.C. v 21st Century Ins. Co. (2022 NY Slip Op 50606(U)) Appellate Term, Second Department, June 17, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the IME scheduling vendor's affidavit sufficiently demonstrated that the IME letters were timely mailed to the assignor.
Regal Acupuncture, P.C. v Allstate Ins. Co. (2022 NY Slip Op 50604(U)) Appellate Term, Second Department, June 17, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer showed prima facie that the EUO scheduling letters were timely and properly mailed, rejecting the provider's challenge to that proof.
Lefferts Gardens Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2022 NY Slip Op 50599(U)) Appellate Term, Second Department, June 17, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's proof sufficient to show its verification requests were timely sent.
Aminov v National Liab. & Fire Ins. (2022 NY Slip Op 50596(U)) Appellate Term, Second Department, June 17, 2022The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld that discrepancies between the insurer's mailing affidavit and its annexed mailing logs raised an issue of fact as to whether the denials were mailed under a standard office practice, defeating the insurer's motion.
Prestige Med., P.C. v Metropolitan Prop. & Cas. Ins. Co. (2022 NY Slip Op 50591(U)) Appellate Term, Second Department, June 10, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that its EUO scheduling letters were properly mailed and its denial forms timely mailed.
Sutphin Complete Med. Care, P.C. v Tri-State Consumer Ins. Co. (2022 NY Slip Op 50586(U)) Appellate Term, Second Department, June 10, 2022The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit failed to establish that the IME scheduling letters were timely generated and properly addressed under the scheduling vendor's standard practices.
Mega Aid Pharm. I, Inc. v A. Cent. Ins. Co. (2022 NY Slip Op 50579(U)) Appellate Term, Second Department, June 10, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims representative's affidavit established that the insurer timely mailed its denial of the claims as submitted more than 45 days after the supplies were furnished.
Dr. Orenbakh Psychologist, P.C. v Nationwide Affinity Ins. Co. of Am. (2022 NY Slip Op 50566(U)) Appellate Term, Second Department, June 10, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld, reversing a finding of fact issues, that the insurer sufficiently established mailing of the EUO scheduling letters under its standard office practices and procedures.
Sure Way NY, Inc. v MVAIC (2022 NY Slip Op 50573(U)) Appellate Term, Second Department, June 10, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's sole appellate contention, holding the claim representative's affidavit sufficient to establish prima facie that the denials were timely mailed.
SVP Med Supply, Inc. (B) v GEICO (2022 NY Slip Op 50585(U)) Appellate Term, Second Department, June 10, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit established timely mailing of the EUO scheduling letters and denial forms under its standard office practices and procedures.
Pavlova v Nationwide Ins. (2022 NY Slip Op 50559(U)) Appellate Term, Second Department, June 3, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer established proper mailing of the EUO scheduling letters, rejecting the provider's sole contention on the motion, and rejected as meritless the argument that the letters had to follow receipt of the NF-2.
AB Quality Health Supply Corp. v Nationwide Ins. (2022 NY Slip Op 50558(U)) Appellate Term, Second Department, June 3, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer established that the EUO scheduling letters were timely mailed, one of the two issues left for trial below, and the provider raised no triable issue.
Columbus Imaging Ctr., LLC v National Liab. & Fire Ins. Co. (2022 NY Slip Op 50556(U)) Appellate Term, Second Department, June 3, 2022The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit did not sufficiently describe a standard office practice ensuring the IME scheduling letters were properly addressed and timely mailed, so mailing was not proved.
Warton Supplies, Inc. v GEICO Gen. Ins. Co. (2022 NY Slip Op 50554(U)) Appellate Term, Second Department, June 3, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit established that the EUO scheduling letters and denial of claim forms were timely mailed under its standard office practices and procedures.
Parisien v Travelers Ins. Co. (2022 NY Slip Op 50553(U)) Appellate Term, Second Department, June 3, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely mailing of the initial and follow-up EUO scheduling letters and timely denial of the claims.
PFJ Med. Care, P.C. v Allstate Ins. Co. (2022 NY Slip Op 50361(U)) Appellate Term, Second Department, April 29, 2022The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer proved timely mailing of its verification requests, but the provider's affidavit raised an issue of fact as to whether the verification was mailed to and received by the insurer.
AB Quality Health Supply Corp. v Nationwide Ins. (2022 NY Slip Op 50299(U)) Appellate Term, Second Department, April 1, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the EUO scheduling letters were properly mailed to the assignor because they went to the address on the provider's NF-3 forms, even though the assignment form listed a different address.
JFL Med. Care, P.C. v Lancer Ins. Co. (2022 NY Slip Op 50056(U)) Appellate Term, Second Department, January 21, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer established that the IME scheduling letters were mailed to the assignor, rejecting the provider's only challenge to the insurer's motion.
Arcadia Acupuncture, P.C. v Nationwide Ins. Co. (2021 NY Slip Op 51258(U)) Appellate Term, Second Department, December 22, 2021The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the record showed prima facie that the EUO scheduling letters were timely mailed to the provider for the later claims.
Warton Supplies, Inc. v GEICO (Gov Empls.) (2021 NY Slip Op 51253(U)) Appellate Term, Second Department, December 22, 2021The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's contention and held the insurer's proof sufficient to presume timely mailing of the EUO scheduling letters and the denial of claim forms.
Tyorkin v Repwest Ins. Co. (2021 NY Slip Op 51208(U)) Appellate Term, Second Department, December 10, 2021The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the assignor's bald denial of receipt of the IME scheduling letters, without evidence that they were not properly mailed, did not rebut the presumption of receipt.
SK Prime Med. Supply v MVAIC (2021 NY Slip Op 51200(U)) Appellate Term, Second Department, December 10, 2021The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the provider owner's affidavit raised a presumption of timely mailing and receipt, but the insurer's prima facie showing of non-receipt required a framed-issue hearing on whether the claims were mailed and received.
Essential Health Chiropractic, P.C. v National Liab. & Fire Ins. Co. (2021 NY Slip Op 50881(U)) Appellate Term, Second Department, September 9, 2021The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer's prima facie proof of mailing the denials was met by the provider owner's affidavit raising a fact issue, and held the insurer failed to prove timely mailing of the EUO scheduling letters.
A.C. Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2021 NY Slip Op 50841(U)) Appellate Term, Second Department, August 27, 2021The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer showed timely mailing of its initial and follow-up verification requests after receiving the bills.
Solution Bridge, Inc. v GEICO Ins. Co. (2021 NY Slip Op 50731(U)) Appellate Term, Second Department, July 23, 2021The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held, as an alternative ground, that the insurer established timely mailing of the initial and follow-up EUO scheduling letters.
Englinton Med., P.C. v Ameriprise Ins. Co. (2021 NY Slip Op 50715(U)) Appellate Term, Second Department, July 22, 2021The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's proof established that the initial and follow-up EUO scheduling letters were timely mailed and the claims timely denied.
Hand By Hand PT, P.C. v Titan Indem. Co. (2021 NY Slip Op 50644(U)) Appellate Term, Second Department, July 2, 2021The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer proved timely mailing of the initial and follow-up EUO scheduling letters and of the denials.
Sheepshead Bay Med. Supply, Inc. v Erie Ins. Co. of N.Y. (2021 NY Slip Op 50491(U)) Appellate Term, Second Department, May 21, 2021The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer established that it mailed the NF-10 denials in duplicate, and counsel's affirmation without personal knowledge raised no triable issue.
JCC Med., P.C. v Lancer Ins. Co. (2021 NY Slip Op 50485(U)) Appellate Term, Second Department, May 21, 2021The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld after trial that the insurer proved first-class mailing of the EUO scheduling letters, making certified-mail proof irrelevant, and that the claims examiner's testimony established timely mailing of denials despite lacking supervisory authority over mail staff.
Madison Prods. of USA, Inc. v 21st Century Ins. Co. (2021 NY Slip Op 50446(U)) Appellate Term, Second Department, May 14, 2021The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer established that the EUO scheduling letters were timely mailed, rejecting the provider's sole contention on appeal.
Jodi Jacobs, D.C., PLLC v Global Liberty Ins. Co. of NY (2021 NY Slip Op 50445(U)) Appellate Term, Second Department, May 14, 2021Different mailing results for different documents or claims in one decisionHeld the IME vendor's affidavit established timely mailing of the scheduling letters, but the provider never established mailing of one claim the insurer showed it never received.
Total Chiropractic, P.C. v Integon Natl. Ins. Co. (2021 NY Slip Op 50443(U)) Appellate Term, Second Department, May 14, 2021The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit did not sufficiently set forth a standard office practice ensuring the IME scheduling letters were properly addressed and mailed, so mailing was not proved.
Allay Med. Servs., P.C. v National Liab. & Fire Ins. Co. (2021 NY Slip Op 50442(U)) Appellate Term, Second Department, May 14, 2021The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld that the provider's billing clerk affidavit raised a presumption that the claim form was mailed and received, creating a triable issue against the insurer's non-receipt showing, and the insurer did not prove the mailing address was wrong.
Ditmas Primary Med. Care, P.C. v Republic W. Ins. Co. (2021 NY Slip Op 50438(U)) Appellate Term, Second Department, May 14, 2021The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's office-practice affidavit established timely mailing of the denials and its attorney's affirmation established timely mailing of the EUO scheduling letters.
BNE Clinton Med., P.C. v Republic W. Ins. Co. (2021 NY Slip Op 50433(U)) Appellate Term, Second Department, May 14, 2021The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's office-practice affidavit established timely mailing of the denials and its attorney's affirmation established timely mailing of the EUO scheduling letters.
JFL Med. Care, P.C. v ELRAC, Inc. (2021 NY Slip Op 50434(U)) Appellate Term, Second Department, May 14, 2021The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit did not set forth a standard office practice or procedure ensuring the IME scheduling letters were properly addressed and mailed.
Longevity Med. Supply, Inc. v MVAIC (2021 NY Slip Op 50440(U)) Appellate Term, Second Department, May 14, 2021The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer proved timely mailing of its 45-day-rule denials, but the provider's affidavit gave rise to a presumption that its claim forms were timely mailed, leaving a triable issue whether the claims were timely submitted.
Active Care Med. Supply Corp. v MVAIC (2021 NY Slip Op 50450(U)) Appellate Term, Second Department, May 14, 2021The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the provider's owner's affidavit prima facie showed the claim was mailed in October 2010, contrary to MVAIC's claimed 2012 receipt, so a framed-issue hearing was needed on when the claim was mailed and received.
City Anesthesia Healthcare, P.C. v Erie Ins. Co. of N.Y. (2021 NY Slip Op 50135(U)) Appellate Term, Second Department, February 19, 2021The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer demonstrated timely denial of the claim, citing the standard for proof of mailing of the denial.
Lenex Servs., Inc. v Global Liberty Ins. of N.Y. (2020 NY Slip Op 51382(U)) Appellate Term, Second Department, November 13, 2020The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's moving papers insufficient to establish that the IME scheduling letters had been properly addressed and mailed.
A.C. Med., P.C. v Ameriprise Ins. Co. (2020 NY Slip Op 51378(U)) Appellate Term, Second Department, November 13, 2020The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that the initial and follow-up EUO scheduling letters and the denials of one provider's claims were timely mailed.
21st Century Pharm., Inc. v Global Liberty Ins. Co. of N.Y. (2020 NY Slip Op 51377(U)) Appellate Term, Second Department, November 13, 2020The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the affidavit of the IME scheduling company's supervisor sufficiently established that the IME scheduling letters were timely mailed, and the denials were shown timely.
Advanced Recovery Equip. & Supplies, LLC v Global Liberty Ins. Co. (2020 NY Slip Op 51373(U)) Appellate Term, Second Department, November 13, 2020The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or received (also decides)Vacated the lower court's finding that the provider's two claims were timely and properly mailed, holding that triable issues existed as to whether the claims had been timely submitted to the insurer.
JPF Med. Servs., P.C. v Hereford Ins. Co. (2020 NY Slip Op 51372(U)) Appellate Term, Second Department, November 13, 2020The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer proved timely mailing of its verification requests, while the provider's affidavit raised a presumption that its response was mailed and received, leaving a triable issue on compliance.
VS Sunrise Med., P.C. v Global Liberty Ins. (2020 NY Slip Op 51370(U)) Appellate Term, Second Department, November 13, 2020The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld that the insurer showed non-receipt of the claim forms while the provider's billing administrator affidavit raised an issue of fact as to mailing, so receipt was a triable issue and neither side won summary judgment.
Island Life Chiropractic Pain Care, PLLC v Ameriprise Ins. (2020 NY Slip Op 51369(U)) Appellate Term, Second Department, November 13, 2020The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that the initial and follow-up EUO scheduling letters were timely mailed and that the claims were timely denied.
Silver Lotus Acupuncture, P.C. v Global Liberty Ins. Co. of N.Y. (2020 NY Slip Op 51368(U)) Appellate Term, Second Department, November 13, 2020The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the record sufficed to establish proper mailing of the IME scheduling letters to the assignor.
NL Quality Med., P.C. v GEICO Ins. Co. (2020 NY Slip Op 51367(U)) Appellate Term, Second Department, November 13, 2020The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected the provider's challenge to the implicit findings, holding the insurer's proof sufficient to show the EUO scheduling letters and denial forms were timely mailed.
NL Quality Med., P.C. v GEICO Ins. Co. (2020 NY Slip Op 51340(U)) Appellate Term, Second Department, November 6, 2020The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof sufficient, over the provider's contentions, to raise a presumption that the EUO scheduling letters and denial forms were timely mailed.
Flushing Traditional Acupuncture, P.C. v GEICO Ins. Co. (2020 NY Slip Op 51337(U)) Appellate Term, Second Department, November 6, 2020The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's contention and held the insurer's proof sufficient to give rise to a presumption that its fee schedule denials were timely mailed.
Lacina v Hereford Ins. Co. (2020 NY Slip Op 51333(U)) Appellate Term, Second Department, November 6, 2020The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the no-fault supervisor's affidavit and the mailing officer's contemporaneous affidavits sufficient to establish proper mailing of the denial of claim forms.
Alpine Chiropractic, P.C. v Integon Natl. Ins. Co. (2020 NY Slip Op 51332(U)) Appellate Term, Second Department, November 6, 2020The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that the initial and follow-up IME scheduling letters were timely mailed and the claims timely denied.
EA Chiropractic Diagnostics, P.C. v GEICO Ins. (2020 NY Slip Op 51331(U)) Appellate Term, Second Department, November 6, 2020The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the affidavit of the IME scheduling company's general manager sufficiently established that the IME scheduling letters were timely mailed, and the denial was shown timely.
Lacina v Hereford Ins. Co. (2020 NY Slip Op 51329(U)) Appellate Term, Second Department, November 6, 2020The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge, holding affidavits of the IME scheduler executed the day the letters were mailed, and the claims examiner's affidavit, established timely mailing of the IME letters and denial.
Domny Med. Servs., P.C. v Travelers Ins. Co. (2020 NY Slip Op 51328(U)) Appellate Term, Second Department, November 6, 2020The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the record sufficient to establish proper mailing of the EUO scheduling letters to the assignor and of the denial of claim forms to the provider.
ESA Med. Supply, Inc. v Nationwide Affinity Ins. Co. of Am. (2020 NY Slip Op 51324(U)) Appellate Term, Second Department, November 6, 2020The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer proved timely mailing of EUO letters to the address on plaintiff's bills, and rejected the objection to its denial-mailing affidavit because the embossed notarial seal was affixed.
Tsatskis v Travelers Ins. Co. (2020 NY Slip Op 51323(U)) Appellate Term, Second Department, November 6, 2020The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the provider owner's affidavit raised a presumption that the claim forms were mailed and received, which, against the insurer's non-receipt affidavit, created a triable issue as to submission of those claims.
Charles Deng Acupuncture, P.C. v Travelers Ins. Co. (2020 NY Slip Op 51320(U)) Appellate Term, Second Department, November 6, 2020The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that the initial and follow-up EUO scheduling letters were timely mailed and the claims timely denied.
Metro Pain Specialist, P.C. v ELRAC, Inc. (2020 NY Slip Op 51341(U)) Appellate Term, Second Department, November 6, 2020The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit did not set forth a standard office practice or procedure ensuring the IME scheduling letters were properly addressed and mailed.
Longevity Med. Supply, Inc. v Nationwide Ins. (2020 NY Slip Op 51133(U)) Appellate Term, Second Department, October 2, 2020The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that the EUO scheduling letters were timely mailed and the claims timely denied.
Focus Chiropractic, P.C. v Global Liberty Ins. Co. of N.Y. (2020 NY Slip Op 51006(U)) Appellate Term, Second Department, August 28, 2020The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit sufficient to establish timely mailing of the IME scheduling letters to the assignor and timely denial of the claim.
S.O.V. Acupuncture, P.C. v Global Liberty Ins. Co. of N.Y. (2020 NY Slip Op 51004(U)) Appellate Term, Second Department, August 28, 2020The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit sufficiently established timely mailing of the IME scheduling letters, and rejected the wrong-address argument because the letters went to the address the assignor gave on the sworn NF-2.
Quest Supply, Inc. v NY Cent. Mut. Fire Ins. Co. (2020 NY Slip Op 51003(U)) Appellate Term, Second Department, August 28, 2020The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the IME vendor employee's affidavit showed the scheduling letters were properly mailed to the assignor and the claim representative's affidavit showed the denial was timely mailed; counsel's affirmation raised no issue.
Colin v Global Liberty Ins. Co. of N.Y. (2020 NY Slip Op 51002(U)) Appellate Term, Second Department, August 28, 2020The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the IME scheduler's affidavit established timely and proper mailing, rejecting the argument that letters had to go to a zip code from the police report when the assignor's sworn NF-2 gave the one used.
NL Quality Med., P.C. v GEICO Ins. Co. (2020 NY Slip Op 50997(U)) Appellate Term, Second Department, August 28, 2020The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit established that the EUO scheduling letters and the denial forms were timely mailed under its standard office practices and procedures.
Parisien v Ameriprise Ins. (2020 NY Slip Op 50990(U)) Appellate Term, Second Department, August 28, 2020The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that the EUO scheduling letters were mailed under its standard office practices and that the claim was timely denied.
Solution Bridge, Inc. v Nationwide Ins. (2020 NY Slip Op 50988(U)) Appellate Term, Second Department, August 28, 2020The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer proved timely mailing of its verification requests, but the provider's affidavit raised a presumption that its verification response was mailed and received, leaving a triable issue against the insurer's nonreceipt showing.
Excel Surgery Ctr., LLC v MVAIC (2020 NY Slip Op 51016(U)) Appellate Term, Second Department, August 27, 2020The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer showed it timely mailed the denial of claim form denying the claim on the IME no-show ground.
Accelerated Med. Supply, Inc. v Ameriprise Ins. Co. (2020 NY Slip Op 50741(U)) Appellate Term, Second Department, June 18, 2020The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established proper mailing of the EUO scheduling letters and timely mailing of the denial forms.
Medcare Supply, Inc. v Global Liberty Ins. (2020 NY Slip Op 50231(U)) Appellate Term, Second Department, February 14, 2020The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's papers demonstrated prima facie timely mailing of both the IME scheduling letters and the denial of claim form.
Active Care Med. Supply Corp. v American Tr. Ins. Co. (2019 NY Slip Op 52068(U)) Appellate Term, Second Department, December 13, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge and held the insurer established timely mailing of the EUO scheduling letters.
Omphil Care, Inc. v GEICO Ins. Co. (2019 NY Slip Op 52065(U)) Appellate Term, Second Department, December 13, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge and held the insurer's proof sufficient to raise a presumption that the EUO scheduling letters and the denial form were timely mailed.
Crystal Acupuncture, P.C. v Travelers Ins. (2019 NY Slip Op 52055(U)) Appellate Term, Second Department, December 13, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's proof sufficient to raise a presumption that its verification requests, EUO scheduling letters and denial forms were timely mailed.
Margulis v Travelers Ins. (2019 NY Slip Op 52051(U)) Appellate Term, Second Department, December 13, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely mailing of the initial and follow-up EUO letters and timely denial of the claims.
Blackman v Nationwide Ins. (2019 NY Slip Op 52038(U)) Appellate Term, Second Department, December 13, 2019The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer proved timely mailing of its verification requests, but the provider's affidavit raised a presumption that the verification was mailed and received, leaving a factual question.
Metro Pain Specialist, P.C. v Hertz Co. (2019 NY Slip Op 52047(U)) Appellate Term, Second Department, December 13, 2019The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or received (also decides)Held the provider owner's affidavit raised a presumption that the claim form was timely mailed and received, so against the insurer's non-receipt showing a triable issue existed on timely submission.
Charles Deng Acupuncture, P.C. v MVAIC (2019 NY Slip Op 52049(U)) Appellate Term, Second Department, December 13, 2019The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld that the provider owner's affidavit raised a presumption that the claim forms were mailed and received despite MVAIC's prima facie showing of non-receipt, so a framed-issue hearing on mailing and receipt was required.
Beacon Acupuncture, P.C. v Hertz Claim Mgt. (2019 NY Slip Op 52059(U)) Appellate Term, Second Department, December 13, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer proved timely mailing of the initial and follow-up EUO scheduling letters for the claims at issue.
Parisien v Nationwide Ins. (2019 NY Slip Op 51980(U)) Appellate Term, Second Department, December 6, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof sufficient to give rise to a presumption that the denial of claim forms were properly mailed, rejecting the provider's sole argument.
Omphil Care, Inc. v GEICO Ins. Co. (2019 NY Slip Op 51979(U)) Appellate Term, Second Department, December 6, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the record showed the insurer established timely and proper mailing of the EUO scheduling letters and the denial forms.
Pro-Align Chiropractic, P.C. v Integon Natl. Ins. Co. (2019 NY Slip Op 51967(U)) Appellate Term, Second Department, December 6, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's arguments and held the insurer's proof sufficiently established timely mailing of the IME scheduling letters and the denial forms.
Longevity Med. Supply, Inc. v Travelers Prop. & Cas. Ins. Co. (2019 NY Slip Op 51956(U)) Appellate Term, Second Department, November 29, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits established its standard office practices and procedures for mailing denial of claim forms and that the denials were properly and timely mailed, rejecting the provider's contrary contention.
Parisien v Nationwide Ins. (2019 NY Slip Op 51949(U)) Appellate Term, Second Department, November 29, 2019The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's papers failed to establish as a matter of law that the denial of claim form had been timely mailed.
Parisien v Travelers Ins. Co. (2019 NY Slip Op 51895(U)) Appellate Term, Second Department, November 22, 2019The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld that the insurer showed non-receipt but the provider owner's affidavit of a standard mailing practice raised an issue of fact on mailing, so receipt was triable and the finding that mailing was incontrovertible was vacated.
Ultra Ortho Prods., Inc. v GEICO Ins. Co. (2019 NY Slip Op 51844(U)) Appellate Term, Second Department, November 15, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected the provider's challenge to the implicit findings and held the insurer's proof sufficient to show timely mailing of the EUO scheduling letters and denial forms.
Allay Med. Servs., P.C. v Travelers Ins. Co. (2019 NY Slip Op 51806(U)) Appellate Term, Second Department, November 8, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's contentions and held the insurer established timely mailing of the EUO scheduling letters and the denial form.
Psychology YME, P.C. v Travelers Ins. (2019 NY Slip Op 51798(U)) Appellate Term, Second Department, November 1, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's proof sufficient to show it timely mailed the initial and follow-up verification requests, supporting its 120-day nonresponse denial.
Acupuncture Now, P.C. v Global Liberty Ins. (2019 NY Slip Op 51796(U)) Appellate Term, Second Department, November 1, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's proof sufficient to give rise to a presumption that its fee schedule denials were timely mailed.
Easy Care Acupuncture, P.C. v Ameriprise Ins. Co. (2019 NY Slip Op 51794(U)) Appellate Term, Second Department, November 1, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer established that the EUO scheduling letters had been timely mailed, rejecting the provider's challenge.
SAS Med., P.C. v Travelers Ins. Co. (2019 NY Slip Op 51759(U)) Appellate Term, Second Department, October 25, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer demonstrated timely mailing of its initial and follow-up verification requests.
Valdan Acupuncture, P.C. v Global Liberty Ins. Co. of NY (2019 NY Slip Op 51705(U)) Appellate Term, Second Department, October 18, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that its initial and follow-up IME scheduling letters were timely mailed and that the claim was timely denied.
Atlas Orthosurgery, P.C. v American Tr. Ins. Co. (2019 NY Slip Op 51697(U)) Appellate Term, Second Department, October 18, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof sufficed to establish proper mailing of the IME scheduling letters, the provider's sole contention.
Body Acupuncture Care, P.C. v Erie Ins. Co. of N.Y. (2019 NY Slip Op 51695(U)) Appellate Term, Second Department, October 18, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that the IME scheduling letters were timely mailed to the address on the assignor's sworn application and that the claims were timely denied.
Charles Deng Acupuncture, P.C. v Allstate Ins. Co. (2019 NY Slip Op 51693(U)) Appellate Term, Second Department, October 18, 2019The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's papers failed to establish timely mailing of its denial of claim forms, so it did not show it was not precluded and its summary judgment motion was denied.
New Horizon Surgical Ctr., LLC v Travelers Ins. Co. (2019 NY Slip Op 51690(U)) Appellate Term, Second Department, October 18, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's proof sufficient to raise a presumption that its initial and follow-up verification requests were properly mailed.
Tyorkin v Global Liberty Ins. (2019 NY Slip Op 51689(U)) Appellate Term, Second Department, October 18, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held an affidavit from a supervisor of the insurer's IME scheduling vendor sufficiently established timely mailing of the IME scheduling letters, and the denials were shown timely.
Lidas Med. Supply, Inc. v Global Liberty Ins. (2019 NY Slip Op 51688(U)) Appellate Term, Second Department, October 18, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the IME scheduling letters went to a proper address because, though lacking an apartment number, it matched the address the assignor gave on the sworn NF-2 and notice of intention.
Gentlecare Ambulatory Anesthesia Servs. v GEICO Ins. Co. (2019 NY Slip Op 51684(U)) Appellate Term, Second Department, October 18, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge and held the insurer's proof sufficient to raise a presumption that the denial of claim form was timely mailed.
Acupuncture Approach, P.C. v Global Liberty Ins. Co. of NY (2019 NY Slip Op 51631(U)) Appellate Term, Second Department, October 11, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld at trial that an employee's testimony on the insurer's mailing policies and procedures established timely and proper mailing of the initial and follow-up EUO letters, contrary to the trial court's finding.
Allay Med. Servs., P.C. v Metropolitan Gen. Ins. Co. (2019 NY Slip Op 51617(U)) Appellate Term, Second Department, October 11, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely mailing of initial and follow-up EUO scheduling letters and timely denial of the claims.
Sunrise Acupuncture, P.C. v Hertz Claim Mgt. Corp. (2019 NY Slip Op 51357(U)) Appellate Term, Second Department, August 16, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims adjuster's affidavit established timely mailing of denials of claims submitted more than 45 days after the services.
Ocean One Physical Therapy, P.C. v 21st Century Centennial Ins. Co. (2019 NY Slip Op 51272(U)) Appellate Term, Second Department, August 2, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Accepted copies of EUO scheduling letters mailed by the insurer's law firm as sufficient where the provider raised no issue with them.
BQE Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2019 NY Slip Op 51260(U)) Appellate Term, Second Department, August 2, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's proof sufficient to give rise to a presumption that its fee schedule denials were timely mailed.
Compas Med., P.C. v American Tr. Ins. Co. (2019 NY Slip Op 51257(U)) Appellate Term, Second Department, August 2, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer established timely mailing of the EUO scheduling letters, rejecting the address challenge because they went to the address the provider gave on its bills.
Acupuncture Now, P.C. v Travelers Ins. Co. (2019 NY Slip Op 51255(U)) Appellate Term, Second Department, August 2, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that proper EUO scheduling letters were timely mailed and that the claim was timely denied, supporting dismissal of one cause of action.
Natural Therapy Acupuncture, P.C. v GEICO Ins. Co. (2019 NY Slip Op 51254(U)) Appellate Term, Second Department, August 2, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer demonstrated that it had timely denied the claims, a finding of timely mailing, while the result turned on its proper use of the fee schedule for the pre-April 2013 services.
Active Care Med. Supply Corp. v Erie Ins. Co. of N.Y. (2019 NY Slip Op 51185(U)) Appellate Term, Second Department, July 19, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that its denial of claim forms based on lack of medical necessity had been timely mailed.
Brand Med. Supply, Inc. v Repwest Ins. Co. (2019 NY Slip Op 51183(U)) Appellate Term, Second Department, July 19, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld IME letters lacking an apartment number properly addressed because the address matched the one on the provider's bill and the assignor's NF-2.
Mollo v 21st Century Ins. Co. (2019 NY Slip Op 51182(U)) Appellate Term, Second Department, July 19, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the EUO scheduling letters were timely mailed by the insurer's law firm, unchallenged, and the insurer's affidavits sufficiently established timely mailing of the denials.
Blackman v Hereford Ins. Co. (2019 NY Slip Op 51166(U)) Appellate Term, Second Department, July 12, 2019The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the provider's affidavit sufficient to raise a presumption that the requested verification was mailed to and received by the insurer, creating a triable issue whether it was provided.
Quality Custom Med. Supply, Inc. v American Country Ins. Co. (2019 NY Slip Op 51165(U)) Appellate Term, Second Department, July 12, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge and held the insurer's proof sufficient to give rise to a presumption that its denial of claim form had been properly mailed.
Parisien v Travelers Ins. Co. (2019 NY Slip Op 51162(U)) Appellate Term, Second Department, July 12, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer showed it timely mailed initial and follow-up verification requests, supporting dismissal of the related claims as premature.
Gentlecare Ambulatory Anesthesia Servs. v GEICO Ins. Co. (2019 NY Slip Op 51161(U)) Appellate Term, Second Department, July 12, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge and held the insurer's proof sufficient to raise a presumption that the denial of claim form was timely mailed.
Parisien v Allstate Ins. Co. (2019 NY Slip Op 51154(U)) Appellate Term, Second Department, July 12, 2019The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's papers failed to establish timely mailing of its denial of claim forms, so it did not show it was not precluded and its cross motion for summary judgment was denied.
Apple Massage Therapy, P.C. v 21st Century Ins. Co. (2019 NY Slip Op 51153(U)) Appellate Term, Second Department, July 12, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge and held the insurer's proof sufficient to raise a presumption that its denial of claim forms had been properly mailed.
Veraso Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2019 NY Slip Op 51149(U)) Appellate Term, Second Department, July 12, 2019The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the provider's opposing affidavit sufficient to give rise to a presumption that the requested verification was mailed to and received by the insurer, so summary judgment on the verification defense was denied for a triable issue.
Central Park Physical Medicine & Rehab., P.C. v IDS Prop. & Cas. Ins. Co. (2019 NY Slip Op 51148(U)) Appellate Term, Second Department, July 11, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the EUO letters proved mailed by first-class mail, so any failure to prove certified mailing of the follow-up letter did not matter; the denials were also proved timely mailed.
Golden Star Acupuncture, P.C. v Erie Ins. Co. of NY (2019 NY Slip Op 50920(U)) Appellate Term, Second Department, June 7, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's proof sufficient to establish proper mailing of the EUO scheduling letters, reversing the lower court on that point, though the insurer's motion failed on proof of nonappearance.
Valdan Acupuncture, P.C. v 21st Century Advantage Ins. Co. (2019 NY Slip Op 50822(U)) Appellate Term, Second Department, May 24, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the IME letters were properly mailed to the address on the sworn NF-2 and police report, the only address known then, with reply evidence answering the new opposition argument.
Gentlecare Ambulatory Anesthesia Servs. v GEICO Ins. Co. (2019 NY Slip Op 50759(U)) Appellate Term, Second Department, May 10, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge and held the insurer's proof raised a presumption that the EUO scheduling letters and the denial form were timely mailed.
Solution Bridge, Inc. v State Farm Mut. Auto. Ins. Co. (2019 NY Slip Op 50749(U)) Appellate Term, Second Department, May 10, 2019The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the provider's affidavit sufficient to raise a presumption that the requested verification was mailed to and received by the insurer, creating a triable issue whether it was provided.
Metro Psychological Servs., P.C. v Allstate Ins. Co. (2019 NY Slip Op 50748(U)) Appellate Term, Second Department, May 10, 2019The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's papers failed to establish timely mailing of its denial of claim forms, so it did not show it was not precluded and its summary judgment motion was denied.
BQE Acupuncture, P.C. v GEICO Ins. Co. (2019 NY Slip Op 50743(U)) Appellate Term, Second Department, May 10, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected the provider's contention and held the insurer's proof sufficient to raise a presumption that the denial of claim forms had been timely mailed.
Active Care Med. Supply Corp. v American Tr. Ins. Co. (2019 NY Slip Op 50742(U)) Appellate Term, Second Department, May 10, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer established that the EUO scheduling letters had been timely mailed, rejecting the provider's contentions.
Chapa Prods. Corp. v 21st Century Ins. Co. (2019 NY Slip Op 50741(U)) Appellate Term, Second Department, May 10, 2019The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer proved timely mailing of its verification requests and denials, but the provider's proof raised a presumption that its claim form and verification were timely mailed, so neither side won summary judgment.
Solution Bridge, Inc. v State Farm Mut. Auto. Ins. Co. (2019 NY Slip Op 50739(U)) Appellate Term, Second Department, May 10, 2019The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the provider's affidavit sufficient to raise a presumption that the requested verification was mailed to and received by the insurer, creating a triable issue whether it was provided.
T & S Med. Supply Corp. v MVAIC (2019 NY Slip Op 50737(U)) Appellate Term, Second Department, May 10, 2019The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the provider's opposing affidavit sufficient to raise a presumption that the requested verification was mailed to and received by the insurer, which defeated summary judgment on the second cause of action.
Veraso Med. Supply Corp. v NY City Tr. Auth. (2019 NY Slip Op 50754(U)) Appellate Term, Second Department, May 10, 2019The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the provider owner's affidavit raised a presumption that the claim form was timely mailed and received, which against the insurer's non-receipt affidavit created a triable issue on submission.
Pavlova v Hartford Ins. Co. (2019 NY Slip Op 50693(U)) Appellate Term, Second Department, May 3, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's proof sufficient to raise a presumption that the denial of claim form was properly mailed.
Solution Bridge, Inc. v Nationwide Ins. (2019 NY Slip Op 50689(U)) Appellate Term, Second Department, May 3, 2019The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the provider's affidavit sufficient to raise a presumption that the requested verification was mailed to and received by the insurer, creating a triable issue whether it was provided.
Preferred Ortho Prods., Inc. v Hereford Ins. Co. (2019 NY Slip Op 50688(U)) Appellate Term, Second Department, May 3, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's arguments and held the insurer's proof sufficiently established proper mailing of the IME scheduling letters.
K.O. Med., P.C. v IDS Prop. Cas. Ins. Co. (2019 NY Slip Op 50687(U)) Appellate Term, Second Department, May 3, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's arguments and held the insurer established timely mailing of its initial and follow-up EUO scheduling letters and denial of claim forms for the remaining claims.
BCc Chiropractic, P.C. v Farmers New Century Ins. Co. (2019 NY Slip Op 50680(U)) Appellate Term, Second Department, May 3, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's proof established timely mailing of the initial and follow-up EUO scheduling letters and of the denial of claim based on the nonappearance.
Alleviation Med. Servs., P.C. v New York Cent. Mut. Fire Ins. Co. (2019 NY Slip Op 50679(U)) Appellate Term, Second Department, May 3, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld, contrary to the provider's arguments, that the insurer's proof sufficiently established the proper mailing of the IME scheduling letters.
Veraso Med. Supply Corp. v Victoria Fire & Cas. Co. (2019 NY Slip Op 50690(U)) Appellate Term, Second Department, May 3, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's only argument, which attacked the insurer's practices and procedures for mailing the denial, as lacking merit.
Serge Chiropractic Servs., P.C. v Farmington Cas. Co. (2019 NY Slip Op 50698(U)) Appellate Term, Second Department, May 3, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof sufficiently established proper mailing of the IME scheduling letters, rejecting the provider's challenge.
Success Rehab P.T., P.C. v NY Cent. Mut. Fire Ins. Co. (2019 NY Slip Op 50572(U)) Appellate Term, Second Department, April 12, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge and held the insurer's proof sufficient to raise a presumption that its medical-necessity denials were timely mailed.
First Class Med., P.C. v Ameriprise Ins. Co. (2019 NY Slip Op 50477(U)) Appellate Term, Second Department, March 28, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established proper mailing of the EUO scheduling letters and timely mailing of its denial of claim forms.
Vital Chiropractic, P.C. v Nationwide Ins. Co. (2019 NY Slip Op 50425(U)) Appellate Term, Second Department, March 22, 2019Different mailing results for different documents or claims in one decisionHeld the insurer proved mailing of the IME scheduling letters and timely mailing of its denials, except for one claim, as to which a triable issue existed whether the insurer ever received it.
Actual Chiropractic, P.C. v State Farm Ins. (2019 NY Slip Op 50421(U)) Appellate Term, Second Department, March 22, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely mailing of the initial and follow-up EUO scheduling letters and of its timely denials.
New Horizon Surgical Ctr., L.L.C. v Travelers Ins. (2019 NY Slip Op 50281(U)) Appellate Term, Second Department, March 8, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely mailing of its initial and follow-up verification requests.
Parisien v 21st Century Ins. Co. (2019 NY Slip Op 50275(U)) Appellate Term, Second Department, March 8, 2019The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the provider made a prima facie showing that the claim was mailed under its standard mailing practice, but the insurer's showing of non-receipt raised a triable issue whether it was timely mailed.
Neptune Med. Care, P.C. v Praetorian Ins. Co. (2019 NY Slip Op 51052(U)) Appellate Term, Second Department, March 1, 2019The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to establish that its initial and follow-up EUO and IME scheduling letters were timely mailed.
Mag Med., P.C. v Kemper Ins. Co. (2019 NY Slip Op 51051(U)) Appellate Term, Second Department, March 1, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's evidence established that it timely mailed the denial of claim forms denying the claims for lack of medical necessity.
Oleg's Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2019 NY Slip Op 51045(U)) Appellate Term, Second Department, March 1, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Upheld, against the provider's challenge, the CPLR 3212 (g) findings that the EUO scheduling letters and denial forms were timely and properly mailed.
Bronx Chiropractic Care, P.C. v State Farm Ins. (2019 NY Slip Op 51041(U)) Appellate Term, Second Department, March 1, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeUpheld the findings that the EUO letters and denials were timely and properly mailed; the office where the letters were generated raised no triable issue.
Island Life Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2019 NY Slip Op 51038(U)) Appellate Term, Second Department, March 1, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits established timely mailing of the EUO scheduling letters and the denial form under its standard office practices.
Healthy Way Acupuncture, P.C. v Country-Wide Ins. Co. (2019 NY Slip Op 50094(U)) Appellate Term, Second Department, January 18, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's trial proof sufficiently demonstrated that it timely mailed the IME scheduling letters and the denials for three claims.
Lenox Hill Radiology & MIA, P.C. v Global Liberty Ins. Co. of N.Y. (2018 NY Slip Op 51810(U)) Appellate Term, Second Department, December 6, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld, contrary to the lower court, that the insurer established timely mailing of its initial and follow-up verification requests.
Solution Bridge, Inc. v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51784(U)) Appellate Term, Second Department, November 30, 2018The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the provider's proof raised presumptions that it timely mailed the first claim and its verification response, and the insurer proved mailing of its requests, leaving triable issues on submission and receipt.
Pavlova v Travelers Ins. Co. (2018 NY Slip Op 51778(U)) Appellate Term, Second Department, November 30, 2018The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer proved timely mailing of its verification requests, but the provider's affidavit raised a presumption that the verification was mailed and received, creating a triable issue.
Gentlecare Ambulatory Anesthesia Servs.; Lyonel F. Paul, M.D. v GEICO Ins. Co. (2018 NY Slip Op 51773(U)) Appellate Term, Second Department, November 30, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld, contrary to the provider's contentions, that the insurer's proof sufficed to give rise to a presumption that the denial of claim form was timely mailed.
Village Med. Supply, Inc. v Citiwide Auto Leasing Ins. Co. (2018 NY Slip Op 51772(U)) Appellate Term, Second Department, November 30, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof sufficed to establish proper mailing of the IME scheduling letters.
Parisien v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51770(U)) Appellate Term, Second Department, November 30, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer established that its denial of claim form, based on the EUO no-show, had been timely mailed, the provider's sole contention.
First Am. Alliance, Inc. v Ameriprise Ins. Co. (2018 NY Slip Op 51765(U)) Appellate Term, Second Department, November 30, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that its denial of the $630 bill on medical-necessity grounds was timely mailed.
Maiga Prods. Corp. v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51763(U)) Appellate Term, Second Department, November 30, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the challenge to the timely mailing of the first EUO scheduling letter, holding the mailing affiant need not show knowledge of the insurer's procedures for receiving claim forms.
Oriental Health Acupuncture, P.C. v 21st Century Ins. Co. (2018 NY Slip Op 51761(U)) Appellate Term, Second Department, November 30, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the EUO scheduling letters mailed by the insurer's retained law firm supported the defense because the provider raised no issue as to their sufficiency, even though other letters were delay letters that did not toll.
Metro Psychological Servs., P.C. v ELRAC, Inc. (2018 NY Slip Op 51760(U)) Appellate Term, Second Department, November 30, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's arguments and held the insurer's proof sufficient to demonstrate proper mailing of the denial of claim form.
Karina K. Acupuncture, P.C. v Hertz Claim Mgt. Corp. (2018 NY Slip Op 51762(U)) Appellate Term, Second Department, November 30, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits established timely mailing of its denials of claims submitted more than 45 days after the services.
Active Care Med. Supply Corp. v American Tr. Ins. Co. (2018 NY Slip Op 51683(U)) Appellate Term, Second Department, November 23, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer established that the EUO scheduling letters had been timely mailed, rejecting the provider's challenge to that proof.
Maiga Prods. Corp. v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51681(U)) Appellate Term, Second Department, November 23, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the challenge to the timely mailing of the first EUO scheduling letter, holding the mailing affiant need not show knowledge of the insurer's procedures for receiving claim forms.
Parisien v NY City Tr. Auth. (2018 NY Slip Op 51699(U)) Appellate Term, Second Department, November 23, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's preserved argument and held the insurer's proof sufficient to establish timely mailing of the denials based on late notice of the accident.
Restoration Chiropractic, P.C. v 21st Century Ins. Co. (2018 NY Slip Op 51656(U)) Appellate Term, Second Department, November 16, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof sufficient to establish the proper mailing of the EUO scheduling letters.
Gentlecare Ambulatory Anesthesia Services; Lyonel F. Paul, M.D. v GEICO Ins. Co. (2018 NY Slip Op 51653(U)) Appellate Term, Second Department, November 16, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof sufficed to give rise to a presumption that the EUO scheduling letters and the denial of claim form were timely mailed.
Parisien v 21st Century Ins. Co. (2018 NY Slip Op 51652(U)) Appellate Term, Second Department, November 16, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer established that its medical-necessity denial of claim forms had been timely mailed, rejecting the provider's appellate argument.
PR Med., P.C. v Travelers Home & Mar. Ins. Co. (2018 NY Slip Op 51649(U)) Appellate Term, Second Department, November 16, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely mailing of the EUO scheduling letters and timely denial of the claims.
Solution Bridge, Inc. v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51648(U)) Appellate Term, Second Department, November 16, 2018The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer proved timely mailing of its verification requests, but the provider's affidavit raised a presumption that the verification was mailed and received, creating a triable issue.
Maiga Prods. Corp. v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51646(U)) Appellate Term, Second Department, November 16, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely mailing of the EUO scheduling letters and timely denial of the claims.
Acupuncture Now, P.C. v GEICO Ins. Co. (2018 NY Slip Op 51643(U)) Appellate Term, Second Department, November 16, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's proof sufficient to raise a presumption that the denial of claim forms had been timely mailed.
Right Aid Med. Supply Corp. v Hereford Ins. Co. (2018 NY Slip Op 51641(U)) Appellate Term, Second Department, November 16, 2018The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the provider's affidavit sufficient to raise a presumption that the requested verification was mailed to and received by the insurer despite the insurer's showing of nonreceipt, creating a triable issue.
SAMA Physical Therapy, P.C. v Tri State Consumers Ins. Co. (2018 NY Slip Op 51635(U)) Appellate Term, Second Department, November 16, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof sufficiently established the proper mailing of the IME scheduling letters.
Jamaica Wellness Med., P.C. v ELRAC, Inc. (2018 NY Slip Op 51637(U)) Appellate Term, Second Department, November 16, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge and held the insurer's moving papers proved timely mailing of both the EUO scheduling letters and the denial of claim forms.
New York Infinity Health Care, LCSW, P.C. v Farmington Cas. Co. (2018 NY Slip Op 51640(U)) Appellate Term, Second Department, November 16, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's contention and held the insurer's proof sufficient to establish proper mailing of the fee schedule denials.
Gentlecare Ambulatory Anesthesia Servs. v Allstate Ins. Co. (2018 NY Slip Op 51607(U)) Appellate Term, Second Department, November 9, 2018The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits did not sufficiently set forth a standard office practice or procedure ensuring the denial of claim form was timely mailed.
Blackman v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51606(U)) Appellate Term, Second Department, November 9, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof sufficient to establish proper mailing of the EUO scheduling letters.
Acupuncture Approach, P.C. v NY Cent. Mut. Fire Ins. Co. (2018 NY Slip Op 51601(U)) Appellate Term, Second Department, November 9, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the IME scheduling letters were properly addressed because the insurer showed copies were mailed to the attorney representing the assignor on the accident.
T & S Med. Supply Corp. v Travelers Ins. Co. (2018 NY Slip Op 51597(U)) Appellate Term, Second Department, November 9, 2018The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer established timely mailing of its verification requests, but the provider owner's affidavit raised a presumption that the verification was mailed and received, creating a triable issue.
Acupuncture Now, P.C. v Tri State Consumers Ins. Co. (2018 NY Slip Op 51596(U)) Appellate Term, Second Department, November 9, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof sufficiently established the proper mailing of the IME scheduling letters.
Gentlecare Ambulatory Anesthesia Servs. v GEICO Ins. Co. (2018 NY Slip Op 51588(U)) Appellate Term, Second Department, November 9, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected the provider's contention and held the insurer's proof sufficient to raise a presumption that its denial was timely mailed.
Active Care Med. Supply Corp. v American Tr. Ins. Co. (2018 NY Slip Op 51584(U)) Appellate Term, Second Department, November 9, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge and held the insurer's proof sufficiently established proper mailing of the EUO scheduling letters, so its time to pay or deny was tolled.
Essential Acupuncture Servs., P.C. v GEICO Indem. Co. (2018 NY Slip Op 51600(U)) Appellate Term, Second Department, November 9, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's proof sufficed to give rise to a presumption that its denials had been timely mailed.
Pavlova v Travelers Ins. Co. (2018 NY Slip Op 51555(U)) Appellate Term, Second Department, November 2, 2018The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer properly mailed its verification requests, but the provider's affidavit raised a presumption that the verification was mailed and received, creating a triable issue.
Island Life Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51551(U)) Appellate Term, Second Department, November 2, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely mailing of the EUO scheduling letters and of its denial of the claims.
Dynasty Med. Care, P.C. v 21st Century Sec. Ins. Co. (2018 NY Slip Op 51550(U)) Appellate Term, Second Department, November 2, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it timely mailed its denials based on late written notice of the accident.
Maiga Prods. Corp. v Hertz Co. (2018 NY Slip Op 51448(U)) Appellate Term, Second Department, October 12, 2018The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer failed to demonstrate it timely denied the claims, so it did not show it was not precluded from its EUO no-show defense.
Neptune Med. Care, P.C. v Allstate Ins. Co. (2018 NY Slip Op 51150(U)) Appellate Term, Second Department, July 20, 2018The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's moving papers failed to establish timely mailing of its denial of claim forms, so it was not entitled to summary judgment on its IME no-show defense.
Parkway Med. Care, P.C. v GEICO Gen. Ins. Co. (2018 NY Slip Op 51005(U)) Appellate Term, Second Department, June 22, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that its medical-necessity denial was timely mailed.
Gentlecare Ambulatory Anesthesia Servs. v GEICO Ins. Co. (2018 NY Slip Op 50864(U)) Appellate Term, Second Department, June 8, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof sufficient to raise a presumption that the EUO scheduling letters and the denial of claim form were timely mailed, rejecting the provider's challenge.
Comprehensive Care Physical Therapy, P.C. v Allstate Ins. Co. (2018 NY Slip Op 50848(U)) Appellate Term, Second Department, June 1, 2018The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits did not sufficiently describe a standard office practice or procedure ensuring the denial of claim forms were timely mailed.
Pavlova v Travelers Ins. Co. (2018 NY Slip Op 50847(U)) Appellate Term, Second Department, June 1, 2018The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer properly mailed its verification requests, but the provider's affidavit raised a presumption that the verification was mailed and received, creating a triable issue.
Maiga Prods. Corp. v 21st Century Ins. Co. (2018 NY Slip Op 50845(U)) Appellate Term, Second Department, June 1, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof sufficient to raise a presumption that the EUO scheduling letters and the denial of claim forms were properly mailed, rejecting the provider's contentions.
Gl Acupuncture, P.C. v Allstate Ins. Co. (2018 NY Slip Op 50842(U)) Appellate Term, Second Department, June 1, 2018The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits did not set forth a standard office practice ensuring timely mailing of the denials, so it did not show it was not precluded from its fee schedule defense.
Gl Acupuncture, P.C. v Allstate Ins. Co. (2018 NY Slip Op 50841(U)) Appellate Term, Second Department, June 1, 2018The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits did not sufficiently describe a standard office practice ensuring timely mailing of the denial, so it did not show it was not precluded and its fee schedule defense failed on summary judgment.
Gentlecare Ambulatory Anesthesia Servs. v GEICO Ins. Co. (2018 NY Slip Op 50837(U)) Appellate Term, Second Department, June 1, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof sufficient to raise a presumption that the EUO scheduling letters and the denial of claim form were properly mailed, rejecting the provider's contention.
Acupuncture Healthcare Plaza I, P.C. v Allstate Ins. Co. (2018 NY Slip Op 50835(U)) Appellate Term, Second Department, June 1, 2018The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits did not sufficiently set forth a standard office practice or procedure that would ensure the denial of claim forms had been timely mailed.
Gl Acupuncture, P.C. v Allstate Ins. Co. (2018 NY Slip Op 50830(U)) Appellate Term, Second Department, June 1, 2018The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits did not set forth a standard office practice ensuring timely mailing of the denials, so it did not show it was not precluded from its fee schedule defense.
Gl Acupuncture, P.C. v Allstate Ins. Co. (2018 NY Slip Op 50829(U)) Appellate Term, Second Department, June 1, 2018The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits did not set forth a standard office practice ensuring timely mailing of the denial, so it did not show it was not precluded from its fee schedule defense.
Compas v Travelers Ins. Co. (2018 NY Slip Op 50821(U)) Appellate Term, Second Department, June 1, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits established that the denial of claim forms were timely mailed.
Active Care Med. Supply Corp. v American Tr. Ins. Co. (2018 NY Slip Op 50820(U)) Appellate Term, Second Department, June 1, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer established that the EUO scheduling letters had been timely mailed, rejecting the provider's contentions.
Pavlova v ELRAC, Inc. (2018 NY Slip Op 50823(U)) Appellate Term, Second Department, June 1, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's sole appellate contention and held the insurer established timely mailing of its denial based on EUO nonappearance.
Active Care Med. Supply Corp. v ELRAC, Inc. (2018 NY Slip Op 50826(U)) Appellate Term, Second Department, June 1, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's preserved contention and held the insurer established timely mailing of its denial based on EUO nonappearance.
S & R Med., P.C. v ELRAC, Inc. (2018 NY Slip Op 50834(U)) Appellate Term, Second Department, June 1, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the providers' contentions and held the insurer's proof sufficiently established proper mailing of the IME scheduling letters.
FEMA Med. Supply, Inc. v Country-Wide Ins. Co. (2018 NY Slip Op 50782(U)) Appellate Term, Second Department, May 25, 2018The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the provider's proof did not establish as a matter of law that it mailed its bills to the insurer, so its summary judgment motion failed.
Irina Acupuncture, P.C. v Auto One Ins. Co. (2018 NY Slip Op 50781(U)) Appellate Term, Second Department, May 25, 2018The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld that the insurer's proof it received the claim forms long after their claimed mailing raised a triable issue whether the provider's mailing practice resulted in timely mailing, defeating the provider's summary judgment.
Pierre J. Renelique, M.D., P.C. v Park Ins. Co. (2018 NY Slip Op 50780(U)) Appellate Term, Second Department, May 25, 2018The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld no presumption of receipt arose because the IME letters went to an address different from the assignor's address on the NF-3, and copies to an attorney not shown to represent the assignor did not suffice.
Mind & Body Acupuncture, P.C. v Allstate Ins. Co. (2018 NY Slip Op 50779(U)) Appellate Term, Second Department, May 25, 2018The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits did not set forth a standard office practice ensuring timely mailing of the denials, so it did not show it was not precluded from its fee schedule defense.
Big Apple Ortho Prods., Inc. v Allstate Ins. Co. (2018 NY Slip Op 50775(U)) Appellate Term, Second Department, May 25, 2018The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits did not sufficiently set forth a standard office practice ensuring timely mailing of the denials, so it did not show its EUO no-show defense was not precluded.
Compas Med., P.C. v 21st Century Ins. Co. (2018 NY Slip Op 50773(U)) Appellate Term, Second Department, May 25, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected the provider's contention and held the insurer's proof sufficient to raise a presumption that the denial of claim forms had been properly mailed.
Gentlecare Ambulatory Anesthesia Servs. v American Tr. Ins. Co. (2018 NY Slip Op 50770(U)) Appellate Term, Second Department, May 25, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer established that the EUO and IME scheduling letters had been timely mailed.
Remedial Med. Care, P.C. v Park Ins. Co. (2018 NY Slip Op 50769(U)) Appellate Term, Second Department, May 25, 2018The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to establish timely mailing of the initial and follow-up IME scheduling letters, so the no-show defense could not support summary judgment on the remaining bills.
Active Care Med. Supply Corp. v American Tr. Ins. Co. (2018 NY Slip Op 50767(U)) Appellate Term, Second Department, May 25, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof sufficiently established proper mailing of the EUO scheduling letters.
Parisien v Maya Assur. Co. (2018 NY Slip Op 50766(U)) Appellate Term, Second Department, May 25, 2018The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit did not set forth a standard office practice or procedure ensuring the IME scheduling letters were properly addressed and mailed.
Valdan Acupuncture, P.C. v NY Cent. Mut. Fire Ins. Co. (2018 NY Slip Op 50739(U)) Appellate Term, Second Department, May 18, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof sufficiently established that it properly mailed the IME scheduling letters to the assignor, the issue the lower court had left for trial.
Maiga Prods. Corp. v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 50736(U)) Appellate Term, Second Department, May 18, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeUpheld the finding that the insurer established timely and proper mailing of the EUO scheduling letters and denial forms, and held its interoffice transmittal of the claims raised no triable issue.
Preferred Ortho Prods., Inc. v Titan Ins. Co. (2018 NY Slip Op 50732(U)) Appellate Term, Second Department, May 18, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge to the insurer's practices and procedures for mailing the denial, leaving intact summary judgment for the insurer on its EUO nonappearance defense.
Goldstar Equip., Inc. v Mercury Cas. Co. (2018 NY Slip Op 50576(U)) Appellate Term, Second Department, April 13, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's assertion and held the insurer established that the EUO scheduling letters and the denial of claim forms were timely mailed.
Active Care Med. Supply Corp. v Amica Mut. Ins. Co. (2018 NY Slip Op 50500(U)) Appellate Term, Second Department, April 6, 2018The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the employee's affidavit of personal mailing created a presumption of receipt, which the insurer rebutted with a claims representative's description of its mail-receiving procedures and statement of non-receipt, raising a triable issue.
Laga v Allstate Ins. Co. (2018 NY Slip Op 50416(U)) Appellate Term, Second Department, March 23, 2018The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's moving papers failed to establish as a matter of law that the denials were timely mailed, so it did not show its defenses were not precluded.
Arnica Acupuncture, P.C. v Allstate Ins. Co. (2018 NY Slip Op 50415(U)) Appellate Term, Second Department, March 23, 2018The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's moving papers failed to establish timely mailing of its denial of claim forms, so it did not show it was not precluded from asserting its defenses and lost summary judgment.
Motionpro Physical Therapy v Hereford Ins. Co. (2018 NY Slip Op 50251(U)) Appellate Term, Second Department, February 16, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established mailing of the IME scheduling letters to the assignor.
Choice Health Chiropractic, P.C. v American Tr. Ins. Co. (2018 NY Slip Op 50185(U)) Appellate Term, Second Department, February 8, 2018Different mailing results for different documents or claims in one decisionFound the IME letters and denials proved mailed, but held the provider's affidavit raised an issue of fact on the mailing of the verification requests, which decided one claim.
Acupuncture Healthcare Plaza I, P.C. v Allstate Ins. Co. (2017 NY Slip Op 51903(U)) Appellate Term, Second Department, December 22, 2017The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits did not sufficiently describe a standard office practice ensuring timely mailing of the denial, so preclusion of its fee schedule defense was not overcome and dismissal was denied.
Active Care Med. Supply Corp v American Tr. Ins. Co. (2017 NY Slip Op 51902(U)) Appellate Term, Second Department, December 22, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof sufficiently established proper mailing of the EUO scheduling letters, rejecting one of the provider's only appellate arguments.
Greenway Med. Supply Corp. v American Tr. Ins. Co. (2017 NY Slip Op 51901(U)) Appellate Term, Second Department, December 22, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof sufficiently established proper mailing of the EUO scheduling letters, rejecting the provider's arguments.
Masigla v Country Wide Ins. Co. (2017 NY Slip Op 51888(U)) Appellate Term, Second Department, December 22, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof sufficient to raise a presumption that the denials were properly mailed, rejecting the provider's challenge and leaving dismissal on late notice of the accident intact.
Renelique v Allstate Ins. Co. (2017 NY Slip Op 51884(U)) Appellate Term, Second Department, December 22, 2017The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits did not sufficiently describe a standard office practice ensuring timely mailing of the denial, so it did not show it was not precluded from its fee schedule defense.
V.S. Care Acupuncture, P.C. v NY Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 51881(U)) Appellate Term, Second Department, December 22, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's motion papers established proper mailing of the denial of claim forms.
Moon Rehab, P.T., P.C. v Ameriprise Ins. Co. (2017 NY Slip Op 51877(U)) Appellate Term, Second Department, December 22, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof sufficient to raise a presumption that the EUO scheduling letters and the denial of claims form were timely mailed, rejecting the provider's contentions.
Bronx Acupuncture Therapy, P.C. v A. Cent. Ins. Co. (2017 NY Slip Op 51870(U)) Appellate Term, Second Department, December 22, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the affidavit of the IME scheduling vendor's operations manager sufficiently established that the IME scheduling letters were timely mailed.
Village Med. Supply, Inc. v Citiwide Auto Leasing Ins. Co. (2017 NY Slip Op 51869(U)) Appellate Term, Second Department, December 22, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that the denial of claim forms on the no-show ground were timely mailed.
Oleg's Acupuncture, P.C. v GEICO Gen. Ins. Co. (2017 NY Slip Op 51863(U)) Appellate Term, Second Department, December 22, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's proof sufficient to raise a presumption that the denial of claim forms had been timely mailed.
Careful Complete Med., P.C. v Hartford Ins. Co. (2017 NY Slip Op 51858(U)) Appellate Term, Second Department, December 22, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's proof sufficient to raise a presumption that the EUO scheduling letters and the denial of claim forms were properly mailed.
Right Aid Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51857(U)) Appellate Term, Second Department, December 22, 2017The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer established timely mailing of its verification requests, but the provider employee's affidavit raised a presumption that the verification was mailed and received, creating a triable issue.
MT Servs. P.T., P.C. v Country-Wide Ins. Co. (2017 NY Slip Op 51851(U)) Appellate Term, Second Department, December 22, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge and held the insurer's proof established that it timely mailed its initial and follow-up verification requests.
Active Chiropractic, P.C. v Country-Wide Ins. Co. (2017 NY Slip Op 51850(U)) Appellate Term, Second Department, December 22, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge and held the insurer established that, after receiving the claim, it timely mailed initial and follow-up verification requests.
Masigla v National Liab. & Fire Ins. Co. (2017 NY Slip Op 51847(U)) Appellate Term, Second Department, December 22, 2017The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit did not sufficiently describe a standard office practice ensuring the IME scheduling letters were properly mailed, so no presumption of mailing arose.
Masigla v ELRAC, Inc. (2017 NY Slip Op 51868(U)) Appellate Term, Second Department, December 22, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's sole appellate contention, holding the insurer's proof sufficient to give rise to a presumption that the denial of claim forms had been timely mailed.
Eastcoast Metro. Med., P.C. v ELRAC, Inc. (2017 NY Slip Op 51872(U)) Appellate Term, Second Department, December 22, 2017The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to establish as a matter of law that the EUO scheduling letters were sent to the assignor's correct address.
W.H.O. Acupuncture, P.C. v GEICO Indem. Co. (2017 NY Slip Op 51900(U)) Appellate Term, Second Department, December 22, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely mailing of its denial of claim forms based on lack of medical necessity, a predicate to reaching the merits of the medical-necessity defense.
Island Life Chiropractic, P.C. v National Liab. & Fire Ins. Co. (2017 NY Slip Op 51843(U)) Appellate Term, Second Department, December 19, 2017The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's papers failed to establish that the IME scheduling letters had been properly mailed.
Compas Med., P.C. v Allstate Ins. Co. (2017 NY Slip Op 51842(U)) Appellate Term, Second Department, December 19, 2017The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit did not sufficiently set forth a standard office practice ensuring timely mailing of the denials, so its EUO no-show summary judgment motion failed.
Charles Deng Acupuncture, P.C. v Unitrin Auto & Home Ins. Co. (2017 NY Slip Op 51834(U)) Appellate Term, Second Department, December 19, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit sufficient to demonstrate that the IME scheduling letters had been timely mailed, rejecting the provider's sole argument.
GBI Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51832(U)) Appellate Term, Second Department, December 19, 2017The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to establish as a matter of law that it timely mailed verification requests tolling its time, so its facially untimely denials of the first four claims could not support dismissal.
Healing Art Acupuncture, P.C. v Allstate Ins. Co. (2017 NY Slip Op 51821(U)) Appellate Term, Second Department, December 19, 2017The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits did not sufficiently describe a standard office practice ensuring timely mailing of the denials, so it did not show it was not precluded from its fee schedule defense.
Shirom Acupuncture, P.C. v 21st Century Natl. Ins. Co. (2017 NY Slip Op 51819(U)) Appellate Term, Second Department, December 19, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof sufficient to establish proper mailing of the denials, rejecting the provider's challenge and upholding dismissal on the fee schedule payment defense.
Irina Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 51817(U)) Appellate Term, Second Department, December 19, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer demonstrated that it timely mailed its initial and follow-up verification requests, supporting its prima facie showing that the action was premature.
Acupuncture Now, P.C. v GEICO Ins. Co. (2017 NY Slip Op 51809(U)) Appellate Term, Second Department, December 19, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's argument and held the insurer's proof established proper mailing of the denials, supporting both dismissal of fee-schedule claims and the finding that remaining claims were timely denied.
Healthway Med. Care, P.C. v Global Liberty Ins. (2017 NY Slip Op 51807(U)) Appellate Term, Second Department, December 19, 2017The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to establish that the initial and follow-up IME scheduling letters had been timely mailed.
Faith Acupuncture, P.C. v Global Liberty Ins. (2017 NY Slip Op 51806(U)) Appellate Term, Second Department, December 19, 2017The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to establish as a matter of law that its initial and follow-up IME scheduling letters were timely mailed.
Gentlecare Ambulatory Anesthesia Servs. v Travelers Ins. Co. (2017 NY Slip Op 51802(U)) Appellate Term, Second Department, December 19, 2017The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the provider's affidavit raised a presumption that the requested verification was mailed and received, which against the insurer's non-receipt showing created a triable issue.
Lynbrook PT & OT, PLLC v Ameriprise Ins. Co. (2017 NY Slip Op 51801(U)) Appellate Term, Second Department, December 19, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge and held the insurer's proof raised a presumption that the EUO scheduling letters and denial for one claim were timely mailed.
JYW Med., P.C. v IDS Prop. Ins. Co. (2017 NY Slip Op 51800(U)) Appellate Term, Second Department, December 19, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely mailing of the EUO scheduling letters to one provider and timely denial of its claims, citing the standard-office-practice rule.
Masigla v Travelers Ins. Co. (2017 NY Slip Op 51794(U)) Appellate Term, Second Department, December 19, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's proof sufficient to give rise to a presumption that its denial of claim forms had been properly mailed.
Easy Care Acupuncture, P.C. v 21 Century Advantage Ins. Co. (2017 NY Slip Op 51792(U)) Appellate Term, Second Department, December 19, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected the provider's contention and held the insurer's proof sufficient to raise a presumption that the denial of claim form had been properly mailed.
Big Apple Ortho Prods., Inc. v Allstate Ins. Co. (2017 NY Slip Op 51791(U)) Appellate Term, Second Department, December 19, 2017The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits did not sufficiently describe a standard office practice ensuring timely mailing of the denial, so its EUO no-show summary judgment motion failed.
Daily Med. Equip. Distrib. Ctr., Inc. v ELRAC, Inc. (2017 NY Slip Op 51805(U)) Appellate Term, Second Department, December 19, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's argument and held the insurer's affidavit sufficient to demonstrate that the denial of claim form was timely mailed.
B.S.A. Chiropractic, P.C. v ELRAC, Inc. (2017 NY Slip Op 51813(U)) Appellate Term, Second Department, December 19, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof sufficiently established proper mailing of the EUO scheduling letters, rejecting the provider's challenge.
Personal Touch Med. Care, P.C. v Maya Assur. Co. (2017 NY Slip Op 51823(U)) Appellate Term, Second Department, December 19, 2017The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit insufficient because it did not set forth a standard office practice or procedure ensuring the IME scheduling letters were properly addressed and mailed.
Canon Chiropractic, P.C. v Travelers Prop. Cas. Co. of Am. (2017 NY Slip Op 51826(U)) Appellate Term, Second Department, December 19, 2017The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to establish as a matter of law that the IME scheduling letters were sent to the assignor's correct address.
Greenway Med. Supply Corp. v Travelers Ins. Co. (2017 NY Slip Op 51765(U)) Appellate Term, Second Department, December 15, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits established that its denial of claim form had been timely mailed.
Logic Chiropractic, P.C. v Hereford Ins. Co. (2017 NY Slip Op 51754(U)) Appellate Term, Second Department, December 15, 2017The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedStruck the CPLR 3212 (g) finding that the IME scheduling letters were properly mailed, because the address they were sent to differed from the assignor's address on the claim and assignment forms, so mailing was not incontrovertible.
Parisien v Travelers Ins. Co. (2017 NY Slip Op 51750(U)) Appellate Term, Second Department, December 12, 2017The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer proved timely mailing of its verification requests, but the provider owner's affidavit raised a presumption that the verification was mailed and received, leaving a factual issue.
Sama Physical Therapy, P.C. v Global Liberty Ins. (2017 NY Slip Op 51736(U)) Appellate Term, Second Department, December 8, 2017The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to establish that its initial and follow-up IME scheduling letters had been timely mailed.
Wellness Plaza Acupuncture, P.C. v Erie Ins. (2017 NY Slip Op 51729(U)) Appellate Term, Second Department, December 8, 2017The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits did not sufficiently describe a standard office practice ensuring timely mailing of the denials, so it was not entitled to dismissal on its EUO nonappearance defense.
Active Care Med. Supply Corp. v Tri State Consumers Ins. Co. (2017 NY Slip Op 51721(U)) Appellate Term, Second Department, December 8, 2017Different mailing results for different documents or claims in one decisionHeld the provider's affidavit raised a presumption that verification was mailed, creating a fact issue on the first claim, while the insurer proved timely mailing of its 45-day-rule denial on the second.
Pierre J. Renelique, M.D., P.C. v Travelers Ins. Co. (2017 NY Slip Op 51718(U)) Appellate Term, Second Department, December 8, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge, holding the insurer's proof sufficient to give rise to a presumption that its verification requests and denial of claim forms had been properly mailed.
Charles Deng Acupuncture, P.C. v Allstate Ins. Co. (2017 NY Slip Op 51716(U)) Appellate Term, Second Department, December 8, 2017The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit did not sufficiently describe a standard office practice ensuring timely mailing of the denials, so it did not show it was not precluded from its fee schedule defense.
KHL Acupuncture, P.C. v Allstate Ins. Co. (2017 NY Slip Op 51709(U)) Appellate Term, Second Department, December 8, 2017The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits did not sufficiently describe a standard office practice ensuring timely mailing of the verification requests and denials, so its EUO no-show cross motion failed.
Greenway Med. Supply Corp. v ELRAC, Inc. (2017 NY Slip Op 51711(U)) Appellate Term, Second Department, December 8, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge and held the insurer's proof sufficient to raise a presumption that the denials based on EUO nonappearance were timely mailed.
Right Aid Med. Supply Corp. v ELRAC, Inc. (2017 NY Slip Op 51714(U)) Appellate Term, Second Department, December 8, 2017The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the provider's opposing affidavit sufficient to raise a presumption that the requested verification was mailed to and received by the insurer, creating a factual question.
Gentlecare Ambulatory Anesthesia Servs. v Geico Ins. Co. (2017 NY Slip Op 51518(U)) Appellate Term, Second Department, November 3, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's contentions, holding the insurer's proof sufficient to presume that both the EUO scheduling letters and the denial of claim form had been timely mailed.
TAM Med. Supply Corp. v 21st Century Ins. Co. (2017 NY Slip Op 51510(U)) Appellate Term, Second Department, November 3, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer sufficiently established that its denial of claim forms had been timely mailed.
Compas Med., P.C. v Allstate Ins. Co. (2017 NY Slip Op 51463(U)) Appellate Term, Second Department, October 27, 2017The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit did not sufficiently set forth a standard office practice ensuring timely mailing of the denials, so it was not entitled to summary judgment.
Adelaida M. Laga, PT v Hereford Ins. Co. (2017 NY Slip Op 51462(U)) Appellate Term, Second Department, October 27, 2017The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the provider's affidavit raised a presumption that the requested verification was mailed and received, which against the insurer's non-receipt showing left a triable issue.
Charles Deng Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51460(U)) Appellate Term, Second Department, October 27, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected the provider's contention and held the insurer's proof sufficient to raise a presumption that the denial of claim forms had been timely mailed.
Chapa Prods. Corp. v Nationwide Ins. (2017 NY Slip Op 51457(U)) Appellate Term, Second Department, October 27, 2017The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof insufficient to show proper mailing of the EUO scheduling letters, because the legal secretary's mailing affidavit relied on appeal was not actually attached to its cross motion.
K.O. Med., P.C. v IDS Prop. Cas. Ins. Co. (2017 NY Slip Op 51454(U)) Appellate Term, Second Department, October 27, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that its initial and follow-up EUO scheduling letters had been timely mailed and that the claims were timely denied.
T & S Med. Supply Corp. v New York Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 51453(U)) Appellate Term, Second Department, October 27, 2017The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the provider's opposing affidavit sufficient to give rise to a presumption that the requested verification was mailed to and received by the insurer, which defeated the insurer's prematurity motion by raising a triable issue.
Charles Deng Acupuncture, P.C. v Allstate Ins. Co. (2017 NY Slip Op 51451(U)) Appellate Term, Second Department, October 27, 2017The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits did not sufficiently describe a standard office practice ensuring timely mailing of the verification requests and denials, so its IME no-show and fee schedule cross motion failed.
Active Care Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51408(U)) Appellate Term, Second Department, October 20, 2017The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the provider's opposing affidavit sufficient to give rise to a presumption that the requested verification was mailed to and received by the insurer, which defeated the insurer's prematurity motion by raising a triable issue.
NYS Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 51263(U)) Appellate Term, Second Department, September 22, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that its initial and follow-up IME scheduling letters had been timely mailed and that the claims were timely denied.
Greenway Med. Supply Corp. v Hartford Ins. Co. (2017 NY Slip Op 51262(U)) Appellate Term, Second Department, September 22, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof sufficient to establish timely denial of the claims, resolving the only remaining issue of proper mailing and entitling it to summary judgment on its IME no-show defense.
Medex Health Supply, Inc. v Travelers Ins. Co. (2017 NY Slip Op 51261(U)) Appellate Term, Second Department, September 22, 2017The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer proved proper mailing of its verification requests, but the provider's affidavit raised a presumption that the verification was mailed and received, leaving a factual issue.
Atlantic Chiropractic, P.C. v Geico Ins. Co. (2017 NY Slip Op 51253(U)) Appellate Term, Second Department, September 22, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's opposing proof sufficient to raise a triable issue as to whether it timely denied the claims, defeating the provider's summary judgment motion.
Charles Deng Acupuncture, P.C. v 21st Century Ins. Co. (2017 NY Slip Op 51252(U)) Appellate Term, Second Department, September 22, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected the provider's challenge to the insurer's proof of mailing of the denial of claim forms as lacking merit.
TAM Med. Supply Corp. v Travelers Ins. Co. (2017 NY Slip Op 51251(U)) Appellate Term, Second Department, September 22, 2017The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer proved proper mailing of its verification requests, but the provider's affidavit raised a presumption that the verification was mailed and received, leaving a factual issue.
AL Acupuncture, P.C. v Geico Ins. Co. (2017 NY Slip Op 51249(U)) Appellate Term, Second Department, September 22, 2017Different mailing results for different documents or claims in one decisionHeld the insurer proved timely mailing of its denials of the earlier claims, but did not establish mailing of the IME scheduling letters because the vendor's affidavit bore an impossible notarization date.
TAM Med. Supply Corp. v New York Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 51248(U)) Appellate Term, Second Department, September 22, 2017The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer proved proper mailing of its verification requests, but the provider's affidavit raised a presumption that the verification was mailed and received, leaving a factual issue.
TAM Med. Supply Corp. v Tri State Consumers Ins. Co. (2017 NY Slip Op 51247(U)) Appellate Term, Second Department, September 22, 2017The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the provider's affidavit raised a presumption that the requested verification was mailed to and received by the insurer, which against the insurer's non-receipt showing created a factual issue.
Laga v Lancer Ins. Co. (2017 NY Slip Op 51244(U)) Appellate Term, Second Department, September 22, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's arguments, holding the insurer's proof sufficiently established proper mailing of the denials and verification requests at issue.
Compas Med., P.C. v American Tr. Ins. Co. (2017 NY Slip Op 51239(U)) Appellate Term, Second Department, September 22, 2017The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the provider's opposing affidavit raised a presumption that its verification responses were mailed and received, which, against the insurer's showing of non-receipt, left a triable issue on whether verification was received.
TAM Med. Supply Corp. v 21st Century Ins. Co. (2017 NY Slip Op 51238(U)) Appellate Term, Second Department, September 22, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof sufficient to establish that the denials had been properly mailed, rejecting the provider's sole argument on appeal.
GBI Acupuncture, P.C. v GEICO Ins. Co. (2017 NY Slip Op 51237(U)) Appellate Term, Second Department, September 22, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's argument and held the insurer's proof established proper mailing of the denials, supporting dismissal of fee-schedule claims and the finding that remaining claims were timely denied.
Royal Med. Supply, Inc. v Nationwide Gen. Ins. Co. (2017 NY Slip Op 51235(U)) Appellate Term, Second Department, September 22, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected as meritless the provider's arguments against the insurer's proof of mailing of the EUO scheduling letters and denial of claim forms.
Citywide Acupuncture Servs., P.L.L.C. v Clarendon Natl. Ins. Co. (2017 NY Slip Op 51233(U)) Appellate Term, Second Department, September 22, 2017The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld that a triable issue of fact existed as to whether the provider had timely submitted the claim, defeating the insurer's late-submission summary judgment motion.
Vladenn Med. Supply Corp. v American Tr. Ins. Co. (2017 NY Slip Op 51230(U)) Appellate Term, Second Department, September 22, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the record established that the insurer timely denied the claim on late notice and late submission grounds, citing the standard mailing-proof rule.
LMS Acupuncture, P.C. v Titan Ins. Co. (2017 NY Slip Op 51229(U)) Appellate Term, Second Department, September 22, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's arguments, holding the insurer established timely mailing of the initial and follow-up EUO scheduling letters and the denials for the fourth through sixth claims.
Tam Med. Supply Corp. v Hereford Ins. Co. (2017 NY Slip Op 51196(U)) Appellate Term, Second Department, September 15, 2017The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the provider's affidavit raised a presumption that the requested verification was mailed and received, which against the insurer's non-receipt showing left a triable issue.
Compas Med., P.C. v American Tr. Ins. Co. (2017 NY Slip Op 51194(U)) Appellate Term, Second Department, September 15, 2017The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the provider's affidavit raised a presumption that the requested verification was mailed to and received by the insurer, which against the insurer's non-receipt showing created a factual issue.
Sama Physical Therapy, P.C. v New York Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 51186(U)) Appellate Term, Second Department, September 15, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's arguments, holding the insurer's proof sufficient to presume that the IME scheduling letters and the denial of claim forms had been properly mailed.
Laga v Country Wide Ins. Co. (2017 NY Slip Op 51155(U)) Appellate Term, Second Department, September 8, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof sufficient to raise a presumption that the denials were properly mailed, rejecting the provider's preserved challenge and upholding dismissal.
Gentlecare Ambulatory Anesthesia Servs. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51152(U)) Appellate Term, Second Department, September 8, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenges to the insurer's proof that the EUO scheduling letters and denial of claim forms had been timely and properly mailed.
JCC Med., P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51140(U)) Appellate Term, Second Department, September 8, 2017The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the provider's affidavit raised a presumption that the requested verification was mailed to and received by the insurer, which against the insurer's non-receipt showing created a factual issue on the second claim.
LMS Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51137(U)) Appellate Term, Second Department, September 8, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that its initial and follow-up EUO scheduling letters had been timely mailed and that the claims were timely denied.
Laga v Amica Mut. Ins. Co. (2017 NY Slip Op 51136(U)) Appellate Term, Second Department, September 8, 2017The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to establish that it mailed the letters scheduling the assignor's IMEs.
K.O. Med., P.C. v Mercury Cas. Co. (2017 NY Slip Op 51158(U)) Appellate Term, Second Department, September 8, 2017The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof insufficient to give rise to a presumption that the IME scheduling letters were properly mailed, so its summary judgment motion on those claims was properly denied.
Renelique v American Tr. Ins. Co. (2017 NY Slip Op 51022(U)) Appellate Term, Second Department, August 11, 2017The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the provider's affidavit raised a presumption that the requested verification was mailed to and received by the insurer, which against the insurer's non-receipt showing created a factual issue.
Compas Med., P.C. v ELRAC, Inc. (2017 NY Slip Op 51019(U)) Appellate Term, Second Department, August 11, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's contention and held the insurer's proof sufficient to raise a presumption that the denial of claim forms were timely mailed.
Elmont Rehab P.T., P.C. v New York Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 50961(U)) Appellate Term, Second Department, July 21, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it mailed initial and follow-up IME scheduling letters before receiving the claims and that it timely denied the claims.
Greenway Med. Supply Corp. v Hartford Ins. Co. (2017 NY Slip Op 50960(U)) Appellate Term, Second Department, July 21, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it mailed initial and follow-up IME scheduling letters before receiving the claims and timely denied the claims.
Mind & Body Acupuncture, P.C. v Global Liberty Ins. Co. of NY (2017 NY Slip Op 50957(U)) Appellate Term, Second Department, July 21, 2017The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to establish that its initial and follow-up EUO scheduling letters had been timely mailed.
Compas Med., P.C. v Hartford Ins. Co. (2017 NY Slip Op 50953(U)) Appellate Term, Second Department, July 21, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's submissions sufficient to raise a presumption that the denials were timely and properly mailed, rejecting the provider's sole argument and upholding dismissal on the IME no-show defense.
Alleviation Med. Servs., P.C. v New York Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 50952(U)) Appellate Term, Second Department, July 21, 2017The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld no presumption of receipt arose because the IME letters were addressed to East 107th St while the assignor resided on East 106th St, and copies to an unconnected attorney did not cure it.
Brand Med. Supply, Inc. v Praetorian Ins. Co. (2017 NY Slip Op 50947(U)) Appellate Term, Second Department, July 21, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the affidavit of the IME scheduling company's president established timely mailing of the IME letters, and the claims examiner's affidavit established timely mailing of the denial of claim form.
Acupuncture Healthcare Plaza I, P.C. v 21st Century Advantage Ins. Co. (2017 NY Slip Op 50945(U)) Appellate Term, Second Department, July 21, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the affidavit of an employee of the insurer's IME scheduling company established timely mailing of the IME scheduling letters under that office's standard mailing practices.
Natural Therapy Acupuncture, P.C. v Nationwide Ins. (2017 NY Slip Op 50943(U)) Appellate Term, Second Department, July 21, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's contention and held the insurer's proof sufficient to raise a presumption that the denial of claim forms had been timely mailed.
Village Med. Supply, Inc. v American Country Ins. Co. (2017 NY Slip Op 50941(U)) Appellate Term, Second Department, July 21, 2017The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer failed to establish that it ever mailed denials for the claims, so its challenge to pre-commencement interest in the default judgment lacked merit.
Acupuncture Healthcare Plaza I, P.C. v Allstate Ins. Co. (2017 NY Slip Op 50939(U)) Appellate Term, Second Department, July 21, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held counsel's affirmation established that the initial EUO scheduling letter was timely mailed, though the result turned on the follow-up letter's untimeliness.
Compas Med., P.C. v American Tr. Ins. Co. (2017 NY Slip Op 50917(U)) Appellate Term, Second Department, July 14, 2017The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer proved timely mailing of its verification requests, but the provider owner's affidavit raised a presumption that the verification was mailed and received, leaving a factual issue.
Doctor Goldshteyn Chiropractic, P.C. v ELRAC, Inc. (2017 NY Slip Op 50923(U)) Appellate Term, Second Department, July 14, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer established that the first EUO scheduling letter was timely and properly mailed, and a dispute over how certified duplicates were sent did not undermine proof of first-class mailing.
Compas Med., P.C. v ELRAC, Inc. (2017 NY Slip Op 50927(U)) Appellate Term, Second Department, July 14, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits sufficed to show that the IME scheduling letters and the denial of claim form were timely mailed, rejecting the provider's challenge.
Sharp View Diagnostic Imaging, P.C. v GEICO Gen. Ins. Co. (2017 NY Slip Op 50855(U)) Appellate Term, Second Department, June 23, 2017The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the provider's affidavit sufficient to establish the claim had been timely and properly mailed to the insurer, though its motion failed on the overdue element.
Progressive Health Chiropractic, P.C. v American Tr. Ins. Co. (2017 NY Slip Op 50603(U)) Appellate Term, Second Department, April 27, 2017The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the provider employee's affidavit of personally generating and mailing the claim raised a presumption of receipt, which, against the insurer's non-receipt affidavit, created a triable issue as to submission.
First Class Med., P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 50593(U)) Appellate Term, Second Department, April 27, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits established that the EUO scheduling letters and denial forms were timely mailed under its standard office practices. The provider failed to show it mailed its objection letters.
Exultant Med. Diagnostics, P.C. v American Commerce Ins. Co. (2017 NY Slip Op 50496(U)) Appellate Term, Second Department, April 13, 2017The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove proper and timely mailing of its denials because the adjuster's affidavit did not explain how mailing addresses were obtained to ensure accuracy or that postage was affixed.
Thomas Dow, D.C., P.C. v New York Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 50495(U)) Appellate Term, Second Department, April 13, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeReversed the lower court's finding of no timely denial, holding the insurer established timely mailing of its denial of claim forms.
Tyorkin v GEICO Gen. Ins. Co. (2017 NY Slip Op 50364(U)) Appellate Term, Second Department, March 29, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that its denial of claim form was timely mailed.
Professional Health Imaging, P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 50199(U)) Appellate Term, Second Department, February 8, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's moving papers established that the EUO scheduling letters had been timely mailed and that the claims were timely denied.
Longevity Med. Supply, Inc. v State Farm Fire & Cas. Co. (2017 NY Slip Op 50118(U)) Appellate Term, Second Department, January 20, 2017The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the billing supervisor's affidavit that she personally and timely mailed the claims raised a presumption of receipt, so the insurer's statement that it never received one claim did not entitle it to dismissal.
Alleviation Med. Servs., P.C. v Hertz Co. (2017 NY Slip Op 50046(U)) Appellate Term, Second Department, January 6, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims adjuster's affidavit established timely mailing of the denial form, which denied the claim for lack of written notice of the accident within 30 days.
National Med. & Surgical Supply, Inc. v ELRAC, Inc. (2017 NY Slip Op 50028(U)) Appellate Term, Second Department, January 5, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits established that the EUO scheduling letters and the denial of claim form were timely mailed.
J.K.M. Med. Care, P.C. v Ameriprise Ins. Co. (2016 NY Slip Op 26424) Appellate Term, Second Department, December 7, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer failed to establish that it timely and properly mailed its EUO scheduling letters.
Greenway Med. Supply Corp. v ELRAC, Inc. (2016 NY Slip Op 51774(U)) Appellate Term, Second Department, December 7, 2016The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the provider's employee affidavit had no probative value to show mailing within 45 days because it claimed mailing on a date before the claim form was even dated.
Neptune Med. Care, P.C. v Dairyland Ins. Co. (2016 NY Slip Op 51705(U)) Appellate Term, Second Department, November 25, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer, despite a canceled check, failed to establish that its payment check was mailed within the 30-day period, leaving an issue of fact on timely payment.
Fontanella v Allstate Ins. Co. (2016 NY Slip Op 51679(U)) Appellate Term, Second Department, November 17, 2016The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the claim representative's conclusory statement that one claim was never mailed to the insurer insufficient to support summary judgment on that claim.
Adelaida M. Laga, Pt v 21st Century Ins. Co. (2016 NY Slip Op 51623(U)) Appellate Term, Second Department, November 1, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer established that its denials were timely mailed, rejecting the provider's sole contention on appeal and upholding dismissal of the causes of action.
Renelique v National Liab. & Fire Ins. Co. (2016 NY Slip Op 51613(U)) Appellate Term, Second Department, November 1, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's cross-motion papers failed to establish that the IME scheduling letters had been mailed.
Prime Diagnostic Med., P.C. v Liberty Mut. Fire Ins. Co. (2016 NY Slip Op 51612(U)) Appellate Term, Second Department, November 1, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's contention and held the claim specialist's affidavit established that the insurer timely mailed its verification requests and follow-up requests.
Art of Healing Medicine, P.C. v Utica Mut. Ins. Co. (2016 NY Slip Op 51610(U)) Appellate Term, Second Department, November 1, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's appellate challenge and held the insurer's proof gave rise to a presumption that both the EUO scheduling letters and the denial forms were timely mailed.
Omphil Care, Inc. v Allstate Ins. Co. (2016 NY Slip Op 51602(U)) Appellate Term, Second Department, November 1, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's cross-moving papers failed to establish as a matter of law that the denial of claim form had been timely mailed.
Central Park Physical Medicine & Rehab., P.C. v National Liab. & Fire Ins. Co. (2016 NY Slip Op 51598(U)) Appellate Term, Second Department, October 31, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to establish as a matter of law that its IME scheduling letters had been timely and properly mailed.
Tam Med. Supply Corp. v National Liab. & Fire Ins. Co. (2016 NY Slip Op 51532(U)) Appellate Term, Second Department, October 13, 2016The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the provider owner's affidavit raised a presumption that the requested verification was mailed to the insurer, which against the insurer's non-receipt showing created a factual issue.
Renelique v National Liab. & Fire Ins. Co. (2016 NY Slip Op 51524(U)) Appellate Term, Second Department, October 13, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's submissions sufficient to give rise to a presumption that the IME scheduling letters and the denial of claim form had been properly mailed.
Prime Diagnostic Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 51523(U)) Appellate Term, Second Department, October 13, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof sufficient to presume proper mailing of the IME scheduling letters and denial, refusing to consider a new wrong-address argument and noting the affiant said the application's address was used.
Integrative Pain Medicine, P.C. v Praetorian Ins. Co. (2016 NY Slip Op 51520(U)) Appellate Term, Second Department, October 13, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof failed to describe a practice and procedure sufficient to raise a presumption that the EUO scheduling letters had been properly mailed.
Metro Health Prods., Inc. v American Tr. Ins. Co. (2016 NY Slip Op 51517(U)) Appellate Term, Second Department, October 13, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof, contrary to the provider's contentions, sufficient to raise a presumption that the EUO scheduling letters had been properly mailed.
Harvard Med., P.C. v Maya Assur. Co. (2016 NY Slip Op 51529(U)) Appellate Term, Second Department, October 13, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit insufficient because it did not set forth a standard office practice or procedure ensuring the IME scheduling letters were properly addressed and mailed.
Island Life Chiropractic, P.C. v Travelers Ins. Co. (2016 NY Slip Op 51511(U)) Appellate Term, Second Department, October 11, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof sufficient to raise a presumption that its initial and follow-up verification requests were properly mailed, rejecting the provider's challenge to that proof.
TAM Med. Supply Corp. v National Liab. & Fire Ins. Co. (2016 NY Slip Op 51506(U)) Appellate Term, Second Department, October 11, 2016The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer proved timely mailing of its verification requests, but the provider owner's affidavit raised a presumption that the verification was mailed and received, creating a triable issue against the insurer's non-receipt proof.
Performance Plus Med., P.C. v Nationwide Ins. (2016 NY Slip Op 51500(U)) Appellate Term, Second Department, October 11, 2016The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the provider owner's affidavit sufficient to raise a presumption that the requested verification was mailed and received, which against the insurer's non-receipt showing created a triable issue.
Mollo Chiropractic, PLLC v Farmington Cas. Co. (2016 NY Slip Op 51496(U)) Appellate Term, Second Department, October 11, 2016The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer's proof raised a presumption that its verification requests were mailed, but the provider owner's affidavit raised a presumption that the verification was mailed and received, leaving a factual question.
Compas Med., P.C. v ELRAC, Inc. (2016 NY Slip Op 51497(U)) Appellate Term, Second Department, October 11, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the third-party administrator employee's affidavit sufficiently established timely mailing of the late-notice denials.
Daily Med. Equip. Distrib. Ctr., Inc. v Auto One Ins. Co. (2016 NY Slip Op 51443(U)) Appellate Term, Second Department, October 5, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits insufficient to establish as a matter of law that it mailed the verification requests, so its motion on two causes of action failed.
Compas Med., P.C. v Travelers Ins. Co. (2016 NY Slip Op 51441(U)) Appellate Term, Second Department, October 5, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof sufficient to raise a presumption that its initial and follow-up verification requests were properly mailed, rejecting the provider's contentions.
Compas Med., P.C. v American Tr. Ins. Co. (2016 NY Slip Op 51433(U)) Appellate Term, Second Department, September 27, 2016The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the provider's owner's affidavit raised a presumption that verification was mailed and received, and the insurer's mail-receipt practices raised a fact issue on receipt of one claim, leaving mailing and receipt for trial.
EMA Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 51428(U)) Appellate Term, Second Department, September 27, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof sufficient, contrary to the provider's contention, to presume proper mailing of the IME scheduling letters and the denial of claim forms.
TAM Med. Supply Corp. v National Liab. & Fire Ins. Co. (2016 NY Slip Op 51423(U)) Appellate Term, Second Department, September 27, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit did not sufficiently describe a standard office practice ensuring that the IME scheduling letters were properly mailed, so its cross motion for summary judgment had to be denied.
Gl Acupuncture, P.C. v Praetorian Ins. Co. (2016 NY Slip Op 51419(U)) Appellate Term, Second Department, September 27, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected the provider's arguments and held the insurer's proof sufficient to raise a presumption that the denial of claim forms had been properly mailed.
Compas Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 51417(U)) Appellate Term, Second Department, September 27, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof gave rise to a presumption that its verification requests and denials were properly mailed, so the claims were timely denied after the verification was received.
Island Life Chiropractic, P.C. v Travelers Ins. Co. (2016 NY Slip Op 51413(U)) Appellate Term, Second Department, September 27, 2016The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer's proof raised a presumption that its verification requests were mailed, but the provider owner's affidavit raised a presumption that the verification was mailed and received, leaving a triable issue.
GBI Acupuncture, P.C. v Allstate Ins. Co. (2016 NY Slip Op 51412(U)) Appellate Term, Second Department, September 27, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits did not sufficiently set forth a standard office practice ensuring timely mailing of its denials, so its fee-schedule summary judgment motion failed.
Treka Med., P.C. v Travelers Ins. Co. (2016 NY Slip Op 51411(U)) Appellate Term, Second Department, September 27, 2016Different mailing results for different documents or claims in one decisionHeld the insurer's proof raised a presumption that its initial and follow-up verification requests were properly mailed, but that the provider's affidavit, dating mailing of one claim before the services were rendered, failed to show that claim was mailed.
Daily Med. Equip. Distrib. Ctr., Inc. v Allstate Ins. Co. (2016 NY Slip Op 51410(U)) Appellate Term, Second Department, September 27, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's motion papers failed to establish that its denial of claim forms had been timely mailed, so it was not entitled to summary judgment dismissing the complaint.
Charles Deng Acupuncture, P.C. v Allstate Ins. Co. (2016 NY Slip Op 51405(U)) Appellate Term, Second Department, September 27, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit did not set forth a standard office practice ensuring timely mailing of the denials, so it was not entitled to summary judgment or a finding that the denials were properly mailed.
Pierre Jean Renelique, MD, P.C. v Farmington Cas. Co. (2016 NY Slip Op 51420(U)) Appellate Term, Second Department, September 27, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit did not sufficiently describe a standard office practice ensuring the IME scheduling letters were properly mailed, so summary judgment was denied.
Compas Med., P.C. v Travelers Insurance Company (2016 NY Slip Op 51424(U)) Appellate Term, Second Department, September 27, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's submissions raised a presumption that its initial and follow-up verification requests were properly mailed, rejecting the provider's only challenge to the first cause of action.
Actual Chiropractic, P.C. v Mercury Cas. Co. (2016 NY Slip Op 51435(U)) Appellate Term, Second Department, September 27, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's proof established timely mailing of both the EUO scheduling letters and the denial of claim forms.
Island Life Chiropractic, P.C. v Country Wide Ins. Co. (2016 NY Slip Op 51378(U)) Appellate Term, Second Department, September 21, 2016The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer's affidavit made a prima facie showing of non-receipt of the claim form, but the provider owner's affidavit showing mailing raised a triable issue as to submission of the claim.
Cpm Surgical Supply, Inc. v Allstate Prop. & Cas. Ins. Co. (2016 NY Slip Op 51377(U)) Appellate Term, Second Department, September 21, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits did not sufficiently set forth a standard office practice ensuring timely mailing of its denial, so its EUO no-show summary judgment motion failed.
K.O. Med., P.C. v Allstate Ins. Co. (2016 NY Slip Op 51367(U)) Appellate Term, Second Department, September 19, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's moving papers did not demonstrate timely mailing of its denial of claim forms.
Synergy First Med., P.L.L.C. v Allstate Ins. Co. (2016 NY Slip Op 51365(U)) Appellate Term, Second Department, September 19, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to establish as a matter of law that its denial of claim forms had been properly and timely mailed.
Ortho Passive Motion, Inc. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 51364(U)) Appellate Term, Second Department, September 19, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established mailing of the pre-claim IME scheduling letters, timely mailing of verification requests, and timely denial of the claims.
Compas Med., P.C. v American Tr. Ins. Co. (2016 NY Slip Op 51361(U)) Appellate Term, Second Department, September 19, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof, contrary to the provider's only contentions, sufficient to presume that the EUO scheduling letters had been properly mailed.
Compas Med., P.C. v American Tr. Ins. Co. (2016 NY Slip Op 51360(U)) Appellate Term, Second Department, September 19, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer did not prove mailing of the EUO letters because its two practice affidavits were inconsistent, one omitting the first letter the other said was mailed.
Renelique v Allstate Ins. Co. (2016 NY Slip Op 51357(U)) Appellate Term, Second Department, September 19, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits did not sufficiently set forth a standard office practice ensuring that the denial of claim form was timely mailed, so the insurer was not entitled to summary judgment.
Compas Med., P.C. v Allstate Ins. Co. (2016 NY Slip Op 51356(U)) Appellate Term, Second Department, September 19, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits did not sufficiently describe a standard office practice ensuring that the denial of claim forms were timely mailed, defeating its EUO no-show cross motion.
AVM Chiropractic, P.C. v 21st Century Ins. Co. (2016 NY Slip Op 51354(U)) Appellate Term, Second Department, September 19, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof, contrary to the provider's only arguments, sufficient to presume that the denial of claim forms had been properly mailed.
Ultimate Health Prods., Inc. v Allstate Ins. Co. (2016 NY Slip Op 51353(U)) Appellate Term, Second Department, September 19, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's papers failed to establish as a matter of law that the verification request letters were timely mailed, so the lower court's finding of timely mailing was vacated.
Alleviation Med. Servs., P.C. v 21st Century Ins. Co. (2016 NY Slip Op 51347(U)) Appellate Term, Second Department, September 19, 2016The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer's affidavit established non-receipt of the claim while the provider owner's affidavit demonstrated mailing, creating an issue of fact as to receipt so neither party obtained summary judgment.
Alleviation Med. Servs., P.C. v Elrac, Inc. (2016 NY Slip Op 51351(U)) Appellate Term, Second Department, September 19, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's contention and held the insurer's affidavit sufficient to demonstrate timely mailing of the denial based on the assignor's nonappearance at IMEs.
GL Acupuncture, P.C. v Allstate Ins. Co. (2016 NY Slip Op 51328(U)) Appellate Term, Second Department, September 15, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits did not sufficiently set forth a standard office practice ensuring timely mailing of its denials, so its fee-schedule summary judgment motion failed.
Restoration Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 51325(U)) Appellate Term, Second Department, September 15, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof, contrary to the provider's argument, sufficient to presume proper mailing of the IME scheduling letters and the denial of claim forms.
Daily Med. Equip. Distrib. Ctr., Inc. v National Liab. & Fire Ins. Co. (2016 NY Slip Op 51323(U)) Appellate Term, Second Department, September 15, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits established timely and proper mailing of the IME scheduling letters and the denial of claim forms.
Infinite Ortho Prods., Inc. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 51320(U)) Appellate Term, Second Department, September 15, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeFound no merit to the provider's challenges to the insurer's proof of timely and proper mailing of the IME scheduling letters and denials; an unpreserved apartment-number addressing argument was not considered.
TAM Med. Supply Corp. v 21st Century Ins. Co. (2016 NY Slip Op 51319(U)) Appellate Term, Second Department, September 15, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's submissions sufficient to raise a presumption that its initial and follow-up verification requests were properly mailed, rejecting the provider's only contentions.
TAM Med. Supply Corp. v American Tr. Ins. Co. (2016 NY Slip Op 51318(U)) Appellate Term, Second Department, September 15, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge and held the insurer's affidavits raised a presumption that its verification request, follow-up request and denial forms for the first claim were properly mailed.
Charles Deng Acupuncture, P.C. v Farmington Cas. Co. (2016 NY Slip Op 51326(U)) Appellate Term, Second Department, September 15, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld, rejecting the provider's arguments, that the insurer's proof established that its denial of claim forms had been timely mailed.
Sin Med., P.C. v Travelers Ins. Co. (2016 NY Slip Op 51246(U)) Appellate Term, Second Department, August 18, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer established timely mailing of the EUO scheduling letters; the letters need not qualify as business records because they were offered to show they were sent, not for their truth.
Al Acupuncture, P.C. v Praetorian Ins. Co. (2016 NY Slip Op 51245(U)) Appellate Term, Second Department, August 18, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that the denial of claim form at issue had been timely mailed, before reaching the fee schedule ground.
Bay LS Med. Supplies, Inc. v Allstate Ins. Co. (2016 NY Slip Op 51244(U)) Appellate Term, Second Department, August 18, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the investigator's affidavit describing the standard mailing practice by which he mailed the denial, plus a signed certified-mail return receipt bearing the claim number, established unrebutted timely mailing of the denial.
Compas Med., P.C. v Praetorian Ins. Co. (2016 NY Slip Op 51000(U)) Appellate Term, Second Department, June 22, 2016Different mailing results for different documents or claims in one decisionHeld the insurer failed to prove timely mailing of EUO scheduling letters, so it did not toll its time to deny three claims, while its verification requests were proved mailed but the provider's affidavit raised a presumption its responses were mailed.
Vladenn Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 50928(U)) Appellate Term, Second Department, June 6, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits established that the EUO scheduling letters and denial of claim forms were timely mailed in accordance with its standard office practices and procedures.
Alleviation Med. Servs., P.C. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 50922(U)) Appellate Term, Second Department, June 6, 2016The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or received (also decides)Held that because each IME scheduling letter was mailed to the assignor at a different address, there was an issue of fact as to whether the assignor received notice of both IMEs.
New Way Med. Supply Corp. v American Tr. Ins. Co. (2016 NY Slip Op 50917(U)) Appellate Term, Second Department, June 6, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that the EUO scheduling letters had been timely mailed, though its defense failed on proof of nonappearance.
Renelique v Travelers Ins. Co. (2016 NY Slip Op 50911(U)) Appellate Term, Second Department, June 6, 2016The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer proved timely mailing of its requests, but the provider owner's affidavit raised a presumption that the verification was mailed and received, creating a triable issue.
Great Health Care Chiropractic, P.C. v Hereford Ins. Co. (2016 NY Slip Op 50910(U)) Appellate Term, Second Department, June 6, 2016The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer proved timely mailing of its requests, but the provider owner's affidavit raised a presumption that the verification was mailed and received, creating a triable issue.
Compas Med., P.C. v Farmington Cas. Co. (2016 NY Slip Op 50925(U)) Appellate Term, Second Department, June 6, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge to the mailing of the IME no-show denials, holding the insurer established the denial forms were timely mailed.
Provek Plus, Inc. v Tri-State Consumer Ins. Co. (2016 NY Slip Op 50870(U)) Appellate Term, Second Department, June 3, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeOn renewal correcting a typographical error in the mail clerk's affidavit, held the insurer's papers established timely mailing of its verification requests and medical-necessity denials.
Renelique v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 50868(U)) Appellate Term, Second Department, June 3, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit established timely and proper mailing of its IME no-show denial, rejecting the provider's preserved challenge on appeal.
Great Health Care Chiropractic, P.C. v Hereford Ins. Co. (2016 NY Slip Op 50858(U)) Appellate Term, Second Department, June 3, 2016The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer proved timely mailing of its requests, but the provider owner's affidavit raised a presumption that the verification was mailed and received, creating a triable issue.
Brand Med. Supply, Inc. v Infinity Ins. Co. (2016 NY Slip Op 50738(U)) Appellate Term, Second Department, May 5, 2016The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the provider owner's trial testimony that he personally mailed the bill, with the admitted proof of mailing, sufficiently proved submission of the claim.
Great Health Care Chiropractic, P.C. v Unitrin Direct Ins. Co. (2016 NY Slip Op 50649(U)) Appellate Term, Second Department, April 19, 2016The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer's showing of non-receipt was met by the provider owner's affidavit raising a presumption that the claim was timely mailed and received, leaving a triable issue on timely submission.
Actual Chiropractic, P.C. v A. Cent. Ins. Co. (2016 NY Slip Op 50397(U)) Appellate Term, Second Department, March 23, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's motion papers failed to establish as a matter of law that the IME scheduling letters had been timely mailed.
Alleviation Med. Servs., P.C. v A Cent. Ins. Co. (2016 NY Slip Op 50383(U)) Appellate Term, Second Department, March 17, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to establish timely and proper mailing of the IME scheduling letters; counsel's reply affirmation lacked personal knowledge and reply papers could not cure the defect.
Alleviation Med. Servs., P.C. v Truck Ins. Exch. (2016 NY Slip Op 50382(U)) Appellate Term, Second Department, March 17, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer sufficiently established timely mailing of its medical-necessity denial.
Vladenn Med. Supply Corp. v Travelers Ins. Co. (2016 NY Slip Op 50381(U)) Appellate Term, Second Department, March 17, 2016The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer proved timely mailing of its requests, but the provider employee's affidavit raised a presumption that the verification was mailed and received, creating a triable issue.
Pro Health Acupuncture, P.C. v Praetorian Ins. (2016 NY Slip Op 50380(U)) Appellate Term, Second Department, March 17, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the IME scheduler's affidavit established timely mailing of the IME requests and the claims examiner's affidavit established timely mailing of the denial of claim forms.
Alleviation Med. Servs., P.C. v Farmers New Century Ins. Co. (2016 NY Slip Op 50379(U)) Appellate Term, Second Department, March 17, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer proved timely mailing of the IME scheduling letters and of its denial of the second claim, rejecting the provider's contrary contention.
Renelique v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 50378(U)) Appellate Term, Second Department, March 17, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit established timely and proper mailing of its IME no-show denial, rejecting the provider's sole contention on appeal.
Meridian Psychological Servs., P.C. v Allstate Ins. Co. (2016 NY Slip Op 50375(U)) Appellate Term, Second Department, March 16, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held trial testimony established that the insurer's counsel timely mailed the EUO letters by first-class and certified mail to the NF-2 address, and undelivered certified copies did not defeat that proof.
New Way Med. Supply Corp. v American Tr. Ins. Co. (2016 NY Slip Op 50370(U)) Appellate Term, Second Department, March 16, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld, contrary to the provider's contention, that the insurer established timely mailing of the EUO scheduling letters and timely denial of the claims.
Tam Med. Supply Corp. v American Tr. Ins. Co. (2016 NY Slip Op 50369(U)) Appellate Term, Second Department, March 16, 2016The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer proved timely mailing of its requests, but the provider owner's affidavit raised a presumption that the verification was mailed and received, creating a triable issue.
Ultimate Health Prods., Inc. v American Tr. Ins. Co. (2016 NY Slip Op 50330(U)) Appellate Term, Second Department, March 15, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld, contrary to the provider's contention, that the insurer established timely mailing of the EUO scheduling letters and timely denial of the claim.
Atlantic Radiology Imaging, P.C. v Metropolitan Prop. & Cas. Ins. Co. (2016 NY Slip Op 50321(U)) Appellate Term, Second Department, March 11, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the administrative assistant's and SIU investigator's affidavits sufficiently described standard office practices for proper and timely mailing of the EUO scheduling letters, so the provider showed no meritorious opposition.
Bay LS Med. Supplies, Inc. v Allstate Ins. Co. (2016 NY Slip Op 50319(U)) Appellate Term, Second Department, March 11, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer proved timely and proper mailing of its EUO scheduling letters and its denial of claim forms, while the dispute centered on alleged defects in the scheduling letters.
Atlantic Radiology Imaging, P.C. v Esurance Ins. Co. (2016 NY Slip Op 50315(U)) Appellate Term, Second Department, March 11, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the affidavit of the insurer's employee sufficient to establish the mailing of the EUO scheduling letters.
EMC Health Prods., Inc. v Allstate Ins. Co. (2016 NY Slip Op 50313(U)) Appellate Term, Second Department, March 11, 2016Different mailing results for different documents or claims in one decisionHeld the insurer's opposition established timely mailing of the denials for two causes of action, raising triable issues, but failed to establish timely mailing of the denials for the other two, which stayed granted.
XVV, Inc. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 50312(U)) Appellate Term, Second Department, March 11, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's motion papers failed to establish that the IME scheduling letters had been timely mailed, so the IMEs were not shown to have been properly scheduled.
Great Health Care Chiropractic, P.C. v Allstate Ins. Co. (2016 NY Slip Op 50311(U)) Appellate Term, Second Department, March 11, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to establish that its initial and follow-up EUO scheduling letters had been timely mailed.
Acupuncture Healthcare Plaza I, P.C. v Truck Ins. Exch. (2016 NY Slip Op 50309(U)) Appellate Term, Second Department, March 11, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected the provider's contention and held the insurer established that the denial of claim form had been timely mailed.
Compas Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 50307(U)) Appellate Term, Second Department, March 11, 2016The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or received (also decides)Held that the insurer proved timely mailing of its 45-day denial, but the provider's owner's affidavit raised a presumption the claim was timely mailed and received, creating a triable issue on timely submission.
Great Health Care Chiropractic, P.C. v Maya Assur. Co. (2016 NY Slip Op 50308(U)) Appellate Term, Second Department, March 11, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit did not set forth a standard office practice or procedure ensuring the IME scheduling letters were properly addressed and mailed.
Gl Acupuncture, P.C. v Maya Assur. Co. (2016 NY Slip Op 50310(U)) Appellate Term, Second Department, March 11, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit insufficient because it did not set forth a standard office practice or procedure ensuring the IME scheduling letters were properly addressed and mailed.
Atlantic Radiology, P.C. v Maya Assur. Co. (2016 NY Slip Op 50316(U)) Appellate Term, Second Department, March 11, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the claims adjuster's affidavit had no probative value on timely mailing because she claimed to have personally mailed the denial in May 2012 but began working for the insurer only in July 2012.
Contemporary Acupuncture, P.C. v Allstate Ins. Co. (2016 NY Slip Op 50464(U)) Appellate Term, Second Department, March 7, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to establish as a matter of law that the EUO notices and denial of claim forms had been properly and timely mailed.
Renelique v National Liab. & Fire Ins. Co. (2016 NY Slip Op 50254(U)) Appellate Term, Second Department, March 1, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's opposing papers established timely mailing of its fraudulent-procurement denial, which with a triable fraud issue defeated the provider's summary judgment motion.
Lenox Hill Radiology v Great N. Ins. Co. (2016 NY Slip Op 50206(U)) Appellate Term, Second Department, February 22, 2016The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer's showing of non-receipt was met by the mailing supervisor's affidavit establishing that the claim was mailed, creating a triable issue as to submission of the claim form.
Careplus Med. Supply, Inc. v Allstate Ins. Co. (2016 NY Slip Op 50196(U)) Appellate Term, Second Department, February 22, 2016The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to establish that its follow-up EUO scheduling notice had been timely mailed, so it did not toll its time to pay or deny that claim.
Emc Health Prods., Inc. v National Liab. & Fire Ins. Co. (2016 NY Slip Op 50132(U)) Appellate Term, Second Department, February 5, 2016The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer proved timely mailing of its requests for four claims, but the provider employee's affidavit raised a presumption that the verification was mailed and received, creating a triable issue.
J.C. Healing Touch Rehab, P.C. v American Tr. Ins. Co. (2016 NY Slip Op 50033(U)) Appellate Term, Second Department, January 8, 2016The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer proved timely mailing of verification requests and follow-ups, but the billing company's affidavit raised a presumption the verification was mailed and received, leaving a triable issue on receipt.
Huntington Regional Chiropractic, P.C. v Mercury Cas. Co. (2015 NY Slip Op 51900(U)) Appellate Term, Second Department, December 18, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that its denial of claim forms based on lack of medical necessity were timely mailed; the result turned on the medical-necessity rebuttal.
Tsatskis v Interboro Mut. Ins. Co. (2015 NY Slip Op 51891(U)) Appellate Term, Second Department, December 15, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely mailing of its medical-necessity denials, preserving that defense and supporting its entitlement to depose the provider.
Parkview Med. Advanced, P.C. v Travelers Ins. Co. (2015 NY Slip Op 51873(U)) Appellate Term, Second Department, December 9, 2015Different mailing results for different documents or claims in one decisionHeld the claim representative's and mail center employee's affidavits proved timely mailing of the verification requests and follow-ups for all claims except one, on which the insurer's mailing was not established.
Compas Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51776(U)) Appellate Term, Second Department, December 2, 2015Different mailing results for different documents or claims in one decisionHeld the insurer's affidavits proved timely mailing of its verification requests, IME scheduling letters and denials, but the provider's owner's affidavit raised a presumption that the requested verification was mailed and received, creating a triable issue.
V.S. Med. Servs., P.C. v Travelers Ins. Co. (2015 NY Slip Op 51760(U)) Appellate Term, Second Department, December 1, 2015The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseRejected the insurer's challenge to the provider's proof of mailing, holding the bills and proof of mailing admitted through the owner's testimony sufficed.
Acupuncture Healthcare Plaza I, P.C. v 21st Century Ins. Co. (2015 NY Slip Op 51716(U)) Appellate Term, Second Department, November 20, 2015The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld a triable issue of fact existed whether the IME scheduling letters were sent to a proper address, though the insurer's affidavits established timely mailing of its denials.
Natural Therapy Acupuncture, P.C. v Travelers Ins. Co. (2015 NY Slip Op 51713(U)) Appellate Term, Second Department, November 20, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected the provider's contention and held the insurer established that the denial of claim form had been timely mailed.
Delta Diagnostic Radiology, P.C. v American Tr. Ins. Co. (2015 NY Slip Op 51711(U)) Appellate Term, Second Department, November 20, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected the provider's contention and held the insurer established timely mailing of its EUO scheduling letters and timely denial of the claims.
Alleviation Med. Servs., P.C. v Esurance (2015 NY Slip Op 51715(U)) Appellate Term, Second Department, November 20, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's proof sufficient to show that both the EUO scheduling letters and the denial forms were timely mailed.
Sharp View Diagnostic Imaging, P.C. v Maya Assur. Co. (2015 NY Slip Op 51721(U)) Appellate Term, Second Department, November 20, 2015The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit insufficient because it did not set forth a standard office practice or procedure ensuring the IME scheduling letters were properly addressed and mailed.
Compas Med., P.C. v Farm Family Cas. Ins. Co. (2015 NY Slip Op 51704(U)) Appellate Term, Second Department, November 19, 2015The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the provider owner's affidavit showed mailing of three claim forms while the insurer's affidavit sufficiently showed non-receipt, leaving an issue of fact whether the time to pay or deny began to run.
Compas Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51699(U)) Appellate Term, Second Department, November 19, 2015Different mailing results for different documents or claims in one decisionHeld the insurer proved timely mailing of its verification requests, IME/EUO scheduling letters and denials, defeating five causes of action. The provider owner's affidavit, however, raised a presumption that its verification response was mailed and received, leaving a triable issue on one claim.
GL Acupuncture, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51698(U)) Appellate Term, Second Department, November 19, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected the provider's contention and held the insurer established that the denial of claim form had been timely mailed.
New Quality Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51697(U)) Appellate Term, Second Department, November 19, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected the provider's contention and held the insurer established timely mailing of the IME and EUO scheduling letters and of its denials under its standard office practice.
Duke Acupuncture, P.C. v Mercury Cas. Co. (2015 NY Slip Op 51701(U)) Appellate Term, Second Department, November 19, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer sufficiently established timely mailing of its medical-necessity denial of claim form, but the outcome rested on the medical-necessity dispute.
Compas Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51679(U)) Appellate Term, Second Department, November 13, 2015Different mailing results for different documents or claims in one decisionHeld the insurer proved timely mailing of its IME letters and denials, while its description of mail-receipt procedures and lack of record rebutted the presumption of receipt of one claim, raising a triable issue.
New Way Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2015 NY Slip Op 51678(U)) Appellate Term, Second Department, November 13, 2015The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer proved timely mailing of its verification and follow-up requests, but the provider's employee affidavit raised a presumption that the requested verification was mailed and received, creating a fact issue.
Barakat Med. Care, P.C. v Nationwide Ins. Co. (2015 NY Slip Op 51677(U)) Appellate Term, Second Department, November 13, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held an investigator's affidavit of standard practices established timely mailing of the EUO scheduling letters, and the denial of claim forms were also shown timely mailed.
Delta Diagnostic Radiology, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51676(U)) Appellate Term, Second Department, November 13, 2015The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer presented no evidence that the IME scheduling letters were ever mailed to the assignor.
T & J Chiropractic, P.C. v American Tr. Ins. Co. (2015 NY Slip Op 51673(U)) Appellate Term, Second Department, November 13, 2015The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the provider owner's affidavit sufficient to raise a presumption that the requested verification was mailed and received, which against the insurer's non-receipt affidavit created a triable issue.
Delta Diagnostic Radiology, P.C. v Country Wide Ins. Co. (2015 NY Slip Op 51672(U)) Appellate Term, Second Department, November 13, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's proof sufficed to show timely mailing of both the IME scheduling letters and the denial of claim forms.
Compas Med., P.C. v American Tr. Ins. Co. (2015 NY Slip Op 51671(U)) Appellate Term, Second Department, November 13, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's contention and held the insurer established timely mailing of the EUO scheduling letters and timely denial of the claims.
Active Chiropractic, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51668(U)) Appellate Term, Second Department, November 13, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's attorney's affirmation sufficiently described his office's standard practices for mailing the EUO scheduling letters.
Compas Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51667(U)) Appellate Term, Second Department, November 13, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely mailing of the IME and EUO scheduling letters and timely denial of most claims, while the remaining claim failed on undisputed denial timing.
Mind & Body Acupuncture, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51658(U)) Appellate Term, Second Department, November 12, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely mailing of its IME and EUO scheduling letters and timely denial of the claims.
Healthway Med. Care, P.C. v Country Wide Ins. Co. (2015 NY Slip Op 51654(U)) Appellate Term, Second Department, November 12, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the litigation supervisor's affidavit established timely mailing of the late-notice denials under standard office practices, as part of the insurer's prima facie showing.
Palafox PT, P.C. v State Farm Mut. Auto. Ins. Co. (2015 NY Slip Op 51653(U)) Appellate Term, Second Department, November 12, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's argument and held the insurer's affidavits of standard office practices established timely mailing of the EUO scheduling letters and the denial of claim forms.
New Way Med. Supply Corp. v Praetorian Ins. Co. (2015 NY Slip Op 51632(U)) Appellate Term, Second Department, November 9, 2015Different mailing results for different documents or claims in one decisionHeld the insurer proved timely mailing of its verification requests, scheduling letters and denials, but the provider's owner's affidavit raised a presumption that the requested verification was mailed and received, creating a triable issue.
Compas Med., P.C. v Farm Family Cas. Ins. Co. (2015 NY Slip Op 51631(U)) Appellate Term, Second Department, November 9, 2015The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer's claims representative established non-receipt of three claims while the provider owner's affidavit demonstrated mailing, leaving an issue of fact as to receipt.
Bay LS Med. Supplies, Inc. v Allstate Ins. Co. (2015 NY Slip Op 51626(U)) Appellate Term, Second Department, November 9, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the investigator's affidavit describing the standard practice by which he mailed the denial, plus a certified-mail return receipt signed by the provider, established unrebutted timely and proper mailing.
Bay LS Med. Supplies, Inc. v Allstate Ins. Co. (2015 NY Slip Op 51625(U)) Appellate Term, Second Department, November 9, 2015The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove mailing of its denial because the certified-mail return receipt its affiant relied on pertained to a different assignor.
Delta Diagnostic Radiology, P.C. v American Tr. Inc. Co. (2015 NY Slip Op 51629(U)) Appellate Term, Second Department, November 9, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit established timely and proper mailing of the EUO scheduling letters, the provider's sole challenge on appeal.
Ultimate Health Prods., Inc. v American Tr. Ins. Co. (2015 NY Slip Op 51592(U)) Appellate Term, Second Department, October 30, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's contention and held the insurer established timely mailing of its EUO scheduling letters and timely denial of the claim.
Healthy Way Acupuncture, P.C. v Farmington Cas. Co. (2015 NY Slip Op 51595(U)) Appellate Term, Second Department, October 30, 2015The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits failed to show the affiants had personal knowledge of its office practices for mailing denial of claim forms, so summary judgment on medical necessity was denied.
Barry G. Fisher, M.D., P.C. v New York City Tr. Auth. (2015 NY Slip Op 51566(U)) Appellate Term, Second Department, October 23, 2015The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the insurer proved timely mailing of its late-claim denial, while the provider's billing manager affidavit and exhibits failed to establish that the claim form was mailed within 45 days.
SAL Med., P.C. v Clarendon Natl. Ins. Co. (2015 NY Slip Op 51449(U)) Appellate Term, Second Department, September 30, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's papers established timely mailing of its medical-necessity denials.
Compas Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51467(U)) Appellate Term, Second Department, September 17, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's claims examiner affidavit proved timely mailing of the verification and follow-up requests, the IME and EUO scheduling letters, and the denials, rejecting the provider's contrary contention.
Healing Art Acupuncture, P.C. v Country Wide Ins. Co. (2015 NY Slip Op 51465(U)) Appellate Term, Second Department, September 17, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's evidence sufficient to show timely mailing of the IME scheduling letters and the denial forms for the second through seventh causes of action.
New Way Med. Supply Corp. v Company (2015 NY Slip Op 51461(U)) Appellate Term, Second Department, September 17, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's proof sufficient to show that the IME scheduling letters and the no-show denial forms were timely mailed.
Metro Health Prods., Inc. v State Farm Mut. Auto. Ins. Co. (2015 NY Slip Op 51419(U)) Appellate Term, Second Department, September 17, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's argument that mailing was unproved, holding the insurer's affidavits established timely mailing of the EUO scheduling letters and denial forms under its standard office practices.
Advanced Chiropractic of NY, P.C. v Chubb Indem. Ins. Co. (2015 NY Slip Op 51409(U)) Appellate Term, Second Department, September 16, 2015The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer's adjuster established non-receipt of the claims, but the provider's billing manager affidavit showed they were mailed, creating an issue of fact whether the time to pay or deny began.
Compas Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51408(U)) Appellate Term, Second Department, September 16, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits proved timely mailing of the verification and follow-up requests, the IME and EUO scheduling letters, and the denials, rejecting the provider's contrary contention.
Ultimate Health Prods., Inc. v American Tr. Ins. Co. (2015 NY Slip Op 51404(U)) Appellate Term, Second Department, September 16, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer established that the EUO scheduling letters had been timely mailed, rejecting the provider's sole merits contention.
Compas Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51403(U)) Appellate Term, Second Department, September 16, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits proved timely mailing of the verification and follow-up requests, the IME and EUO scheduling letters, and the denials, rejecting the provider's contrary contention.
Hammond v Unitrin Advantage Ins. Co. (2015 NY Slip Op 51241(U)) Appellate Term, Second Department, August 6, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the scheduler's standard-practice affidavit proved mailing of the IME letters, and the claims representative's affidavit plus affidavits of service proved timely mailing of the denial forms.
Compas Med., P.C. v American Tr. Ins. Co. (2015 NY Slip Op 51240(U)) Appellate Term, Second Department, August 6, 2015The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the billing manager's affidavit of standard office practice proved the claim was mailed, but the insurer examiner's affidavit raised a triable issue as to whether the claim was ever received.
Neomy Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51237(U)) Appellate Term, Second Department, August 6, 2015The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to demonstrate that its denials of one provider's bills had been timely and properly mailed, so summary judgment on those bills was denied.
GBI Acupuncture, P.C. v 21st Century Ins. Co. (2015 NY Slip Op 51235(U)) Appellate Term, Second Department, August 6, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected the provider's challenge and held the insurer's affidavits sufficiently established timely mailing of the denial of claim forms.
Alleviation Med. Servs., P.C. v Maya Assur. Co. (2015 NY Slip Op 51238(U)) Appellate Term, Second Department, August 6, 2015The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's papers failed to establish timely mailing of the IME scheduling letters, so summary judgment on its no-show defense was denied.
Delta Diagnostic Radiology, P.C. v Hertz Co. (2015 NY Slip Op 51242(U)) Appellate Term, Second Department, August 6, 2015The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedFound a triable issue of fact as to whether the IME scheduling letters were sent to a proper address, leaving mailing for trial.
Bay LS Med. Supplies, Inc. v Allstate Ins. Co. (2015 NY Slip Op 51229(U)) Appellate Term, Second Department, August 5, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the special investigator's affidavit of standard mailing practice, with a signed certified-mail return receipt bearing the claim number, proved the denial was timely mailed, and the provider's lack of an opposing affidavit left it unrebutted.
Lynbrook Med. of NY, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51226(U)) Appellate Term, Second Department, August 5, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's evidence established timely mailing of its medical-necessity denials.
Great Health Care Chiropractic, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51224(U)) Appellate Term, Second Department, August 5, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's evidence sufficient to show that the denial of claim form was timely mailed.
Starlite Acupuncture, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51209(U)) Appellate Term, Second Department, August 5, 2015Different mailing results for different documents or claims in one decisionHeld the insurer's proof of receiving only resubmitted bills did not rebut the provider's proof of mailing two bills earlier, but found a triable issue as to when the third bill was received.
Arcadia Imaging, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51208(U)) Appellate Term, Second Department, August 5, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the scheduler's and claims examiner's descriptions of standard mailing practices proved timely mailing of the IME scheduling letters and the denial form.
Delta Diagnostic Radiology, P.C. v Esurance (2015 NY Slip Op 51212(U)) Appellate Term, Second Department, August 5, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's contention and held the insurer established timely mailing of the EUO scheduling letters and timely denial of the claims on the no-show ground.
Gutierrez v Elrac, Inc. (2015 NY Slip Op 51215(U)) Appellate Term, Second Department, August 5, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits sufficed to show that the denial and IME scheduling letters were timely mailed, rejecting the provider's challenge on appeal.
Mind & Body Acupuncture, P.C. v Elrac, Inc. (2015 NY Slip Op 51219(U)) Appellate Term, Second Department, August 5, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit sufficiently set forth its standard mailing practices and procedures for denial of claim forms, rejecting the provider's challenge.
Great Health Care Chiropractic, P.C. v Elrac, Inc. (2015 NY Slip Op 51223(U)) Appellate Term, Second Department, August 5, 2015The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the provider's NF-2 and notice of injury were not mailed until the postmark date, because its own affidavit showed delivery directly to a postal clerk, so the notice was untimely; the insurer's denial mailing was proved.
Tam Med. Supply Corp. v Lancer Ins. Co. (2015 NY Slip Op 51126(U)) Appellate Term, Second Department, July 27, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer demonstrated timely mailing of its initial and follow-up verification requests.
Bronx Mega Care Med, PLLC v Federal Ins. Co. (2015 NY Slip Op 51060(U)) Appellate Term, Second Department, July 7, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the third-party claims adjuster's affidavit describing her office's procedure for generating and mailing denials established that the denials were timely mailed.
Nova Acupuncture, P.C. v Mercury Cas. Co. (2015 NY Slip Op 50914(U)) Appellate Term, Second Department, June 16, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims representative's affidavit demonstrated timely mailing of the medical-necessity denials for two claims, with the result on those claims turning on the unrebutted IME report.
New Way Med. Supply Corp. v American Tr. Ins. Co. (2015 NY Slip Op 50809(U)) Appellate Term, Second Department, May 19, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely mailing of the EUO scheduling letters and timely denial of the claims under the standard-office-practice test.
Great Health Care Chiropractic, P.C. v Esurance (2015 NY Slip Op 50807(U)) Appellate Term, Second Department, May 19, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's contention and held the insurer established timely mailing of the EUO scheduling letters and timely denial of the claims, so it was entitled to summary judgment.
Compas Med., P.C. v Hartford Ins. Co. (2015 NY Slip Op 50784(U)) Appellate Term, Second Department, May 18, 2015Different mailing results for different documents or claims in one decisionHeld the insurer proved timely mailing of denials for most claims but not for two, and the provider's mailing proof created a presumption of receipt that a conclusory non-receipt allegation failed to rebut.
New Way Med. Supply Corp. v National Liab. & Fire Ins. Co. (2015 NY Slip Op 50783(U)) Appellate Term, Second Department, May 18, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer demonstrated timely mailing of its initial and follow-up verification requests.
Great Health Care Chiropractic, P.C. v Unitrin Advantage Ins. Co. (2015 NY Slip Op 50782(U)) Appellate Term, Second Department, May 18, 2015The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the claim representative's affidavit and EUO counsel's affirmation failed to establish actual mailing of the EUO scheduling letters or mailing under a standard office practice.
New Way Med. Supply Corp. v Praetorian Ins. Co. (2015 NY Slip Op 50780(U)) Appellate Term, Second Department, May 18, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer established timely mailing of the chiropractic IME scheduling letters and timely denial of the claims.
Health Needles Acupuncture, P.C. v Allstate Ins. Co. (2015 NY Slip Op 50776(U)) Appellate Term, Second Department, May 18, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's opposing affidavits sufficiently described its standard mailing practices to establish timely mailing of the denials, raising a triable issue that defeated the provider's motion.
Healthy Way Acupuncture, P.C. v NY Cent. Mut. Fire Ins. Co. (2015 NY Slip Op 50773(U)) Appellate Term, Second Department, May 18, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer demonstrated timely mailing of its initial and follow-up verification requests.
Gutierrez v Farmington Cas. Co. (2015 NY Slip Op 50781(U)) Appellate Term, Second Department, May 18, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer established that its IME scheduling letters and denial of claim form were timely mailed, rejecting the provider's challenge to its mailing proof.
Delta Diagnostic Radiology, P.C. v Esurance (2015 NY Slip Op 50785(U)) Appellate Term, Second Department, May 18, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's contention and held the insurer's proof established timely mailing of the EUO scheduling letters and timely denial of the claims, entitling it to summary judgment.
Delta Diagnostic Radiology, P.C. v Maya Assur. Co. (2015 NY Slip Op 50786(U)) Appellate Term, Second Department, May 18, 2015The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit did not set forth a standard office practice or procedure ensuring the IME scheduling letters were properly addressed and mailed.
Longevity Med. Supply, Inc. v Praetorian Ins. Co. (2015 NY Slip Op 50685(U)) Appellate Term, Second Department, May 1, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held counsel's affirmation of the law office's standard practices proved mailing of the EUO letters, and the insurer sufficiently established timely mailing of the denial forms.
Lenox Hill Radiology & MIA, P.C. v Great N. Ins. Co. (2015 NY Slip Op 50680(U)) Appellate Term, Second Department, May 1, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that its medical-necessity denials were timely and properly mailed.
Compas Med., P.C. v ELRAC, Inc. (2015 NY Slip Op 50675(U)) Appellate Term, Second Department, May 1, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit established that the denials were mailed on the alleged dates under its standard office practices, so the claims in the second through seventh causes of action were timely denied and the provider's motion failed.
Meridian Acupuncture Care, P.C. v Mercury Cas. Co. (2015 NY Slip Op 50681(U)) Appellate Term, Second Department, May 1, 2015The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld that for six bills the insurer's detailed non-receipt affidavit stood unrebutted because no one with personal knowledge swore the claim forms were submitted, so those claims were dismissed; denials on three other bills were proved timely mailed.
Metro Psychological Servs., P.C. v 21st Century N. Am. Ins. Co. (2015 NY Slip Op 50470(U)) Appellate Term, Second Department, April 7, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the affidavit of the paralegal who personally mailed the EUO letters under the law office's standard practice proved their mailing, and the denial form was shown timely mailed.
Parkview Med. & Surgical, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 50491(U)) Appellate Term, Second Department, March 26, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims examiner's affidavit established timely mailing of the verification request and follow-up request.
Renelique v American Tr. Ins. Co. (2015 NY Slip Op 50482(U)) Appellate Term, Second Department, March 26, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the no-fault examiner's and mail room supervisor's affidavits established timely mailing of the verification requests and follow-up requests.
T & J Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2015 NY Slip Op 50406(U)) Appellate Term, Second Department, March 17, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's argument that mailing was unproved, holding the insurer's affidavits established timely mailing of the EUO letters and denial forms under its standard office practices.
Metro Health Prods., Inc. v State Farm Mut. Auto. Ins. Co. (2015 NY Slip Op 50402(U)) Appellate Term, Second Department, March 17, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's argument that mailing was unproved, holding the insurer's affidavits established timely mailing of the EUO letters and denial forms under its standard office practices.
Longevity Med. Supply, Inc. v Praetorian Ins. Co. (2015 NY Slip Op 50401(U)) Appellate Term, Second Department, March 17, 2015Different mailing results for different documents or claims in one decisionHeld the provider's proof of mailing its claim was not rebutted by a mere denial of receipt, while on another claim its affidavit of mailing verification only raised a fact issue against the insurer's non-receipt proof.
Performance Plus Med., P.C. v Utica Mut. Ins. Co. (2015 NY Slip Op 50399(U)) Appellate Term, Second Department, March 16, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the scheduling letters and denials proved timely mailed, noting the mailing affidavit did allege that two copies of each denial were mailed to the provider.
Tong Li v Praetorian Ins. Co. (2015 NY Slip Op 50397(U)) Appellate Term, Second Department, March 16, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the IME scheduler's affidavit established timely mailing of the IME requests and the claims examiner's affidavit established timely mailing of the denial forms.
Cortland Med. Supply, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 50394(U)) Appellate Term, Second Department, March 16, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the IME scheduler's affidavit established timely mailing of the IME requests and the claims examiner's affidavit established timely mailing of the denial forms.
Longevity Med. Supply, Inc. v Praetorian Ins. Co. (2015 NY Slip Op 50393(U)) Appellate Term, Second Department, March 16, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the IME scheduler's affidavit sufficiently established timely mailing of the IME requests and the claims examiner's affidavit established timely mailing of the denial.
Compas Med., P.C. v 21st Century Ins. Co. (2015 NY Slip Op 50388(U)) Appellate Term, Second Department, March 16, 2015The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits showing denial envelopes were picked up by third-party mailing services insufficient because they did not describe those services' standard mailing practice; the provider's mailing affidavit also raised a fact issue on one claim.
Healing Art Acupuncture, P.C. v Maya Assur. Co. (2015 NY Slip Op 50387(U)) Appellate Term, Second Department, March 13, 2015The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit did not sufficiently describe a standard office practice ensuring the IME scheduling letters were properly addressed and mailed.
Top Choice Med., P.C. v Clarendon Natl. Ins. Co. (2015 NY Slip Op 50384(U)) Appellate Term, Second Department, March 12, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer sufficiently established timely mailing of its denial.
I.V. Med. Supply, Inc. v Praetorian Ins. Co. (2015 NY Slip Op 50380(U)) Appellate Term, Second Department, March 12, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the affidavit of the president of the insurer's IME scheduling company sufficiently established that the IME requests were timely mailed, resolving one of the two issues left for trial.
Ultimate Health Prods., Inc. v Travelers Ins. Co. (2015 NY Slip Op 50377(U)) Appellate Term, Second Department, March 12, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that its denial of claim forms were timely mailed.
Power Supply, Inc. v Praetorian Ins. Co. (2015 NY Slip Op 50218(U)) Appellate Term, Second Department, February 24, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer demonstrated that it timely mailed the initial and follow-up EUO and IME requests.
Healing Health Prods., Inc. v New York Cent. Mut. Fire Ins. Co. (2015 NY Slip Op 50080(U)) Appellate Term, Second Department, January 15, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the litigation examiner's affidavit established timely mailing of the verification request and follow-up request.
Healing Art Acupuncture, P.C. v Amica Mut. Ins. Co. (2015 NY Slip Op 50078(U)) Appellate Term, Second Department, January 15, 2015The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the claims representative's affidavit sufficiently established timely mailing of the denials, and its lack of a certificate of conformity for out-of-state notarization was a disregardable defect absent prejudice.
XVV, Inc. v Praetorian Ins. Co. (2014 NY Slip Op 51862(U)) Appellate Term, Second Department, December 19, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely mailing of the IME and EUO scheduling letters and timely denial of the first claim.
Right Solution Med. Supply, Inc. v NY Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 51860(U)) Appellate Term, Second Department, December 19, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's litigation examiner and IME scheduler affidavits, describing standard mailing practices, proved timely mailing of the verification requests, IME scheduling letters and denials, warranting reversal of judgment for the provider.
Coney Is. Physician Care, P.C. v Praetorian Ins. Co. (2014 NY Slip Op 51859(U)) Appellate Term, Second Department, December 19, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the claims examiner, IME scheduler and litigation examiner affidavits sufficiently described standard mailing practices to prove timely mailing of the verification requests, IME scheduling letters and denials.
Flatlands Med., P.C. v Travelers Ins. Co. (2014 NY Slip Op 51856(U)) Appellate Term, Second Department, December 19, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeFor two causes of action, held the insurer's affidavits sufficient to show timely mailing of the EUO scheduling letters and denial forms.
Compas Med., P.C. v GEICO Ins. Co. (2014 NY Slip Op 51857(U)) Appellate Term, Second Department, December 19, 2014The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the insurer failed to rebut the provider's showing that a claim had been mailed within 45 days of the services, so the insurer did not prove a 45-day-rule violation as a matter of law and its cross motion on that claim was denied.
Faith Acupuncture, P.C. v Maya Assur. Co. (2014 NY Slip Op 51863(U)) Appellate Term, Second Department, December 19, 2014The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit did not sufficiently set forth a standard office practice ensuring the IME scheduling letters were properly addressed and mailed.
Skymed Med., P.C. v Tri-State Consumer Ins. (2014 NY Slip Op 51833(U)) Appellate Term, Second Department, December 17, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits sufficient to establish timely mailing of its initial and follow-up verification requests, supporting dismissal of the action as premature.
Bronx Park Med., P.C. v Clarendon Natl. Ins. Co. (2014 NY Slip Op 51832(U)) Appellate Term, Second Department, December 17, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit established timely mailing of its medical-necessity denial.
Medical Assoc., P.C. v Geico Gen. Ins. Co. (2014 NY Slip Op 51829(U)) Appellate Term, Second Department, December 17, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's moving papers established timely denial of the claim, citing the standard-office-practice mailing rule.
Cherkin v Praetorian Ins. Co. (2014 NY Slip Op 51828(U)) Appellate Term, Second Department, December 17, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer sufficiently established timely mailing of its denials.
Compas Med., P.C. v Nationwide Ins. (2014 NY Slip Op 51826(U)) Appellate Term, Second Department, December 17, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits sufficient to show that the denials and IME scheduling letters were mailed under a standard office practice and procedure, rejecting the provider's challenge.
Northshore Chiropractic Diagnostics, P.C. v A. Cent. Ins. Co. (2014 NY Slip Op 51825(U)) Appellate Term, Second Department, December 17, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer demonstrated that it mailed its initial and follow-up verification requests and that both sets were timely, contrary to the lower court's finding.
Compas Med., P.C. v Nationwide Ins. (2014 NY Slip Op 51824(U)) Appellate Term, Second Department, December 17, 2014Different mailing results for different documents or claims in one decisionHeld the insurer proved timely mailing of its scheduling letters and denials, while its described mail-receipt procedures and lack of record rebutted the presumption of receipt of one claim, raising a triable issue.
Parkview Med. & Surgical, P.C. v Geico Gen. Ins. Co. (2014 NY Slip Op 51822(U)) Appellate Term, Second Department, December 17, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the affidavit of a manager of the insurer's IME scheduling vendor sufficiently established timely mailing of the IME requests.
True-Align Chiropractic Care, P.C. v Country Wide Ins. Co. (2014 NY Slip Op 51821(U)) Appellate Term, Second Department, December 17, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit sufficiently established the timely and proper mailing of its verification requests and denial of claim forms, rejecting the provider's arguments.
Utopia Equip., Inc. v NY Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 51820(U)) Appellate Term, Second Department, December 17, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely mailing of the IME scheduling letters through the scheduler's standard practice affidavit and timely mailing of the denials for two claims.
XVV, Inc. v Praetorian Ins. Co. (2014 NY Slip Op 51819(U)) Appellate Term, Second Department, December 17, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the affidavit of the president of the insurer's IME scheduling company sufficiently established that the IME requests were timely mailed.
All About Rehabilitation & P.T., P.C. v Praetorian Ins. Co. (2014 NY Slip Op 51815(U)) Appellate Term, Second Department, December 17, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the scheduler's standard mailing practice affidavit established timely mailing of the IME letters and the litigation examiner's description of standard practices established timely mailing of the denials.
EMC Health Prods., Inc. v Praetorian Ins. Co. (2014 NY Slip Op 51806(U)) Appellate Term, Second Department, December 17, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's papers established timely denial of the claims, citing the standard-office-practice mailing rule.
City Chiropractic, P.C. v Eveready Ins. Co. (2014 NY Slip Op 51802(U)) Appellate Term, Second Department, December 17, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims examiner's affidavit established timely mailing of the verification request and follow-up requests, supporting dismissal as premature.
Excel Imaging, P.C. v Infinity Select Ins. Co. (2014 NY Slip Op 51796(U)) Appellate Term, Second Department, December 17, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely mailing of the EUO scheduling letters, which tolled its time to pay or deny.
Island Chiropractic Testing, P.C. v Praetorian Ins. Co. (2014 NY Slip Op 51795(U)) Appellate Term, Second Department, December 17, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer demonstrated timely mailing of its initial and follow-up verification requests.
MML Med. Care, P.C. v Praetorian Ins. Co. (2014 NY Slip Op 51792(U)) Appellate Term, Second Department, December 17, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer proved timely mailing of the EUO letters and denials; certified-mail tracking showing nondelivery did not defeat the presumption since nothing showed the first-class mailing was insufficient.
Great Health Care Chiropractic, P.C. v Maya Assur. Co. (2014 NY Slip Op 51803(U)) Appellate Term, Second Department, December 17, 2014The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's cross-motion papers failed to establish that the IME scheduling letters had been mailed.
Advanced Psychological Care, P.C. v MVAIC (2014 NY Slip Op 51809(U)) Appellate Term, Second Department, December 17, 2014The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the IME scheduler's employee affidavit did not sufficiently set forth a standard office practice establishing that the scheduling letters were properly addressed and mailed.
Great Health Care Chiropractic, P.C. v Hertz Co. (2014 NY Slip Op 51814(U)) Appellate Term, Second Department, December 17, 2014Different mailing results for different documents or claims in one decisionHeld the insurer proved timely mailing of its denial form, defeating the provider's motion, but failed to establish a proper practice for mailing the IME scheduling notices, defeating its own cross motion.
All Boro Psychological Servs., P.C. v State Farm Mut. Auto. Ins. Co. (2014 NY Slip Op 51787(U)) Appellate Term, Second Department, December 11, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge and held the insurer's affidavits established timely mailing of the EUO scheduling letters and the denial of claim forms.
Delta Diagnostic Radiology, P.C. v National Liab. & Fire Ins. Co. (2014 NY Slip Op 51322(U)) Appellate Term, Second Department, August 20, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's papers established timely mailing of its fraudulent-procurement denial, which with a triable fraud issue required denial of the provider's summary judgment motion.
Lotus Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2014 NY Slip Op 51315(U)) Appellate Term, Second Department, August 20, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's arguments and held the insurer's proof sufficient to show timely mailing of the EUO scheduling letters and the denial of claim form.
Natural Therapy Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2014 NY Slip Op 51310(U)) Appellate Term, Second Department, August 20, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's argument and held affidavits describing standard office practices established timely mailing of the EUO scheduling letters and denial of claim forms.
SS Med. Care, P.C. v Eveready Ins. Co. (2014 NY Slip Op 51305(U)) Appellate Term, Second Department, August 20, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims examiner's affidavit established timely mailing of the verification and follow-up requests, and rejected any requirement to prove the annexed letter copies had not been altered.
Promed Durable Equip., Inc. v GEICO Ins. (2014 NY Slip Op 51262(U)) Appellate Term, Second Department, August 8, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit established timely mailing of its medical-necessity denials.
Arco Med. NY, P.C. v AIG Indem. Ins. Co. (2014 NY Slip Op 51257(U)) Appellate Term, Second Department, August 8, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the IME scheduling company's affidavit of standard mailing practices established timely mailing of the IME letters, and the insurer's affidavits established timely denial.
Quality Psychological Servs., P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 51256(U)) Appellate Term, Second Department, August 8, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the IME scheduler's standard-mailing-practice affidavit established timely mailing of the scheduling letters to the assignor, and the claims examiner's affidavit established timely mailing of the no-show denial.
Longevity Med. Supply, Inc. v IDS Prop. & Cas. Ins. Co. (2014 NY Slip Op 51244(U)) Appellate Term, Second Department, July 28, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeReversing the lower court, held the litigation examiner's personal-knowledge affidavit showed the denial mailing procedures were followed, and the attorney's affidavit sufficiently described office practice for mailing EUO letters.
By MD, P.C. v NY Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 51232(U)) Appellate Term, Second Department, July 28, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeReversing a finding of a triable issue on receipt, held the IME scheduler's standard-practice affidavit established mailing and the provider's affidavit was insufficient to rebut the presumption of receipt.
Hillside OpenMRI, P.C. v Allstate Ins. Co. (2014 NY Slip Op 51143(U)) Appellate Term, Second Department, July 7, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely issuance of the EUO scheduling letters and timely denial of one claim, citing the standard-office-practice rule.
Clinton Place Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50963(U)) Appellate Term, Second Department, May 29, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held standard-practice affidavits established timely mailing of the IME scheduling letters and of the denial forms for the first thirteen causes of action.
Clinton Place Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50960(U)) Appellate Term, Second Department, May 29, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the litigation examiner's affidavit established that the denial of claim forms were timely mailed under the insurer's standard mailing practices and procedures.
Clinton Place Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50954(U)) Appellate Term, Second Department, May 29, 2014The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or received (also decides)Found a question of fact as to whether the insurer timely denied the claims, the lower court having limited trial to the mailing of the denial.
Eagle Surgical Supply, Inc. v Allstate Prop. & Cas. Ins. Co. (2014 NY Slip Op 50950(U)) Appellate Term, Second Department, May 29, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits and documents sufficient to establish timely mailing of the denial, rejecting the provider's sole appellate challenge, and treated the unraised CPLR 2309 (c) objection to one affidavit as waived.
Triumph Assoc. Physical Therapy, P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50875(U)) Appellate Term, Second Department, May 22, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the litigation examiner's affidavit established that the insurer timely denied the claims; the result turned on the fee schedule and medical-necessity proof.
Bronze Acupuncture, P.C. v Travelers Ins. Co. (2014 NY Slip Op 50873(U)) Appellate Term, Second Department, May 22, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits sufficiently established timely mailing of the denials, noting the out-of-state mailing affidavit carried a proper certificate of conformity, while the dispute centered on the policy deductible.
Diagnostic Radiographic Imaging v GEICO Gen. Ins. Co. (2014 NY Slip Op 50869(U)) Appellate Term, Second Department, May 22, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's moving papers established timely denial of the claims, citing the standard-office-practice mailing rule.
Healing Health Prods., Inc. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 24145) Appellate Term, Second Department, May 22, 2014The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer's standard-practice proof raised a presumption of receipt, but the provider's detailed no-record affidavit rebutted it, creating a triable issue whether the verification requests were mailed at all.
Mount Sinai Hosp. of Queens v Country Wide Ins. Co. (2014 NY Slip Op 50780(U)) Appellate Term, Second Department, April 30, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the litigation supervisor's affidavit sufficient to establish timely mailing of the denial, which supported dismissal on the ground that the claim was submitted beyond 45 days without excuse.
J.C. Healing Touch Rehab, P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50635(U)) Appellate Term, Second Department, April 7, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld standard-mailing-practice affidavits established timely mailing of the IME scheduling letters and of the denial of claim forms.
Active Chiropractic, P.C. v Praetorian Ins. Co. (2014 NY Slip Op 50634(U)) Appellate Term, Second Department, April 7, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely mailing of the EUO scheduling letters and denial, and that an out-of-state affidavit lacking a certificate of conformity should not have been excluded.
Healing Art Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50633(U)) Appellate Term, Second Department, April 7, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the IME scheduling company's affidavit of standard mailing practices established timely mailing of the IME scheduling letters, the sole issue for trial.
BR Clinton Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50632(U)) Appellate Term, Second Department, April 7, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the IME scheduler's standard-practice affidavit established timely mailing of the IME scheduling letters to the assignor, the sole issue for trial.
Village Med. Supply, Inc. v NY Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50631(U)) Appellate Term, Second Department, April 7, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the IME scheduler's and litigation examiner's affidavits sufficiently described standard mailing practices to prove timely mailing of the IME scheduling letters, verification requests and denials.
SK Prime Med. Supply, Inc. v State Farm Mut. Auto. Ins. Co. (2014 NY Slip Op 50630(U)) Appellate Term, Second Department, April 7, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's argument and held the insurer's affidavits sufficiently established timely mailing of the denial of claim form.
Clinton Place Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50472(U)) Appellate Term, Second Department, March 17, 2014Different mailing results for different documents or claims in one decisionHeld the insurer proved by office-practice affidavits that the IME letters and the denials of some claims were timely mailed, but its employee's affidavit did not establish timely denial of the remaining claims.
Clinton Place Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50471(U)) Appellate Term, Second Department, March 17, 2014Different mailing results for different documents or claims in one decisionHeld office-practice affidavits proved timely mailing of the IME letters and of the denials for some claims, but the insurer's affidavit did not establish timely denial of two other claims.
Clinton Place Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50468(U)) Appellate Term, Second Department, March 17, 2014The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or received (also decides)Held a question of fact existed as to whether the insurer timely mailed its denial after the IME nonappearances, so its cross motion was properly denied.
Favorite Health Prods., Inc. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50467(U)) Appellate Term, Second Department, March 17, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims examiner's affidavit established timely mailing of the verification requests and follow-up requests.
Right Aid Med. Supply Corp. v Utica Mut. Ins. Co. (2014 NY Slip Op 50421(U)) Appellate Term, Second Department, March 11, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely issuance of its EUO scheduling letters, tolling its time to pay or deny.
Advanced Orthopedics, PLLC v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50418(U)) Appellate Term, Second Department, March 11, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer sufficiently established timely mailing of its denial of claim form, but the motion still failed on medical necessity.
Clinton Place Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50413(U)) Appellate Term, Second Department, March 11, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the IME scheduling company's affidavit established timely mailing of the scheduling letters to the assignor under its standard office practices and procedures.
Martin Plutno v Travelers Ins. Co. (2014 NY Slip Op 50412(U)) Appellate Term, Second Department, March 11, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected the provider's challenge and held the insurer's affidavits sufficient to establish timely denial of the claims on fee schedule and medical-necessity grounds.
Eagle Surgical Supply, Inc. v Allstate Prop. & Cas. Ins. Co. (2014 NY Slip Op 50411(U)) Appellate Term, Second Department, March 11, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenges to the insurer's denial-mailing affidavits as unpreserved and held, in any event, that the missing CPLR 2309 (c) certificate was not fatal absent prejudice.
Aminov v Country Wide Ins. Co. (2014 NY Slip Op 24066) Appellate Term, Second Department, March 5, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer proved timely mailing of the denial, so that prejudgment interest ran from commencement and, given the provider's unreasonable delay, from the notice of trial.
Westchester Med. Ctr. v A Cent. Ins. Co. (2014 NY Slip Op 50347(U)) Appellate Term, Second Department, February 28, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the litigation examiner's affidavit demonstrated timely mailing of initial and follow-up verification requests on the stated dates.
American Chiropractic Care, P.C. v Praetorian Ins. Co. (2014 NY Slip Op 50346(U)) Appellate Term, Second Department, February 28, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely mailing of its denial of claim forms, but the result turned on the provider's medical-necessity rebuttal.
Natural Therapy Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2014 NY Slip Op 50134(U)) Appellate Term, Second Department, January 28, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's argument and held the insurer's affidavits established that the EUO letters and denial forms were timely mailed under its standard office practices and procedures.
Comprehensive MRI of N.Y., P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50128(U)) Appellate Term, Second Department, January 27, 2014The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held, contrary to the lower court, that the insurer's affidavit established timely mailing of its denial of claim forms, though the motion was still denied on medical necessity.
Concourse Chiropractic, PLLC v State Farm Mut. Ins. Co. (2013 NY Slip Op 52225(U)) Appellate Term, Second Department, December 20, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits established that the EUO notices were timely sent and the denials timely issued.
Mollo Chiropractic, PLLC v American Commerce Ins. Co. (2013 NY Slip Op 23419) Appellate Term, Second Department, December 9, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits established that it timely issued the denial of claim form, which, with the peer review, raised a triable issue.
Olmeur Med., P.C. v Nationwide Gen. Ins. Co. (2013 NY Slip Op 52031(U)) Appellate Term, Second Department, December 3, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the denial-mailing affidavits, including an out-of-state affidavit with a corrected certificate of conformity, established timely mailing, and the attorney's affirmation proved mailing of the EUO letters.
Art of Healing Medicine, P.C. v Amica Mut. Ins. Co. (2013 NY Slip Op 52014(U)) Appellate Term, Second Department, November 29, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the scheduler's affidavit established mailing of the IME letters and the out-of-state denial-mailing affidavit could be cured nunc pro tunc with a proper certificate of conformity.
J.C. Healing Touch Rehab, P.C. v Nationwide Ins. (2013 NY Slip Op 52011(U)) Appellate Term, Second Department, November 26, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the affirmation established that the EUO scheduling letters were timely mailed under the law firm's standard office practices; the provider's challenge to the denial-mailing affidavit was waived as raised first on appeal.
Arco Med. NY, P.C. v Metropolitan Cas. Ins. Co. (2013 NY Slip Op 52001(U)) Appellate Term, Second Department, November 26, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits established that its EUO scheduling letters were mailed under its standard office practices and that its denials were issued within 30 days.
Vit Acupuncture, P.C. v Praetorian Ins. Co. (2013 NY Slip Op 52000(U)) Appellate Term, Second Department, November 26, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the scheduling company's and claims examiner's affidavits established timely mailing of the IME requests and of the denial forms.
Alev Med. Supply, Inc. v Praetorian Ins. Co. (2013 NY Slip Op 51999(U)) Appellate Term, Second Department, November 26, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's papers sufficiently established timely mailing of its denial of claim forms based on lack of medical necessity.
Dream Acupuncture, P.C. v State Farm Fire & Cas. Co. (2013 NY Slip Op 51997(U)) Appellate Term, Second Department, November 26, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge and held the insurer's affidavits sufficiently described standard practices for mailing EUO scheduling letters and denial of claim forms.
Jesa Med. Supply, Inc. v NYC Tr. Auth. (2013 NY Slip Op 52007(U)) Appellate Term, Second Department, November 26, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims representative's affidavit sufficient to establish timely mailing of the denials based on late submission of the claims.
Ortho Prods. & Equip., Inc. v Interboro Ins. Co. (2013 NY Slip Op 52054(U)) Appellate Term, Second Department, November 21, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely mailing of its denials and of its EUO scheduling letters.
Megacure Acupuncture, P.C. v Lancer Ins. Co. (2013 NY Slip Op 51994(U)) Appellate Term, Second Department, November 21, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established in opposition that its EUO scheduling letters were timely mailed and that the claims were timely denied, citing the standard-office-practice rule.
Flatbush Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2013 NY Slip Op 51880(U)) Appellate Term, Second Department, October 29, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits established that the EUO scheduling letters and denial of claim forms had been timely mailed in accordance with its standard office practices and procedures, rejecting the provider's argument.
Barclays Med., P.C. v NY Cent. Mut. Fire Ins. Co. (2013 NY Slip Op 51758(U)) Appellate Term, Second Department, October 15, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the affidavits of the IME scheduling vendor's manager and the insurer's litigation examiner established timely mailing of the IME requests and of the denial of claim forms to the provider's address.
Lenox Hill Radiology & Mia, P.C. v American Mfrs. Mut. Ins. Co. (2013 NY Slip Op 51750(U)) Appellate Term, Second Department, October 15, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims examiner's affidavit sufficient to establish timely mailing of the denial, supporting dismissal because the claims were submitted beyond 45 days without any explanation.
Right Aid Med. Supply Corp. v Nationwide Ins. (2013 NY Slip Op 51746(U)) Appellate Term, Second Department, October 15, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Noted the insurer established that all its mailings, including the pre-claim EUO scheduling letter and follow-ups, were made under its standard office practices and procedures.
20th Ave Acupuncture, P.C. v MVAIC (2013 NY Slip Op 51741(U)) Appellate Term, Second Department, October 10, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it issued timely partial denials of most claims, but one denial issued over six months after receipt was untimely.
Gl Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2013 NY Slip Op 51748(U)) Appellate Term, Second Department, October 8, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims representatives' affidavits sufficiently established timely mailing of the denial of claim forms.
Elite Med. NY, P.C. v American Tr. Ins. Co. (2013 NY Slip Op 51738(U)) Appellate Term, Second Department, October 8, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits sufficient to establish timely mailing of verification requests and follow-up requests for the remaining claim.
Shara Acupuncture, P.C. v Allstate Ins. Co. (2013 NY Slip Op 51731(U)) Appellate Term, Second Department, October 8, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits established that its denial of claim forms were timely mailed under its standard office practices and procedures, rejecting the provider's challenge.
Ranbow Supply of N.Y., Inc. v Progressive Northeastern Ins. Co. (2013 NY Slip Op 51729(U)) Appellate Term, Second Department, October 8, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the wrong-address argument, holding the insurer showed it addressed the IME scheduling letters to the assignor at the address the insured provided, with copies addressed to and received by the assignor's attorney.
Delta Diagnostic Radiology, P.C. v Mvaic (2013 NY Slip Op 51733(U)) Appellate Term, Second Department, October 8, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's argument and held the insurer established that it timely denied, by mailing, the claim submitted more than 45 days after the services.
Compas Med., P.C. v Elrac, Inc. (2013 NY Slip Op 51734(U)) Appellate Term, Second Department, October 8, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held affidavits of the IME scheduling vendor's employee and the claims examiner sufficiently described standard office mailing practices, proving timely mailing of the IME scheduling letters and denial forms.
Canarsie Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2013 NY Slip Op 51457(U)) Appellate Term, Second Department, August 26, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits established that the EUO scheduling letters and denial of claim forms had been timely mailed, rejecting the provider's contrary argument.
Mega Supplies Billing, Inc. v State Farm Fire & Cas. Co. (2013 NY Slip Op 51462(U)) Appellate Term, Second Department, August 26, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's sole appellate contention and held the insurer's affidavits established timely mailing of the EUO requests and the denial.
South Nassau Community Hosp. v Kemper Independence Ins. Co. (2013 NY Slip Op 51384(U)) Appellate Term, Second Department, August 8, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the IME scheduler's owner's affidavit established that the IME scheduling letters had been timely mailed in accordance with the scheduler's standard office practices and procedures.
Bright Med. Supply Co. v Tri State Consumer Ins. Co. (2013 NY Slip Op 51122(U)) Appellate Term, Second Department, July 5, 2013The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the provider's opposition failed to show proper mailing of the claim form, since the insurer showed the Philadelphia post office box it was allegedly sent to was not the insurer's address.
Quality Health Prods. v GEICO Gen. Ins. Co. (2013 NY Slip Op 51118(U)) Appellate Term, Second Department, July 5, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected the provider's appellate challenge and held the insurer established mailing of the denials at issue.
SP Chiropractic, P.C. v MVAIC (2013 NY Slip Op 51126(U)) Appellate Term, Second Department, July 5, 2013The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the IME scheduler's employee affidavit did not sufficiently describe a standard office practice ensuring the initial and follow-up scheduling letters were properly addressed and mailed.
SS Med. Care, P.C. v Nationwide Ins. (2013 NY Slip Op 51109(U)) Appellate Term, Second Department, July 1, 2013The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove proper addressing and mailing because the scheduler's practice was to use the NF-2 address, yet the IME letters went to two Bronx addresses different from it, and EUO follow-ups were not shown mailed.
Right Aid Diagnostic Medicine, P.C. v GEICO Ins. Co. (2013 NY Slip Op 51034(U)) Appellate Term, Second Department, June 17, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's cross-motion papers established that it timely mailed its denial of the claim, though the result turned on its unrebutted peer review.
Right Aid Diagnostic Medicine, P.C. v Travelers Ins. Co. (2013 NY Slip Op 51033(U)) Appellate Term, Second Department, June 17, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the IME scheduler's employee affidavit established timely mailing of the IME scheduling letters, and the insurer's affidavits established timely mailing of the denial of claim forms.
Ss Med. Care, P.C. v Hartford Ins. Co. (2013 NY Slip Op 51032(U)) Appellate Term, Second Department, June 17, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer properly demonstrated that it had mailed the EUO scheduling letters and denials, rejecting the provider's sole argument.
Brooklyn Chiropractic & Sports Therapy, P.C. v A. Cent. Ins. Co. (2013 NY Slip Op 50904(U)) Appellate Term, Second Department, May 22, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer showed timely mailing of its medical-necessity denials and of initial and follow-up verification requests under the standard office practice rule.
Right Aid Diagnostic Medicine, P.C. v Geico Ins. Co. (2013 NY Slip Op 50901(U)) Appellate Term, Second Department, May 22, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's cross-motion papers established that it timely denied the claims, a mailing finding supported by the St. Vincent's citation.
Ortho Prods. & Equipments, Inc. v Eveready Ins. Co. (2013 NY Slip Op 50856(U)) Appellate Term, Second Department, May 14, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims examiner's affidavit established timely mailing of the request and follow-up request for verification seeking prescribed NF-3 forms.
Avenue I Med., P.C. v Hertz (2013 NY Slip Op 50840(U)) Appellate Term, Second Department, May 13, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the IME scheduler's affidavit established timely mailing of the scheduling letters under its standard office practices, and the insurer also established timely mailing of its denials.
Flatlands Med., P.C. v State Farm Mut. Auto. Ins. Co. (2013 NY Slip Op 50763(U)) Appellate Term, Second Department, May 6, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits established that the EUO scheduling letters and the denial of claim forms had been timely mailed, rejecting the provider's argument.
Compas Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2013 NY Slip Op 50762(U)) Appellate Term, Second Department, May 6, 2013The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the claims representative's affidavit failed to establish that the insurer timely mailed its denial of claim forms, so the insurer was precluded from most defenses.
Jamaica Med. Supply, Inc. v GEICO Gen. Ins. Co. (2013 NY Slip Op 50760(U)) Appellate Term, Second Department, May 6, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's papers sufficiently established timely mailing of its denial of claim form based on lack of medical necessity.
B & Y Surgical Supplies, Inc. v GEICO Gen. Ins. Co. (2013 NY Slip Op 50759(U)) Appellate Term, Second Department, May 6, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's papers sufficiently established timely mailing of the denials, which defeated the provider's motion together with the medical-necessity issue.
Flatbush Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2013 NY Slip Op 50758(U)) Appellate Term, Second Department, May 6, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits established that the EUO scheduling letters and the denial of claim forms had been timely mailed, rejecting the provider's argument.
Medical Assoc., P.C. v Unitrin Advantage Ins. Co. (2013 NY Slip Op 50757(U)) Appellate Term, Second Department, May 6, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely mailing of its denial of claim forms based on lack of medical necessity.
Baybenson Chiropractic, LLC v Clarendon Natl. Ins. (2013 NY Slip Op 50756(U)) Appellate Term, Second Department, May 6, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's moving papers established that it timely denied the claims, a mailing finding supported by the St. Vincent's citation.
Five Boro Psychological Servs., P.C. v State Farm Mut. Auto. Ins. Co. (2013 NY Slip Op 50753(U)) Appellate Term, Second Department, May 6, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld, contrary to the provider's contentions, that the insurer's affidavits established timely mailing of the EUO scheduling letters and the denial of claim form.
Infinity Health Prods., Ltd. v Redland Ins. Co. (2013 NY Slip Op 50751(U)) Appellate Term, Second Department, May 6, 2013The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld no presumption of receipt arose because the IME letters and mailing logs used a zip code different from the assignor's on the claim form and assignment, and the attorney copied was not shown to represent the assignor.
Leica Supply, Inc. v American Tr. Ins. Co. (2013 NY Slip Op 50711(U)) Appellate Term, Second Department, April 30, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims examiner's affidavit sufficient to establish timely mailing of the denial, supporting dismissal because the claims were submitted beyond 45 days without adequate justification.
Crotona Hgts. Med., P.C. v Clarendon Natl. Ins. Co. (2013 NY Slip Op 50473(U)) Appellate Term, Second Department, March 29, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely mailing of its denial of claim forms and verification requests, with the results resting on unanswered verification and unrebutted peer reviews.
Five Boro Psychological Servs., P.C. v GEICO Gen. Ins. Co. (2013 NY Slip Op 50454(U)) Appellate Term, Second Department, March 20, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit established timely denial of the three remaining claims, as a predicate to dismissing them on the unrebutted peer reviews.
Broad St. Acupuncture, P.C. v American Tr. Ins. Co. (2013 NY Slip Op 50453(U)) Appellate Term, Second Department, March 20, 2013Different mailing results for different documents or claims in one decisionHeld the insurer timely mailed its partial denials but failed to prove mailing of IME scheduling letters, and its examiner's affidavit rebutted the presumption that one claim was mailed.
Norman Y. Schoenberg, M.D., P.C. v N.Y.C. Tr. Auth. (2013 NY Slip Op 50421(U)) Appellate Term, Second Department, March 15, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims examiner's affidavit sufficient to establish timely mailing of the denial based on the provider's late submission of its claim.
All Boro Psychological Servs., P.C. v Allstate Ins. Co. (2013 NY Slip Op 50307(U)) Appellate Term, Second Department, February 20, 2013The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer did not demonstrate as a matter of law that the IME scheduling letters were timely mailed, so it failed to show its time to pay or deny was tolled.
Alev Med. Supply, Inc. v New York Cent. Mut. Fire Ins. Co. (2013 NY Slip Op 50258(U)) Appellate Term, Second Department, February 19, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer demonstrated timely mailing of initial and follow-up IME scheduling letters and written verification requests, while the dispute turned on the timeliness of the denials.
Triangle R, Inc. v Tri-State Consumer Ins. Co. (2013 NY Slip Op 50256(U)) Appellate Term, Second Department, February 19, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits established timely mailing of initial and follow-up verification requests, and the office manager's mere denial of receipt did not overcome the presumption of receipt.
Compas Med., P.C. v Farm Family Cas. Ins. Co. (2013 NY Slip Op 50254(U)) Appellate Term, Second Department, February 19, 2013The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the provider's affidavit established mailing of the claim forms and the insurer's mere denial of receipt of two claims failed to rebut the presumption of receipt.
Infinity Health Prods., Ltd. v Travelers Ins. Co. (2013 NY Slip Op 50253(U)) Appellate Term, Second Department, February 19, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Found the claim for the last bill had been denied within 30 days of receipt, citing the standard-office-practice mailing authorities.
Compas Med., P.C. v Praetorian Ins. Co. (2013 NY Slip Op 50251(U)) Appellate Term, Second Department, February 19, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims examiner's and IME scheduler's affidavits sufficient to establish timely mailing of the verification requests, the IME scheduling letters and the denials.
Quality Psychological Servs., P.C. v Metropolitan Cas. Ins. Co. (2013 NY Slip Op 50250(U)) Appellate Term, Second Department, February 19, 2013The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to establish that its EUO scheduling letters had been mailed before the dates of the scheduled EUOs.
Compas Med., P.C. v Praetorian Ins. Co. (2013 NY Slip Op 50249(U)) Appellate Term, Second Department, February 19, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Found the IME scheduler's and claims examiner's affidavits sufficiently established timely mailing of the IME scheduling letters, the denials and the verification requests.
Jamaica Med. Supply, Inc. v GEICO Gen. Ins. Co. (2013 NY Slip Op 50247(U)) Appellate Term, Second Department, February 19, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected the provider's appellate argument and held the insurer's affidavit established timely mailing of the denial of claim forms.
Favorite Health Prods., Inc. v GEICO Ins. Co. (2013 NY Slip Op 50201(U)) Appellate Term, Second Department, February 11, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims examiner's affidavit sufficiently established timely mailing of the medical-necessity denial forms, so the defense was preserved and, with the peer reviews, defeated the provider's summary judgment motion.
Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co. (2013 NY Slip Op 50199(U)) Appellate Term, Second Department, February 11, 2013Different mailing results for different documents or claims in one decisionHeld the litigation supervisor's affidavit established timely mailing of denials and verification requests for most claims but not for one claim, about which the affidavit was silent.
Viviane Etienne Med. Care, P.C. v GEICO Gen. Ins. Co. (2013 NY Slip Op 50197(U)) Appellate Term, Second Department, February 11, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit sufficient to establish timely mailing of the denial of claim forms based on lack of medical necessity.
Barakat Med. Care, P.C. v Praetorian Ins. Co. (2013 NY Slip Op 50180(U)) Appellate Term, Second Department, February 1, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit established that it timely mailed its denials of the claims for the two dates of service on the ground of lack of medical necessity.
Flatlands Med., P.C. v State Farm Mut. Auto. Ins. Co. (2013 NY Slip Op 50071(U)) Appellate Term, Second Department, January 14, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits established that the EUO scheduling letters and the denial of claim forms had been timely mailed.
All Boro Psychological Servs., P.C. v Allstate Ins. Co. (2013 NY Slip Op 50069(U)) Appellate Term, Second Department, January 14, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits established timely mailing of its initial and follow-up verification requests.
Axis Chiropractic, PLLC v Geico Gen. Ins. Co. (2013 NY Slip Op 50068(U)) Appellate Term, Second Department, January 14, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit established timely mailing of the denial of claim forms based on lack of medical necessity.
Axis Chiropractic, PLLC v Geico Gen. Ins. Co. (2013 NY Slip Op 50067(U)) Appellate Term, Second Department, January 14, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit established timely mailing of the denial of claim forms based on lack of medical necessity.
Axis Chiropractic, PLLC v Geico Gen. Ins. Co. (2013 NY Slip Op 50066(U)) Appellate Term, Second Department, January 14, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit established timely mailing of the denial of claim forms based on lack of medical necessity.
Parsons Med. Supply, Inc. v Progressive Northeastern Ins. Co. (2013 NY Slip Op 50065(U)) Appellate Term, Second Department, January 14, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit established timely mailing of the denial of claim form based on lack of medical necessity.
Alfa Med. Supplies v GEICO Gen. Ins. Co. (2013 NY Slip Op 50064(U)) Appellate Term, Second Department, January 14, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit established timely mailing of the denial of claim form based on lack of medical necessity.
Quality Psychological Servs., P.C. v New York Cent. Mut. Fire Ins. Co. (2013 NY Slip Op 50063(U)) Appellate Term, Second Department, January 14, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the litigation examiner's affidavit sufficed to establish timely mailing of the NF-10 denial based on lack of medical necessity.
Eastern Star Acupuncture, P.C. v American Tr. Ins. Co. (2013 NY Slip Op 50059(U)) Appellate Term, Second Department, January 14, 2013Different mailing results for different documents or claims in one decisionHeld the scheduler's affidavit proved the IME letters were mailed under standard office practice and denials of three claims timely mailed, but the insurer failed to establish timely denial of another claim.
Brooklyn Hgts. Physical Therapy, P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 52406(U)) Appellate Term, Second Department, December 21, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the scheduler's standard-practice affidavit proved timely mailing of the IME letters and the litigation examiner's affidavit proved timely mailing of the denials.
Alfa Med. Supplies v GEICO Gen. Ins. Co. (2012 NY Slip Op 52405(U)) Appellate Term, Second Department, December 21, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit established that it timely denied the claim for lack of medical necessity, so the denial was proved mailed in time.
Essential Acupuncture Servs., P.C. v Ameriprise Auto & Home Ins. (2012 NY Slip Op 52404(U)) Appellate Term, Second Department, December 21, 2012The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to establish that its initial and follow-up EUO scheduling letters had been timely mailed.
Brooklyn Hgts. Physical Therapy, P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 52398(U)) Appellate Term, Second Department, December 21, 2012The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the litigation examiner's affidavit insufficient to establish timely mailing of the denials, so the insurer was not entitled to summary judgment.
Infinity Health Prods., Ltd. v Liberty Mut. Fire Ins. Co. (2012 NY Slip Op 52396(U)) Appellate Term, Second Department, December 21, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claim specialist's affidavit established timely mailing of the verification requests and follow-ups; the dispute below concerned whether the provider had responded.
Huntington Hosp. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 52274(U)) Appellate Term, Second Department, December 7, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the litigation examiner's affidavit established timely mailing of the initial and follow-up verification requests, and the provider did not rebut that showing.
Lenox Hill Radiology, P.C. v Redland Ins. Co. (2012 NY Slip Op 52263(U)) Appellate Term, Second Department, December 7, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit established that the denial had been issued in duplicate, resolving the only issue the lower court left for trial and entitling the insurer to summary judgment.
Essential Acupuncture Servs., P.C. v Amex Assur. Co. (2012 NY Slip Op 52259(U)) Appellate Term, Second Department, December 7, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely issuance of the EUO scheduling letters, tolling its time to pay or deny the $556.90 claim.
Morris Med., P.C. v Amex Assur. Co. (2012 NY Slip Op 52260(U)) Appellate Term, Second Department, December 7, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely issuance of EUO scheduling letters that tolled its time to pay or deny six claims.
Alev Med. Supply, Inc. v Eveready Ins. Co. (2012 NY Slip Op 52184(U)) Appellate Term, Second Department, November 26, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims examiner's affidavit established timely mailing of the verification requests and follow-up requests.
Oriental World Acupuncture, P.C. v American Tr. Ins. Co. (2012 NY Slip Op 52181(U)) Appellate Term, Second Department, November 26, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit established timely mailing of its verification requests and follow-up requests.
Arco Med. NY, P.C. v Lancer Ins. Co. (2012 NY Slip Op 52178(U)) Appellate Term, Second Department, November 26, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld, reversing the lower court's contrary finding, that the insurer's opposition established timely mailing of the EUO scheduling letters and of the denial on the no-show ground.
Ukon Med. Care, P.C. v Clarendon Natl. Ins. Co. (2012 NY Slip Op 52176(U)) Appellate Term, Second Department, November 26, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims employee's affidavit established that the insurer timely mailed its denials asserting late notice of the accident, supporting the insurer's prima facie showing on that defense.
Quality Psychological Servs., P.C. v Travelers Ins. Co. (2012 NY Slip Op 52080(U)) Appellate Term, Second Department, October 25, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld, contrary to the lower court, that the insurer's affidavit sufficed to establish timely mailing of its denial of claim forms.
Complete Radiology, P.C. v Progressive Ins. Co. (2012 NY Slip Op 52079(U)) Appellate Term, Second Department, October 25, 2012Different mailing results for different documents or claims in one decisionHeld the insurer's proof established a standard office practice ensuring its denials were properly addressed and mailed, and timely denial of one claim, but a triable issue existed on the other claim given conflicting sent and received dates of the bill.
Infinity Health Prods., Ltd. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 51955(U)) Appellate Term, Second Department, October 16, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the scheduler's standard-practice affidavit proved timely mailing of the IME letters and the litigation examiner's affidavit proved timely mailing of the denials.
Ayoob Khodadadi, M.D.,MRI, P.C. v Clarendon Natl. Ins. Co. (2012 NY Slip Op 51968(U)) Appellate Term, Second Department, October 11, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims examiner's affidavit demonstrated that the insurer timely mailed its denial of claim forms based on lack of medical necessity.
Rainbow Med. Care, P.C. v Kemper Ins. Co. (2012 NY Slip Op 51923(U)) Appellate Term, Second Department, October 5, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the scheduling company owner's standard-practice affidavit proved timely mailing of the IME letters, and the insurer proved timely mailing of the denials.
Alfa Med. Supplies v Utica Mut. Ins. Co. (2012 NY Slip Op 51890(U)) Appellate Term, Second Department, September 28, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit established that it timely denied the $2,199 claim on the ground of lack of medical necessity.
All Boro Psychological Servs., P.C. v Hartford Ins. Co. (2012 NY Slip Op 51849(U)) Appellate Term, Second Department, September 19, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's contentions and held the insurer's affidavits established timely mailing of both the EUO scheduling letters and the denial of claim form.
Ying E. Acupuncture, P.C. v GEICO Ins. Co. (2012 NY Slip Op 51805(U)) Appellate Term, Second Department, September 13, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims employee's affidavit submitted in opposition sufficiently established timely mailing of the denial of claim forms.
Jamaica Med. Supply, Inc. v Encompass Indem. Co. (2012 NY Slip Op 51825(U)) Appellate Term, Second Department, September 13, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's contentions and held the insurer's affidavits established timely mailing of the EUO scheduling letters and denial of claim forms.
AIM Acupuncture, P.C. v Travelers Ins. Co. (2012 NY Slip Op 51773(U)) Appellate Term, Second Department, September 5, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits established timely mailing of its verification requests and follow-up requests.
Flushing Traditional Acupuncture, P.C. v GEICO Ins. Co. (2012 NY Slip Op 51772(U)) Appellate Term, Second Department, September 5, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeReversed the lower court and held the employee's affidavit, describing the standard mailing practice of the office the denials were mailed from, established timely mailing.
BLR Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 51770(U)) Appellate Term, Second Department, September 5, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the litigation examiner's affidavit demonstrated that the denial of claim form was timely mailed, contrary to the lower court's finding of a triable issue.
Hollis Med. Servs., P.C. v GEICO Ins. Co. (2012 NY Slip Op 51768(U)) Appellate Term, Second Department, September 5, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld, contrary to the lower court, that the employee's affidavit established timely mailing of the denials because it showed they were mailed from a specific office and described that office's standard mailing practice.
Alfa Med. Supplies v GEICO Gen. Ins. Co. (2012 NY Slip Op 51765(U)) Appellate Term, Second Department, September 5, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's appellate challenge and held the insurer's affidavit established timely mailing of the denial of claim forms.
Atlantic Radiology Imaging, P.C. v NY Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 51725(U)) Appellate Term, Second Department, August 31, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the scheduler employee's standard-practice affidavit proved timely mailing of the IME letters and the insurer's employee affidavit proved timely mailing of the denials.
Five S & A Rehab Pt, P.C. v Praetorian Ins. Co. (2012 NY Slip Op 51724(U)) Appellate Term, Second Department, August 31, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it had timely mailed its denial of claim forms.
Dr. Todd Goldman, D.C., P.C. v Kemper Cas. Ins. Co. (2012 NY Slip Op 51713(U)) Appellate Term, Second Department, August 31, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit established that it had timely denied the claims for lack of medical necessity, proving timely mailing of the denials.
Brooklyn Hgts. Physical Therapy, P.C. v Liberty Mut. Fire Ins. Co. (2012 NY Slip Op 51712(U)) Appellate Term, Second Department, August 31, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's opposition proved timely mailing of the IME letters under the scheduler's standard practice and timely mailing of the denials, defeating the provider's summary judgment motion.
W.H.O. Acupuncture, P.C. v Travelers Home & Mar. Ins. Co. (2012 NY Slip Op 51707(U)) Appellate Term, Second Department, August 31, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge and held the sending entity's standard-practice affidavit sufficiently showed the IME scheduling letters were mailed.
Five Boro Psychological Servs., P.C. v GEICO Gen. Ins. Co. (2012 NY Slip Op 51705(U)) Appellate Term, Second Department, August 31, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected the provider's appellate argument and held the insurer's affidavit established timely mailing of the denial of claim form.
Five Boro Psychological Servs., P.C. v GEICO Gen. Ins. Co. (2012 NY Slip Op 51704(U)) Appellate Term, Second Department, August 31, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected the provider's appellate argument and held the insurer's affidavit established timely mailing of the denial of claim form.
Five Boro Psychological Servs., P.C. v GEICO Gen. Ins. Co. (2012 NY Slip Op 51703(U)) Appellate Term, Second Department, August 31, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's appellate argument and held the insurer's affidavit established timely mailing of the denial of claim form.
Axis Chiropractic, PLLC v GEICO Gen. Ins. Co. (2012 NY Slip Op 51702(U)) Appellate Term, Second Department, August 31, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's appellate argument and held the insurer's affidavit established timely mailing of the denial of claim forms.
VE Med. Care, P.C. v NY Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 51659(U)) Appellate Term, Second Department, August 27, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected the provider's arguments and held the litigation examiner's affidavit sufficient to establish that the insurer timely denied the claims.
Jamaica Med. Supply, Inc. v NY City Tr. Auth. (2012 NY Slip Op 51660(U)) Appellate Term, Second Department, August 27, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims examiner's affidavit established timely mailing of the denial, which rested on late written notice of the accident.
Viviane Etienne Med. Care, P.C. v GEICO Gen. Ins. Co. (2012 NY Slip Op 51655(U)) Appellate Term, Second Department, August 24, 2012Different mailing results for different documents or claims in one decisionHeld the claims employee's affidavit established timely mailing of denials for four claims but the insurer failed to establish timely denial of two other claims, which therefore survived.
Acupuncture Works, P.C. v State Farm Mut. Auto. Ins. Co. (2012 NY Slip Op 51654(U)) Appellate Term, Second Department, August 24, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's contentions and held the insurer's moving papers established that the denial of claim forms had been timely mailed.
Neomy Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 51653(U)) Appellate Term, Second Department, August 24, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the scheduler's affidavit proved timely mailing of the IME scheduling letters and the litigation examiner's affidavit proved timely denial.
Jamhil Med., P.C. v Clarendon Natl. Ins. Co. (2012 NY Slip Op 51644(U)) Appellate Term, Second Department, August 23, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the review service president's affidavit proved timely mailing of the IME scheduling letters and the claims examiner's affidavit proved timely denial.
Quality Health Prods. v Country-Wide Ins. Co. (2012 NY Slip Op 51641(U)) Appellate Term, Second Department, August 23, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the litigation supervisor's affidavit established timely mailing of the initial and follow-up verification requests to the provider.
Neomy Med., P.C. v Clarendon Natl. Ins. Co. (2012 NY Slip Op 51639(U)) Appellate Term, Second Department, August 23, 2012The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit failed to establish that it timely denied the claims, so the insurer did not show its medical-necessity defense was not precluded.
BLR Chiropractic, P.C. v GEICO (2012 NY Slip Op 51647(U)) Appellate Term, Second Department, August 23, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge and held the insurer established timely mailing of its verification requests and denials, supporting dismissal of the complaint.
All Star Wellness Med., P.C. v Praetorian Ins. Co. (2012 NY Slip Op 51630(U)) Appellate Term, Second Department, August 7, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the IME scheduling vendor's affidavit of its standard office practices sufficiently established that the IME requests were timely mailed.
Brownsville Advance Med., P.C. v Kemper Independence Ins. Co. (2012 NY Slip Op 51629(U)) Appellate Term, Second Department, August 7, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer sufficiently established that its denial of claim form, based on lack of medical necessity, had been timely mailed.
Quality Psychological Servs., P.C. v Interboro Mut. Indem. Ins. Co. (2012 NY Slip Op 51628(U)) Appellate Term, Second Department, August 7, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits established timely mailing of both the EUO scheduling letters and the denial of claim form.
Essential Acupuncture Servs., P.C. v NY Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 51623(U)) Appellate Term, Second Department, August 7, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it timely denied three claims on medical-necessity grounds, a mailing finding supported by citation to the standard-office-practice rule.
Infinity Health Prods., Ltd. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 51497(U)) Appellate Term, Second Department, August 6, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the scheduler's standard-practice affidavit established that the IME scheduling letters were timely mailed.
Qi-Health Acupuncture Servs., P.C. v Clarendon Natl. Ins. Co. (2012 NY Slip Op 51494(U)) Appellate Term, Second Department, August 6, 2012The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit failed to establish timely denial of the claims, so the IME no-show defense was precluded.
Jamaica Dedicated Med. Care, P.C. v State Farm Mut. Auto. Ins. Co. (2012 NY Slip Op 51493(U)) Appellate Term, Second Department, August 6, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits sufficient to establish that both the EUO scheduling letters and the denial of claim forms were timely and properly mailed.
Rainbow Supply of NY, Inc. v Clarendon Natl. Ins. Co. (2012 NY Slip Op 51489(U)) Appellate Term, Second Department, August 6, 2012The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit failed to establish timely mailing of its denial, so the insurer did not show it was not precluded from asserting the IME no-show defense and its motion was properly denied.
Perfect Point Acupuncture, P.C. v Auto One Ins. Co. (2012 NY Slip Op 51486(U)) Appellate Term, Second Department, August 6, 2012The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to establish that the IME scheduling letters were mailed to the assignor, so its no-show defense could not support summary judgment.
Five Boro Psychological Servs., P.C. v GEICO Gen. Ins. Co. (2012 NY Slip Op 51447(U)) Appellate Term, Second Department, July 25, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's contention and held the claims employee's affidavit established timely mailing of the denial of claim forms.
Midtown Med. Assoc., P.C. v Clarendon Natl. Ins. Co. (2012 NY Slip Op 51351(U)) Appellate Term, Second Department, July 13, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit sufficient to establish that its denial of claim forms had been timely mailed.
Natural Therapy Acupuncture, P.C. v Interboro Ins. Co. (2012 NY Slip Op 51350(U)) Appellate Term, Second Department, July 13, 2012The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the insurer's detailed non-receipt affidavit established the second claim form was never received, and with no sworn statement from anyone with knowledge of its submission the claim was dismissed; denials were also held timely mailed.
J.M. Chiropractic Servs., PLLC v State Farm Mut. Ins. Co. (2012 NY Slip Op 51348(U)) Appellate Term, Second Department, July 13, 2012The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove mailing of the EUO letters because no affidavit attested to actual mailing or described a standard office practice, despite attached certificates of mailing.
All Boro Psychological Servs., P.C. v State Farm Mut. Auto. Ins. Co. (2012 NY Slip Op 51346(U)) Appellate Term, Second Department, July 13, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer proved mailing of the EUO scheduling letters and denial because the claims representative tied the letter's article number to the certificate of mailing and other affiants detailed the mailing practices.
Dr. Stephen Matrangolo, D.C., P.C. v Encompass Indem. Co. (2012 NY Slip Op 51338(U)) Appellate Term, Second Department, July 12, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims representative's affidavit sufficient to establish timely mailing of the initial and follow-up verification requests.
Dr. Todd Goldman, D.C., P.C. v Kemper Cas. Ins. Co. (2012 NY Slip Op 51296(U)) Appellate Term, Second Department, June 28, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that the denial forms annexed to its motion had been timely mailed.
Richmond Radiology, P.C. v State Farm Ins. Co. (2012 NY Slip Op 51293(U)) Appellate Term, Second Department, June 28, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it timely denied the claims on lack-of-medical-necessity grounds, a finding on its mailing proof, though the result turned on the provider's medical-necessity rebuttal.
Olga Bard Acupuncture, P.C. v GEICO Ins. Co. (2012 NY Slip Op 51292(U)) Appellate Term, Second Department, June 28, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits sufficed to establish timely denial of the fee-schedule claims, a mailing finding supported by standard-practice authority.
Megacure Acupuncture, P.C. v GEICO Ins. Co. (2012 NY Slip Op 51291(U)) Appellate Term, Second Department, June 28, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims-division employee's affidavit sufficient to establish timely mailing of the denial of claim forms.
Gentle Care Acupuncture, P.C. v GEICO Ins. Co. (2012 NY Slip Op 51290(U)) Appellate Term, Second Department, June 28, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims-division employees' affidavits sufficient to establish that the insurer timely denied the provider's claims.
Mega Supplies Billing, Inc. v State Farm Mut. Auto. Ins. Co. (2012 NY Slip Op 51276(U)) Appellate Term, Second Department, June 27, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the SIU employees' affidavits sufficient to establish timely mailing of the EUO scheduling letters and the denial forms.
Colonia Med., P.C. v State Farm Mut. Auto. Ins. Co. (2012 NY Slip Op 51273(U)) Appellate Term, Second Department, June 27, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld affidavits of the SIU team manager, mail room employee and bulk mail vendor sufficient to establish timely mailing of the EUO scheduling letters and denial forms, rejecting the provider's challenge.
BR Clinton Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 51270(U)) Appellate Term, Second Department, June 27, 2012The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to establish timely mailing of its initial and follow-up verification requests to the assignor, so tolling was not shown and its IME denials were not shown timely.
Mega Supplies Billing, Inc. v State Farm Mut. Auto. Ins. Co. (2012 NY Slip Op 51269(U)) Appellate Term, Second Department, June 27, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld affidavits of the litigation examiner, SIU and mail room employees sufficient to establish timely mailing of the EUO scheduling letters and denial forms, rejecting the provider's challenge.
A.M. Med., P.C. v General Assur. Co. (2012 NY Slip Op 51272(U)) Appellate Term, Second Department, June 27, 2012The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer did not show it timely denied the claims because its litigation examiner's affidavit failed to establish when the denial of claim form was mailed.
VE Med. Care, P.C. v NY Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 51074(U)) Appellate Term, Second Department, June 11, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the scheduling vendor's affidavit established timely mailing of IME letters under its standard practices and the claims examiner's affidavit established timely mailing of the denial.
Five Boro Psychological Servs., P.C. v GEICO Gen. Ins. Co. (2012 NY Slip Op 51057(U)) Appellate Term, Second Department, June 11, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims examiner's affidavit sufficient to establish that the NF-10 denials based on lack of medical necessity were timely mailed.
Vista Surgical Supplies, Inc. v Clarendon Natl. Ins. Co. (2012 NY Slip Op 51056(U)) Appellate Term, Second Department, June 11, 2012The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseUpheld the finding that the provider failed to prove timely mailing because its certified-mail receipt and unsigned return receipt lacked postage, clerk, date and delivery information, and the insurer denied receipt.
Midwood Total Rehabilitation Med., P.C. v State Farm Mut. Auto. Ins. Co. (2012 NY Slip Op 50931(U)) Appellate Term, Second Department, May 15, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the scheduling vendor's affidavit established timely mailing of the IME letters and the claims examiner's and supervisor's affidavits established timely mailing of the denials.
Med-Tech Prod., Inc. v Progressive Northeastern Ins. Co. (2012 NY Slip Op 50930(U)) Appellate Term, Second Department, May 15, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims examiner's affidavit established timely mailing of the verification requests and follow-up requests to the provider.
Eastern Star Acupuncture, P.C. v GEICO Ins. Co. (2012 NY Slip Op 51010(U)) Appellate Term, Second Department, May 14, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims-division employees' affidavits sufficiently established timely mailing of the claim denial forms.
Leica Supply, Inc. v Encompass Indem. Co. (2012 NY Slip Op 50890(U)) Appellate Term, Second Department, May 14, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge and held the insurer's affidavits established timely mailing of the EUO scheduling letters and the denial of claim form.
Mega Supplies Billing, Inc. v State Farm Fire & Cas. Co. (2012 NY Slip Op 51014(U)) Appellate Term, Second Department, May 14, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's arguments and held the insurer's affidavits established timely mailing of the EUO scheduling letters and denial of claim forms.
W.H.O. Acupuncture, P.C. v GEICO Gen. Ins. Co. (2012 NY Slip Op 50884(U)) Appellate Term, Second Department, May 11, 2012The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer's standard-office-practice affidavit made a prima facie showing of timely denial, but the provider's employee affidavit raised a triable issue whether one claim was timely denied, so summary judgment was denied for it.
BLR Chiropractic, P.C. v American Tr. Ins. Co. (2012 NY Slip Op 50882(U)) Appellate Term, Second Department, May 11, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits sufficient to establish that it timely denied the claim on the ground of lack of medical necessity.
BR Clinton Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 50880(U)) Appellate Term, Second Department, May 11, 2012Different mailing results for different documents or claims in one decisionHeld the IME scheduler's office-practice affidavit proved timely mailing of the scheduling letters and the litigation examiner proved timely mailing of denials for four claims, but no mailing proof covered the remaining claim's denial.
Raz Acupuncture, P.C. v New S. Ins. Co. (2012 NY Slip Op 50865(U)) Appellate Term, Second Department, May 11, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits established timely denial of the claims on the fee schedule ground, a mailing finding supported by standard-practice authority.
Exclusive Physical Therapy, P.C. v MVAIC (2012 NY Slip Op 50862(U)) Appellate Term, Second Department, May 11, 2012The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to show timely mailing of its denials because its claims representative began working there after the denials were allegedly mailed and established neither actual mailing nor the practice then in effect.
Infinity Health Prods. Ltd. v Liberty Mut. Fire Ins. Co. (2012 NY Slip Op 50774(U)) Appellate Term, Second Department, April 27, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claim specialist's affidavit established timely mailing of the verification requests and follow-up requests.
Neomy Med., P.C. v American Tr. Ins. Co. (2012 NY Slip Op 50769(U)) Appellate Term, Second Department, April 25, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it timely mailed its denial of the claim, which was based on lack of medical necessity.
Alfa Med. Supplies v Geico Gen. Ins. Co. (2012 NY Slip Op 50762(U)) Appellate Term, Second Department, April 25, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge and held the claim representative's affidavit sufficient to establish timely mailing of the denials, the sole issue on appeal.
Axis Chiropractic, PLLC v Clarendon Natl. Ins. Co. (2012 NY Slip Op 50753(U)) Appellate Term, Second Department, April 25, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the scheduling company president's affidavits established timely mailing of IME letters under standard practices, and the claims examiner's affidavit established timely mailing of the denials.
Quality Psychological Servs., P.C. v MVAIC (2012 NY Slip Op 50757(U)) Appellate Term, Second Department, April 25, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits established timely mailing of the IME scheduling letters and the no-show denials.
New York Diagnostic Med. Care, P.C. v Geico Cas. Ins. Co. (2012 NY Slip Op 50681(U)) Appellate Term, Second Department, April 10, 2012The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the billing manager's affidavit established that the claim forms were mailed within 45 days of service, defeating the insurer's late-submission denial measured from its date of receipt.
East-West Acupuncture v Safeco Ins. Co. of Ind. (2012 NY Slip Op 22095) Appellate Term, Second Department, April 4, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits sufficiently set forth its procedures for mailing EUO letters and denials, and allowed a defective out-of-state certificate of conformity to be cured nunc pro tunc.
Viviane Etienne Med. Care, P.C. v State Farm Mut. Auto. Ins. Co. (2012 NY Slip Op 50579(U)) Appellate Term, Second Department, April 2, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits established timely mailing of the EUO scheduling letters and denial forms under its standard office practices.
East 75th St. Diagnostic Imaging, P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 50564(U)) Appellate Term, Second Department, March 28, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the scheduling vendor's affidavit established the IME notices were sent under its standard practices and that the denials were timely mailed under the insurer's standard practices.
Vincent Med. Servs., P.C. v Clarendon Natl. Ins. Co. (2012 NY Slip Op 50431(U)) Appellate Term, Second Department, March 6, 2012Different mailing results for different documents or claims in one decisionHeld the insurer proved timely mailing of its denials for the eighth cause of action, but the provider's claim of personally mailing the $608.40 bill on a date before the bill's own date failed against the insurer's detailed non-receipt showing.
Rally Chiropractic, P.C. v Nationwide Mut. Ins. Co. (2012 NY Slip Op 50417(U)) Appellate Term, Second Department, March 6, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it timely denied the claim, though the ineligibility defense was in any event not subject to preclusion.
MSSA Corp. v Praetorian Ins. Co. (2012 NY Slip Op 50413(U)) Appellate Term, Second Department, March 6, 2012The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the claims examiner's affidavit failed to show the verification request was timely mailed under standard office practices, so the time to deny was not tolled and the late denial left the defense precluded.
Crotona Hgts. Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 50401(U)) Appellate Term, Second Department, March 5, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit established that it timely denied the claims on the ground of lack of medical necessity.
Perfect Point Acupuncture, P.C. v Clarendon Ins. Co. (2012 NY Slip Op 50399(U)) Appellate Term, Second Department, March 5, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims examiner's affidavit sufficient to establish timely denial of the disputed portions of the claims, a mailing finding supported by standard-practice authority.
Quality Psychological Servs., P.C. v MVAIC (2012 NY Slip Op 50404(U)) Appellate Term, Second Department, March 5, 2012The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the insurer showed non-receipt of the claim and the provider failed to establish that it mailed the claim form, so the 30-day period never began.
MIA Acupuncture, P.C. v Integon Gen. Ins. Corp. (2012 NY Slip Op 50393(U)) Appellate Term, Second Department, March 2, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims representative's affidavit and an affidavit of the third-party mailing vendor's employee together demonstrated timely denial of the disputed portion of the claims.
Medical Assoc., P.C. v Interboro Ins. Co. (2012 NY Slip Op 50392(U)) Appellate Term, Second Department, March 2, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit established that it timely denied the claim on the ground of lack of medical necessity.
Superior Oxygen & Ortho Supplies, Ltd. v Auto One Ins. Co. (2012 NY Slip Op 50348(U)) Appellate Term, Second Department, February 21, 2012The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to establish that its EUO scheduling letters had been timely mailed, so it could not show tolling or timely denials.
Raz Acupuncture, P.C. v Praetorian Ins. Co. (2012 NY Slip Op 50305(U)) Appellate Term, Second Department, February 14, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims examiner's affidavit established that the denials were timely mailed in accordance with the insurer's standard office practices and procedures.
Elmont Open MRI & Diagnostic Radiology, P.C. v Tri-State Ins. Co. (2012 NY Slip Op 50170(U)) Appellate Term, Second Department, January 24, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits sufficient to demonstrate that it timely denied the claims on the ground of lack of medical necessity.
Eagle Surgical Supply, Inc. v Progressive Cas. Ins. Co. (2012 NY Slip Op 50151(U)) Appellate Term, Second Department, January 24, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the litigation representative's affidavit sufficient to establish that the NF-10 denials based on lack of medical necessity were timely mailed.
Ortho-Med Surgical Supply, Inc. v Progressive Cas. Ins. Co. (2012 NY Slip Op 50149(U)) Appellate Term, Second Department, January 24, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it timely denied the $498 claim on the ground of lack of medical necessity.
Neomy Med., P.C. v Geico Ins. Co. (2012 NY Slip Op 50145(U)) Appellate Term, Second Department, January 24, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it timely denied the claim on the ground of lack of medical necessity.
Jesa Med. Supply, Inc. v American Tr. Ins. Co. (2012 NY Slip Op 50052(U)) Appellate Term, Second Department, January 13, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the litigation representative's affidavit established timely mailing of the verification request and follow-up under the insurer's standard office practices and procedures.
Sky Med. Supply, Inc. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 50050(U)) Appellate Term, Second Department, January 13, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit sufficient to establish that the denial was timely mailed in accordance with its standard office practices and procedures.
MIA Acupuncture, P.C. v Praetorian Ins. Co. (2011 NY Slip Op 21480) Appellate Term, Second Department, December 29, 2011The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld a triable issue existed on when the provider mailed its claim form, given the billing manager's averment of personal mailing against the insurer's later-postmarked envelope, so the 45-day denial could not be resolved on summary judgment.
Arco Med. NY, P.C. v Lancer Ins. Co. (2011 NY Slip Op 52384(U)) Appellate Term, Second Department, December 23, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's attorney's affirmation established that the EUO scheduling letters were mailed under the law firm's standard office practices, and that the denials of five claims were timely mailed.
Arco Med. NY, P.C. v Lancer Ins. Co. (2011 NY Slip Op 52383(U)) Appellate Term, Second Department, December 23, 2011The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer submitted no evidence that it mailed the denial forms addressing the claims at issue, although they appeared timely on their face, so it failed to prove timely denial.
ARCO Med. N.Y., P.C. v Lancer Ins. Co. (2011 NY Slip Op 52382(U)) Appellate Term, Second Department, December 23, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's attorney's affirmation established mailing of the EUO scheduling letters under the law firm's standard office practices, contrary to the lower court's finding, and that the denials were issued.
Biobalance Med., P.C. v Clarendon Natl. Ins. Co. (2011 NY Slip Op 52378(U)) Appellate Term, Second Department, December 23, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it timely denied the claim on the ground of lack of medical necessity.
WJJ Acupuncture, P.C. v Geico Ins. Co. (2011 NY Slip Op 52377(U)) Appellate Term, Second Department, December 23, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims division employee's affidavit sufficient to establish timely denial of the unpaid portion on the fee schedule ground, a mailing finding supported by standard-practice authority.
Liu Yong, Acupuncture v Metropolitan Prop. & Cas. Ins. Co. (2011 NY Slip Op 52375(U)) Appellate Term, Second Department, December 23, 2011Different mailing results for different documents or claims in one decisionHeld the litigation representative's affidavit established timely mailing of the denials for most claims, but not of the partial-denial form for one claim, so summary judgment on that claim was denied.
Right Aid Diagnostic Medicine, P.C. v GEICO Ins. Co. (2011 NY Slip Op 52367(U)) Appellate Term, Second Department, December 23, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims examiner's affidavit sufficient to establish that the insurer timely denied the claim on the ground of lack of medical necessity.
Apple Tree Acupuncture, P.C. v Interboro Ins. Co. (2011 NY Slip Op 52364(U)) Appellate Term, Second Department, December 23, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely mailing of the denial forms under its standard office practices; the result turned on denial specificity and medical necessity.
Quality Health Prods. v Geico Gen. Ins. Co. (2011 NY Slip Op 52299(U)) Appellate Term, Second Department, December 19, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit established timely denial of the claim in accordance with its standard office practices and procedures.
W.H.O. Acupuncture, P.C. v State-Wide Ins. Co. (2011 NY Slip Op 52298(U)) Appellate Term, Second Department, December 19, 2011The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's moving papers insufficient to establish timely mailing of verification requests, so it could not show tolling of its 30-day period to pay or deny.
Comfort Supply, Inc. v Progressive Northeastern Ins. Co. (2011 NY Slip Op 52289(U)) Appellate Term, Second Department, December 19, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the litigation representative's affidavit sufficient to establish that the denials were timely mailed in accordance with the insurer's standard office practices and procedures.
WJJ Acupuncture, P.C. v Nationwide Mut. Ins. Co. (2011 NY Slip Op 52288(U)) Appellate Term, Second Department, December 19, 2011The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the claims representative's affidavit established neither actual timely mailing nor mailing under a standard office practice, so no presumption of mailing arose and the insurer's fee-schedule motion failed.
Queens Med. Supply, Inc. v Geico Gen. Ins. Co. (2011 NY Slip Op 52284(U)) Appellate Term, Second Department, December 16, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit established timely denial of the claim in accordance with its standard office practices and procedures.
Quality Psychological Servs., P.C. v Auto One Ins. Co. (2011 NY Slip Op 52281(U)) Appellate Term, Second Department, December 16, 2011The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the claims representative's affidavit insufficient to establish that the denial had been timely mailed under the insurer's standard office practices.
Neomy Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 52279(U)) Appellate Term, Second Department, December 16, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the scheduling vendor's affidavit established timely mailing of IME letters and the litigation examiner's affidavit established timely mailing of the denials under standard practices.
Metrostar, Inc. v Electric Ins. Co. (2011 NY Slip Op 52277(U)) Appellate Term, Second Department, December 16, 2011The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits insufficient to establish proper mailing of the IME scheduling letters.
Psychology YM, P.C. v Progressive Northeastern Ins. Co. (2011 NY Slip Op 52275(U)) Appellate Term, Second Department, December 16, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the litigation representative's affidavit sufficient to establish timely mailing of verification requests and follow-ups under the insurer's standard office practices and procedures.
Eastern Star Acupuncture, P.C. v American Tr. Ins. Co. (2011 NY Slip Op 52205(U)) Appellate Term, Second Department, December 5, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely mailing of its denials and, through a scheduler employee who personally mailed them on specific dates, of the IME requests.
Megacure Acupuncture, P.C. v Clarendon Natl. Ins. Co. (2011 NY Slip Op 52199(U)) Appellate Term, Second Department, November 30, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims employee's affidavit sufficed to establish that the verification requests and denials were timely mailed under the insurer's standard office practices and procedures.
Parsons Med. Supply, Inc. v Metropolitan Prop. & Cas. Ins. Co. (2011 NY Slip Op 52198(U)) Appellate Term, Second Department, November 30, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer demonstrated timely mailing of the NF-10 denials based on its standard office practices and procedures.
Top Choice Med., P.C. v GEICO Gen. Ins. Co. (2011 NY Slip Op 52063(U)) Appellate Term, Second Department, November 4, 2011The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the billing clerk's affidavit established mailing of two claims and the insurer's bare non-receipt statement did not rebut it; separately held the insurer's practice affidavit proved timely mailing of denials for two other claims.
Park Slope Med. v Praetorian Ins. Co. (2011 NY Slip Op 52062(U)) Appellate Term, Second Department, November 4, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the scheduling service president's affidavit established timely mailing of the IME letters and the claims employee's affidavit established timely mailing of the denials under standard practices.
Comfort Supply, Inc. v Clarendon Natl. Ins. Co. (2011 NY Slip Op 52018(U)) Appellate Term, Second Department, October 28, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims employee's affidavit established that the insurer timely mailed its late-notice denial in accordance with its standard office practices and procedures.
Trimed Med. Supply, Inc. v American Tr. Ins. Co. (2011 NY Slip Op 51880(U)) Appellate Term, Second Department, October 18, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer showed its claim denial forms were timely mailed in accordance with its standard office practices and procedures, a finding that supported its cross motion decided on medical necessity.
Padova Physical Rehab. Medicine, P.C. v Praetorian Ins. Co. (2011 NY Slip Op 51862(U)) Appellate Term, Second Department, October 14, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the IME service manager's affidavit established timely mailing of the IME notices and the examiner's affidavit established timely mailing of the denials under standard practices.
Radiology Imaging of Queens v Progressive Ins. (2011 NY Slip Op 51860(U)) Appellate Term, Second Department, October 14, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that its denial of claim form was timely mailed in accordance with its standard office practices and procedures.
Crotona Hgts. Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 51859(U)) Appellate Term, Second Department, October 12, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the litigation examiner's affidavit sufficient to establish that the insurer timely denied each claim, citing the standard-office-practice mailing rule.
Five Boro Psychological Servs., P.C. v Clarendon Natl. Ins. Co. (2011 NY Slip Op 51858(U)) Appellate Term, Second Department, October 12, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it timely mailed the denial of claim form denying the claim for lack of medical necessity.
AVA Acupuncture, P.C. v GEICO Gen. Ins. Co. (2011 NY Slip Op 51856(U)) Appellate Term, Second Department, October 12, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected the provider's contention and held the claims employee's affidavit established that the denial forms were timely mailed under the insurer's standard office practices and procedures.
Proscan Imaging Buffalo v Clarendon Natl. Ins. Co. (2011 NY Slip Op 51855(U)) Appellate Term, Second Department, October 12, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the scheduling service president's affidavit established timely mailing of the IME requests and the claims employee's affidavit established timely mailing of the denials under standard practices.
Triangle R, Inc. v Clarendon Natl. Ins. Co. (2011 NY Slip Op 51854(U)) Appellate Term, Second Department, October 12, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the scheduling entity president's affidavit established timely mailing of the IME requests and the claims examiner's affidavit established timely mailing of the denial under standard practices.
Parkway Imaging & Diagnostic, P.C. v Clarendon Natl. Ins. Co. (2011 NY Slip Op 51853(U)) Appellate Term, Second Department, October 12, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the scheduling service president's affidavit established timely mailing of the IME requests and the claims examiner's affidavit established timely mailing of the denial under standard practices.
Alfa Medical Supplies, Inc.. v Auto One Ins. Co. (2011 NY Slip Op 51851(U)) Appellate Term, Second Department, October 12, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the affidavits of the insurer's litigation examiner and office services manager sufficiently established timely mailing of the denials under its standard office practices and procedures.
Five Boro Psychological Servs., P.C. v State Farm Mut. Auto. Ins. Co. (2011 NY Slip Op 51846(U)) Appellate Term, Second Department, October 11, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits sufficient to show that the EUO scheduling letters and the denial were timely mailed under its standard office practices and procedures.
LVOV Acupuncture, P.C. v GEICO Ins. Co. (2011 NY Slip Op 51845(U)) Appellate Term, Second Department, October 11, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims employee's affidavit sufficient to establish that the partial denials were timely mailed under the insurer's standard office practices and procedures.
Lynbrook Med., P.C. v GEICO Gen. Ins. Co. (2011 NY Slip Op 51841(U)) Appellate Term, Second Department, October 11, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer established that its denial of claim forms were timely mailed in accordance with its standard office practices and procedures.
Fiutek v Clarendon Natl. Ins. Co. (2011 NY Slip Op 51840(U)) Appellate Term, Second Department, October 11, 2011Different mailing results for different documents or claims in one decisionFound the IME letters and most denials proved mailed by office-practice affidavits, but held a triable issue on one denial dated weeks before the date the affiant said it was mailed.
Delta Diagnostic Radiology, P.C. v Autoone Ins. Co. (2011 NY Slip Op 51839(U)) Appellate Term, Second Department, October 11, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the scheduling company manager's affidavit established timely mailing of the IME letters under the employer's standard office practices.
Park v Zurich American Ins. Co. (2011 NY Slip Op 51836(U)) Appellate Term, Second Department, October 11, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the no-fault specialist's affidavit sufficiently established that the 45-day-rule denials were timely mailed under standard office practices.
LVOV Acupuncture, P.C. v GEICO (2011 NY Slip Op 51844(U)) Appellate Term, Second Department, October 11, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims employee's affidavit sufficient to establish that the partial fee-schedule denials were timely mailed under the insurer's standard office practices and procedures.
Vincent Med. Servs., P.C. v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 51718(U)) Appellate Term, Second Department, September 16, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held office-practice affidavits sufficient to establish timely mailing of both the IME requests and the claim denial forms.
MSSA Corp. v Redland Ins. Co. (2011 NY Slip Op 51606(U)) Appellate Term, Second Department, August 16, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit sufficiently established that its denial forms were timely mailed in accordance with its standard office practices and procedures.
Jesa Med. Supply, Inc. v Progressive Ins. Co. (2011 NY Slip Op 51603(U)) Appellate Term, Second Department, August 16, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the litigation representative's affidavit of standard office practice established timely mailing of verification requests and follow-ups to the provider and prescribing doctor, and timely denial of the remaining claim.
Neomy Med., P.C. v GEICO Ins. Co. (2011 NY Slip Op 51532(U)) Appellate Term, Second Department, August 4, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it timely mailed the denial of claim form under its standard office practices, a showing the provider did not defeat.
Shoreline Healing Acupuncture Group, P.C. v American Tr. Ins. Co. (2011 NY Slip Op 51531(U)) Appellate Term, Second Department, August 4, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held office-practice affidavits sufficient to establish timely mailing of the IME notices and of the denial of claim forms.
Alrof, Inc. v Nationwide Ins. Co. (2011 NY Slip Op 51451(U)) Appellate Term, Second Department, July 28, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held office-practice affidavits sufficient to establish timely mailing of the IME scheduling letters and of the claim denial forms.
Radiology Today, P.C. v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 52452(U)) Appellate Term, Second Department, July 27, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejecting the provider's contention, held the litigation examiner's affidavit established timely mailing of the verification requests and follow-up requests.
South Nassau Orthopedic Surgery and Sports Medicine, P.C. v Auto One Ins. Co. (2011 NY Slip Op 51300(U)) Appellate Term, Second Department, July 7, 2011The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to show timely mailing of its denials because its litigation manager began working after the alleged mailing and it proved neither actual mailing nor its standard mailing practice for that period.
Corona Hgts. Med., P.C. v Lancer Ins. Co. (2011 NY Slip Op 51293(U)) Appellate Term, Second Department, July 5, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the EUO law firm's and the insurer's office-practice proof sufficient to establish timely mailing of the EUO scheduling letters and the denial.
Manhattan Med. Imaging, P.C. v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 51230(U)) Appellate Term, Second Department, June 30, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's and its IME scheduler's standard-office-practice affidavits established timely mailing of the medical-necessity denials and of the IME notices.
East Coast Acupuncture, P.C. v Clarendon Natl. Ins. Co. (2011 NY Slip Op 51229(U)) Appellate Term, Second Department, June 30, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's motion papers sufficient to establish timely mailing of the IME scheduling letters and claim denial forms under standard office practices.
Lifex Med. Care, P.C. v Safeco Natl. Ins. Co. (2011 NY Slip Op 51221(U)) Appellate Term, Second Department, June 28, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the claims examiner's affidavit established timely mailing of two denial forms despite the provider's assertion of non-receipt, so the provider was not entitled to summary judgment on those claims.
Jesa Med. Supply, Inc. v Republic W. Ins. Co. (2011 NY Slip Op 51127(U)) Appellate Term, Second Department, June 15, 2011The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the provider's billing manager proved mailing of the claim because she averred that she personally mailed it to the insurer.
Five Boro Psychological Servs., P.C. v Utica Mut. Ins. Co. (2011 NY Slip Op 51119(U)) Appellate Term, Second Department, June 14, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the no-fault specialist's affidavit established timely verification requests and timely denials of the other two claims, with results resting on unanswered verification and unrebutted peer reviews.
Gentle Care Acupuncture, P.C. v GEICO (2011 NY Slip Op 51121(U)) Appellate Term, Second Department, June 14, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims employee's affidavit sufficed to establish that the denials were timely mailed under the insurer's standard office practices and procedures.
Rogy Med., P.C. v Geico Ins. Co. (2011 NY Slip Op 50990(U)) Appellate Term, Second Department, May 26, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that its denial of claim forms were timely mailed in accordance with its standard office practices and procedures.
All Borough Group Med. Supply, Inc. v Utica Mut. Ins. Co. (2011 NY Slip Op 50949(U)) Appellate Term, Second Department, May 23, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held office-practice affidavits sufficient to establish timely mailing of the IME requests and the claim denial forms.
Central Radiology Servs., P.C. v Commerce Ins. Co. (2011 NY Slip Op 50948(U)) Appellate Term, Second Department, May 23, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the claims adjuster's affidavit sufficient to establish that the denials were timely mailed under standard office practices, so the insurer was not precluded from its fraudulent-procurement defense.
Crescent Radiology, PLLC v American Tr. Ins. Co. (2011 NY Slip Op 50622(U)) Appellate Term, Second Department, April 6, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the no-fault examiner's and mailroom supervisor's affidavits sufficient to establish mailing of the EUO notices and timely mailing of the denials under standard office practices.
All County, LLC v Unitrin Advantage Ins. Co. (2011 NY Slip Op 50621(U)) Appellate Term, Second Department, April 6, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the scheduler's and insurer's office-practice proof sufficient to establish mailing of the IME notices and timely mailing of the denials.
Urban Radiology, P.C. v Clarendon Natl. Ins. Co. (2011 NY Slip Op 50601(U)) Appellate Term, Second Department, April 5, 2011The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the EUO law firm attorney's affirmation insufficient because it did not describe the office's standard practices for ensuring the EUO requests were properly addressed and mailed.
Pomona Med. Diagnostics, P.C. v Travelers Ins. Co. (2011 NY Slip Op 50447(U)) Appellate Term, Second Department, March 17, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the claims examiner's standard-practice affidavit established timely mailing of the verification requests, and the medical biller's mere denial of receipt did not overcome the presumption of receipt.
Alur Med. Supply, Inc. v GEICO Ins. Co. (2011 NY Slip Op 50438(U)) Appellate Term, Second Department, March 15, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims examiner's affidavit sufficiently established timely mailing of the denials under standard office practices, and handwritten notations on the forms did not affect their validity.
Tri-Mount Acupuncture, P.C. v N.Y. Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 50335(U)) Appellate Term, Second Department, March 2, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held office-practice affidavits sufficient to establish mailing of the IME scheduling letters and timely mailing of the denial of claim forms.
GLM Med., P.C. v State Farm Mut. Auto. Ins. Co. (2011 NY Slip Op 50194(U)) Appellate Term, Second Department, February 14, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits established that the EUO scheduling letters were timely mailed in accordance with the affiants' employers' standard office practices and procedures.
ARCO Med. NY, P.C. v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 50184(U)) Appellate Term, Second Department, February 14, 2011The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits failed to show the IME scheduling letters were mailed under the scheduling vendor's standard office practice or that the affiants personally mailed them.
Sound Shore Med. Ctr. v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 50033(U)) Appellate Term, Second Department, January 10, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeReversing the lower court, held the claims examiner's standard-office-practice affidavit sufficient to establish timely mailing of the initial and follow-up verification requests.
Allstate Social Work & Psychological Servs., PLLC v Utica Mut. Ins. Co. (2011 NY Slip Op 21010) Appellate Term, Second Department, January 10, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Treated as uncontested that the scheduler's office-practice affidavit established timely mailing of the IME requests.
Gentle Care Acupuncture, P.C. v Geico Ins. Co. (2010 NY Slip Op 52226(U)) Appellate Term, Second Department, December 16, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer timely denied the acupuncture and post-IME claims, citing the standard-office-practice mailing rule.
Elmont Open MRI & Diagnostic Radiology, P.C. v New York Cent. Mut. Fire Ins. Co. (2010 NY Slip Op 52222(U)) Appellate Term, Second Department, December 16, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld, contrary to the lower court, that the senior litigation examiner's affidavit sufficed to establish timely mailing of the denial forms in accordance with the insurer's standard office practices and procedures.
Elmont Open MRI & Diagnostic Radiology, P.C. v Travelers Indem. Co. (2010 NY Slip Op 52223(U)) Appellate Term, Second Department, December 16, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld, contrary to the lower court, that the affidavits of the insurer's litigation examiner and claims support specialist established timely mailing of the denials under its standard office practices.
Triangle R, Inc. v Clarendon Ins. Co. (2010 NY Slip Op 52159(U)) Appellate Term, Second Department, December 10, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the claims examiner's standard-practice affidavit established timely mailing of the verification requests, and the billing manager's mere denial of receipt did not overcome the presumption.
Urban Radiology, P.C. v GEICO Gen. Ins. Co. (2010 NY Slip Op 52157(U)) Appellate Term, Second Department, December 10, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims-division employee's affidavit established timely mailing of the denial forms in accordance with the insurer's standard office practices and procedures.
Iav Med. Supply, Inc. v Progressive Ins. Co. (2010 NY Slip Op 52155(U)) Appellate Term, Second Department, December 10, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the litigation representative's affidavit established timely mailing of the denial form in accordance with the insurer's standard office practices and procedures.
Vincent Med. Servs., P.C. v GEICO Ins. Co. (2010 NY Slip Op 52153(U)) Appellate Term, Second Department, December 8, 2010Different mailing results for different documents or claims in one decisionHeld the insurer's standard-office-practice affidavit proved timely mailing of the denials for most claims, but because it did not address the denial for one claim, mailing of that denial was not shown and defenses to it were precluded.
St. Vincent's Hosp. & Med. Ctr. v American Tr. Ins. Co. (2010 NY Slip Op 52063(U)) Appellate Term, Second Department, November 26, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held, contrary to the lower court, that the claims examiner's affidavit established timely mailing of the initial and follow-up verification requests under the insurer's standard office practices and procedures.
Dynamic Med. Imaging, P.C. v New York Cent. Mut. Fire Ins. Co. (2010 NY Slip Op 52062(U)) Appellate Term, Second Department, November 26, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the no-fault litigation examiner's affidavit demonstrated timely mailing of the denial forms in accordance with the insurer's standard office practices and procedures.
Elmont Open MRI & Diagnostic Radiology, P.C. v Clarendon Natl. Ins. Co. (2010 NY Slip Op 52061(U)) Appellate Term, Second Department, November 26, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims-division employee's affidavits demonstrated timely mailing of the denial forms in accordance with the insurer's standard office practices and procedures.
Delta Diagnostic Radiology, P.C. v Interboro Ins. Co. (2010 NY Slip Op 52022(U)) Appellate Term, Second Department, November 19, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims representative's affidavit established timely verification requests and a timely medical-necessity denial, with results resting on unanswered verification and the unrebutted peer review.
Radiology Today, P.C. v Mercury Ins. Co. (2010 NY Slip Op 52020(U)) Appellate Term, Second Department, November 19, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit established that it timely denied the bills, the cited authority showing a finding of timely mailing under standard office practices.
Crotona Hgts. Med., P.C. v Mercury Ins. Co. (2010 NY Slip Op 52019(U)) Appellate Term, Second Department, November 19, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit established that it timely denied the bills at issue on medical-necessity grounds, a finding of timely mailing, while the result turned on the peer reviews.
Richmond Pain Mgt., P.C. v Clarendon Natl. Ins. Co. (2010 NY Slip Op 52015(U)) Appellate Term, Second Department, November 19, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits sufficiently established timely mailing of the denial forms in accordance with standard office practices and procedures.
Ave T MPC Corp. v Amica Mut. Ins. Co. (2010 NY Slip Op 52009(U)) Appellate Term, Second Department, November 19, 2010The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the insurer showed it never received the claim forms before suit because the provider's own proof of mailing showed the forms were sent to an address where the insurer was never located.
High Quality Med., P.C. v Mercury Ins. Co. (2010 NY Slip Op 51900(U)) Appellate Term, Second Department, November 8, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit sufficient to establish that its medical-necessity denial was timely mailed in accordance with its standard office practices and procedures.
MIA Acupuncture, P.C. v Geico Ins. Co. (2010 NY Slip Op 51899(U)) Appellate Term, Second Department, November 8, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld, reversing the lower court, that the insurer's affidavit sufficiently established timely mailing of its denials in accordance with its standard office practices and procedures.
Olga Bard Acupuncture, P.C. v Geico Ins. Co. (2010 NY Slip Op 51898(U)) Appellate Term, Second Department, November 8, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit sufficed to show the denials were timely mailed in accordance with its standard office practices and procedures.
Vinings Spinal Diagnostic, P.C. v Geico Gen. Ins. Co. (2010 NY Slip Op 51897(U)) Appellate Term, Second Department, November 8, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims employee's affidavit established timely mailing of the medical-necessity denial under the insurer's standard office practices, preserving the defense.
Active Imaging, P.C. v Progressive Northeastern Ins. Co. (2010 NY Slip Op 51842(U)) Appellate Term, Second Department, October 20, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it timely denied the claims on medical-necessity grounds, as part of its prima facie showing.
Friendly Physician, P.C. v GEICO Ins. Co. (2010 NY Slip Op 51772(U)) Appellate Term, Second Department, October 5, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims employee's affidavit showed the denials were timely mailed under the insurer's standard office practices, supporting a meritorious defense for vacating the default.
Park Slope Med. & Surgical Supply, Inc. v GEICO Ins. Co. (2010 NY Slip Op 51771(U)) Appellate Term, Second Department, October 5, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the claims employee's affidavit established timely mailing of the denial under the insurer's standard office practices and procedures, reversing the lower court's contrary finding.
Friendly Physician, P.C. v GEICO Ins. Co. (2010 NY Slip Op 51770(U)) Appellate Term, Second Department, October 5, 2010The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove timely mailing of its denials because its claim representative began working after the alleged mailing and no actual mailing or standard office practice for that period was shown.
Eagle Surgical Supply, Inc. v Travelers Indem. Co. (2010 NY Slip Op 51775(U)) Appellate Term, Second Department, October 5, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's moving papers established that it timely requested additional verification, the mailing finding supporting dismissal of the action as premature.
Manhattan Med. Imaging, P.C. v GEICO Ins. Co. (2010 NY Slip Op 51737(U)) Appellate Term, Second Department, October 1, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's opposing affidavit sufficed to establish timely mailing of its denial under its standard office practices and procedures.
I.V. Med. Supply, Inc. v Mercury Ins. Group (2010 NY Slip Op 51736(U)) Appellate Term, Second Department, October 1, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit sufficient to establish timely mailing of the medical-necessity denial in accordance with its standard office practices and procedures.
Irina Kazanskaya, Ac v GEICO Ins. Co. (2010 NY Slip Op 51735(U)) Appellate Term, Second Department, October 1, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's employee affidavit established timely mailing of the denial under its standard office practices and procedures, reversing the lower court's finding that timely mailing was not shown.
Alfa Med. Supplies v Progressive Northeastern Ins. Co. (2010 NY Slip Op 51733(U)) Appellate Term, Second Department, October 1, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit sufficient to establish timely mailing of the medical-necessity denial of the remaining claim under its standard office practices.
MIA Acupuncture, P.C. v GEICO Ins. Co. (2010 NY Slip Op 51731(U)) Appellate Term, Second Department, October 1, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit sufficed to establish that its denials were timely mailed in accordance with its standard office practices and procedures.
St. Vincent Med. Care, P.C. v Clarendon Natl. Ins. Co. (2010 NY Slip Op 51728(U)) Appellate Term, Second Department, October 1, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's standard-office-practice affidavit established timely mailing of its denials and the IME scheduler's affidavit established mailing of the IME notices.
Neomy Med., P.C. v Auto One Ins. Co. (2010 NY Slip Op 51727(U)) Appellate Term, Second Department, October 1, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the affidavits of the insurer's mail and file manager and litigation examiner established timely mailing of the denial under standard office practices.
Point of Health Acupuncture, P.C. v GEICO Ins. Co. (2010 NY Slip Op 51724(U)) Appellate Term, Second Department, October 1, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeReversing a finding that the insurer failed to specify mailing dates, held the claims employee's affidavit established the denials were timely mailed under the insurer's standard office practices and procedures.
Altair Med., P.C. v Clarendon Natl. Ins. Co. (2010 NY Slip Op 51721(U)) Appellate Term, Second Department, October 1, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit established timely mailing of the medical-necessity denials under its standard office practices and procedures.
Mutual Care Med. Supply, Inc. v Mercury Cas. Co. (2010 NY Slip Op 51734(U)) Appellate Term, Second Department, October 1, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit sufficient to establish that its denials were timely mailed in accordance with its standard office practices and procedures.
Ortho-Med Surgical Supply, Inc. v MVAIC (2010 NY Slip Op 51526(U)) Appellate Term, Second Department, August 24, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the claims representative's affidavit, describing in detail from personal knowledge the standard office practices used to ensure proper mailing, sufficiently established timely mailing of the denial.
Points of Health Acupuncture, P.C. v Lancer Ins. Co. (2010 NY Slip Op 51455(U)) Appellate Term, Second Department, August 12, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeReversed findings that mailing was unproved, holding the EUO law firm partner's detailed description of office mailing practice and the specialist's affidavit established timely mailing of the scheduling letters and denials.
Mega Supply & Billing, Inc. v Larendon Natl. Ins. Co. (2010 NY Slip Op 51452(U)) Appellate Term, Second Department, August 12, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected the provider's challenge and held the insurer's affidavit established that it timely denied the claim on medical-necessity grounds.
Eagle Surgical Supply, Inc. v Travelers Indem. Co. (2010 NY Slip Op 51456(U)) Appellate Term, Second Department, August 12, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer demonstrated that it timely mailed its verification requests, but the defense failed on another element because no one with personal knowledge showed the verification remained outstanding.
Points of Health Acupuncture, P.C. v Lancer Ins. Co. (2010 NY Slip Op 51338(U)) Appellate Term, Second Department, July 22, 2010Different mailing results for different documents or claims in one decisionHeld a law partner's detailed office-practice affirmation proved mailing of the EUO letters and the specialist proved mailing of denials for three claims, but the specialist's affidavit did not prove timely mailing of verification requests on the remaining claims.
Yklik, Inc. v GEICO Ins. Co. (2010 NY Slip Op 51336(U)) Appellate Term, Second Department, July 22, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it timely denied the claims on the ground of lack of medical necessity.
Infinity Health Prods., Ltd. v Progressive Ins. Co. (2010 NY Slip Op 51334(U)) Appellate Term, Second Department, July 22, 2010The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to establish that its EUO scheduling letters were timely mailed, so it could not show tolling of the claim determination period.
Alfa Med. Supplies, Inc. v GEICO Gen. Ins. Co. (2010 NY Slip Op 51332(U)) Appellate Term, Second Department, July 22, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it timely denied the claims for lack of medical necessity, so its defense was not precluded.
Neomy Med., P.C. v GEICO Ins. Co. (2010 NY Slip Op 51252(U)) Appellate Term, Second Department, July 16, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld, reversing the lower court, that the insurer demonstrated its denial of claim forms were timely mailed.
Eagle Surgical Supply, Inc. v Unitrin Advantage Ins. Co. (2010 NY Slip Op 51183(U)) Appellate Term, Second Department, July 7, 2010The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the affidavit of a Kemper Independence Insurance Company employee did not describe standard office practices ensuring proper addressing and mailing, so timely mailing of the denial, and thus non-preclusion of the medical-necessity defense, was not shown.
Raz Acupuncture, P.C. v AIG Indem. Ins. Co. (2010 NY Slip Op 51177(U)) Appellate Term, Second Department, July 7, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit sufficiently established that its denials were timely mailed under its standard office practices and procedures.
Proscan Imaging, P.C. v Travelers Indem. Co. (2010 NY Slip Op 51176(U)) Appellate Term, Second Department, July 7, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the affidavits of the claims representative and mail-facility director showed timely mailing of the verification request and follow-up, and the provider admitted receiving them.
Alur Med. Supply, Inc. v GEICO Ins. Co. (2010 NY Slip Op 51053(U)) Appellate Term, Second Department, June 11, 2010The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the provider did not prove submission of the claim because the certificate of mailing referred to in its billing manager's affidavit showed the claim form was mailed to a different insurer.
Urban Radiology, P.C. v Tri-State Consumer Ins. Co. (2010 NY Slip Op 50987(U)) Appellate Term, Second Department, June 8, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the claims examiner's and mail clerk's affidavits sufficient to show timely mailing of the verification requests and denials because they described in detail, from personal knowledge, the standard office practice designed to ensure mailing.
Ortho-Med Surgical Supply, Inc. v Progressive Cas. Ins. Co. (2010 NY Slip Op 50997(U)) Appellate Term, Second Department, June 4, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely mailing of the medical-necessity denial as part of its prima facie showing.
Innovative Chiropractic, P.C. v Travelers Ins. Co. (2010 NY Slip Op 50994(U)) Appellate Term, Second Department, June 4, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it timely mailed the denials based on lack of medical necessity.
Five Boro Psychological Servs., P.C. v Progressive Northeastern Ins. Co. (2010 NY Slip Op 50991(U)) Appellate Term, Second Department, June 4, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's litigation representative sufficiently described a standard office mailing practice, establishing that the denials were mailed on the stated date, and that the EUO notices were properly mailed by its law firm.
Triangle R, Inc. v GEICO Ins. Co. (2010 NY Slip Op 50885(U)) Appellate Term, Second Department, May 13, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims representative's affidavit established that the insurer timely mailed its initial and follow-up verification requests.
Innovative Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2010 NY Slip Op 50884(U)) Appellate Term, Second Department, May 13, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the senior litigation examiner's affidavit sufficiently established timely mailing of the denials under the insurer's standard office practice.
We Care Med., P.C. v GEICO Ins. Co. (2010 NY Slip Op 50831(U)) Appellate Term, Second Department, May 10, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it timely denied the third cause of action's claim on the ground of lack of medical necessity.
Elmont Open MRI & Diagnostic Radiology, P.C. v State Farm Ins. Co. (2010 NY Slip Op 50829(U)) Appellate Term, Second Department, May 10, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established in opposition that its denial forms relying on the peer review reports were timely.
Riu Chiropractic, P.C. v AutoOne Ins. Co. (2010 NY Slip Op 50653(U)) Appellate Term, Second Department, April 9, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the litigation specialist's affidavit established that the IME scheduling letters were timely sent under a standard office practice designed to ensure proper addressing and mailing.
Quality Psychological Servs., P.C. v Mercury Ins. Group (2010 NY Slip Op 50601(U)) Appellate Term, Second Department, April 2, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeReversing the lower court's finding, held the claims representative's affidavit established timely mailing because it described in detail, from personal knowledge, the standard practices ensuring the denial was properly addressed and mailed.
Delta Diagnostic Radiology, P.C. v Liberty Mut. Ins. Co. (2010 NY Slip Op 50597(U)) Appellate Term, Second Department, April 2, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims specialist's detailed, personal-knowledge description of standard office practices showed timely and proper mailing of the denials and verification request, supporting a meritorious defense.
First Aid Occupational Therapy, PLLC v Country-Wide Ins. Co. (2010 NY Slip Op 50594(U)) Appellate Term, Second Department, April 2, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's litigation supervisor's affidavit established timely mailing of its denials and verification requests because it described in detail, from personal knowledge, the standard office practices ensuring proper mailing.
Laperla Supply, Inc. v Progressive Northwestern Ins. Co. (2010 NY Slip Op 50586(U)) Appellate Term, Second Department, March 31, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer sufficiently established timely mailing of the medical-necessity denial.
Prime Psychological Servs., P.C. v Mercury Ins. Group (2010 NY Slip Op 50585(U)) Appellate Term, Second Department, March 31, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely mailing of the medical-necessity denial as part of its prima facie showing.
Gz Med. & Diagnostic, P.C. v Mercury Ins. Co. (2010 NY Slip Op 50491(U)) Appellate Term, Second Department, March 19, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it timely mailed its medical-necessity denials, as part of its prima facie showing, though the result turned on the unrebutted peer review.
St. Vincent Med. Care, P.C. v Country Wide Ins. Co. (2010 NY Slip Op 50488(U)) Appellate Term, Second Department, March 19, 2010The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the provider's billing manager's affidavit sufficiently established that the bills were mailed to the insurer, rejecting the insurer's argument that mailing was not shown.
Advanced Med., P.C. v GEICO Ins. Co. (2010 NY Slip Op 50454(U)) Appellate Term, Second Department, March 10, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavit sufficiently established that the denials were timely mailed under its standard office practice or procedure, a predicate to its medical-necessity defense.
Favorite Health Prods., Inc. v Geico Ins. Co. (2010 NY Slip Op 50453(U)) Appellate Term, Second Department, March 10, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it timely mailed the denials asserting lack of medical necessity, before turning to the peer review proof that decided the case.
Prestige Med. & Surgical Supply, Inc. v Chubb Indem. Ins. Co. (2010 NY Slip Op 50449(U)) Appellate Term, Second Department, March 10, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims adjuster's affidavit established timely mailing of the denial because it described in detail the standard office practices ensuring the denial was properly addressed and mailed.
High Quality Med., P.C. v Mercury Ins. Co. (2010 NY Slip Op 50447(U)) Appellate Term, Second Department, March 10, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it timely denied the claim on medical-necessity grounds, a mailing finding supported by the standard-practice authorities, though the result rested on the peer review.
Right Aid Diagnostic Medicine, P.C. v Geico Ins. Co. (2010 NY Slip Op 50445(U)) Appellate Term, Second Department, March 10, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely mailing of its denial through an affidavit of an employee with knowledge of its standard office practices designed to ensure items are properly addressed and mailed.
St. Vincent Med. Care, P.C. v Country-Wide Ins. Co. (2010 NY Slip Op 50444(U)) Appellate Term, Second Department, March 10, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's litigation supervisor's affidavit established timely mailing of its denials and verification requests because it described in detail, from personal knowledge, the standard office practices ensuring proper mailing.
Infinity Health Prods., Ltd. v Mercury Ins. Co. (2010 NY Slip Op 50385(U)) Appellate Term, Second Department, March 8, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims representative's affidavit sufficiently established timely mailing of the denial, though the motion failed on the medical-necessity rebuttal.
Bath Med. Supply, Inc. v Allstate Indem. Co. (2010 NY Slip Op 20059) Appellate Term, Second Department, February 19, 2010The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer made no showing that its denial of claim forms were timely mailed, so it was precluded from its fraudulent-billing and EUO no-show defenses.
All Borough Group Med. Supply, Inc. v Travelers Ins. Co. (2010 NY Slip Op 50153(U)) Appellate Term, Second Department, January 29, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge and held the insurer's affidavits sufficient to establish that the medical-necessity denial was timely mailed under its standard office practice and procedure.
Innovative Chiropractic, P.C. v Progressive Ins. Co. (2010 NY Slip Op 50148(U)) Appellate Term, Second Department, January 29, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the litigation representative's affidavit established timely mailing of the denial under the insurer's standard office practice, supporting dismissal of the portion denied on the deductible.
Canarsie Family Med. Practice, PLLC v American Tr. Ins. Co. (2010 NY Slip Op 50070(U)) Appellate Term, Second Department, January 12, 2010The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the billing manager's affidavit established that the claims were mailed because he stated he had personally mailed them, rejecting the insurer's challenge to the provider's mailing proof.
Amercure Acupuncture, P.C. v GEICO Ins. Co. (2010 NY Slip Op 50068(U)) Appellate Term, Second Department, January 12, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the claims employee's affidavit, describing office practices ensuring items are properly addressed and mailed, established timely mailing of the denials, reversing the lower court's untimely-denial finding.
Quality Rehab & P.T., P.C. v GEICO Ins. Co. (2010 NY Slip Op 50067(U)) Appellate Term, Second Department, January 12, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the claim representative's affidavit sufficiently established timely mailing of the initial and follow-up verification requests, reversing the contrary finding below.
Metropolitan Med. Supplies, LLC v GEICO Ins. Co. (2010 NY Slip Op 50066(U)) Appellate Term, Second Department, January 12, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld, contrary to the lower court, that the claims representative's affidavit sufficiently established timely mailing of the denials based on medical necessity and excessive fees.
Right Aid Diagnostic Medicine, P.C. v GEICO Ins. Co. (2009 NY Slip Op 52635(U)) Appellate Term, Second Department, December 23, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeReversing the lower court's contrary finding, held the claims representative's affidavit sufficiently established timely mailing of the denial forms.
Staten Is. Advanced Surgical Supply v GEICO Ins. Co. (2009 NY Slip Op 52633(U)) Appellate Term, Second Department, December 23, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely mailing of its verification request and denial through an affidavit of an employee with knowledge of its standard office mailing practices.
Quality Rehab & P.T., P.C. v GEICO Ins. Co. (2009 NY Slip Op 52632(U)) Appellate Term, Second Department, December 23, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeReversing the lower court's contrary finding, held the claims representative's affidavit sufficiently established timely mailing of the denial form.
Crotona Hgts. Med., P.C. v GEICO Ins. Co. (2009 NY Slip Op 52466(U)) Appellate Term, Second Department, December 7, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established that it timely denied the third and fourth causes of action's claims for lack of medical necessity.
Innovative Chiropractic, P.C. v Travelers Ins. Co. (2009 NY Slip Op 52447(U)) Appellate Term, Second Department, December 1, 2009Different mailing results for different documents or claims in one decisionHeld the insurer's affidavits proved timely mailing of the denial of one claim under its standard office practice, so it was not precluded there, but it failed to establish timely denial of the other claim, which stayed in the case.
AJS Chiropractic, P.C. v Travelers Ins. Co. (2009 NY Slip Op 52446(U)) Appellate Term, Second Department, December 1, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits established timely denial through its standard office practice ensuring the denial was properly addressed and mailed, a predicate to the medical-necessity ruling.
Points of Health Acupuncture, P.C. v GEICO Ins. Co. (2009 NY Slip Op 52445(U)) Appellate Term, Second Department, December 1, 2009The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove timely mailing of its denials because its claim representative began working after the alleged mailing and it proved neither actual mailing nor its standard mailing practice then.
Innovative Chiropractic, P.C. v Mercury Ins. Co. (2009 NY Slip Op 52321(U)) Appellate Term, Second Department, November 13, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld, contrary to the lower court, that the insurer showed timely mailing of its denials through its standard office practice designed to ensure denials are properly addressed and mailed.
Exclusive Med. Supply, Inc. v Mercury Ins. Group (2009 NY Slip Op 52273(U)) Appellate Term, Second Department, November 5, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected the provider's challenge and held the claims representative's affidavit established timely mailing of the denials under a standard practice ensuring proper addressing and mailing.
New Wave Oriental Acupuncture, P.C. v Government Employees Ins. Co. (2009 NY Slip Op 52211(U)) Appellate Term, Second Department, October 23, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge and held the insurer's affidavit established that the denials were timely mailed under its standard office practices and procedures.
Radiology Today, P.C. v GEICO Ins. Co. (2009 NY Slip Op 52208(U)) Appellate Term, Second Department, October 23, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the IME scheduling service manager's affidavit sufficiently described a standard practice for generating and mailing IME notices, reversing a finding that mailing was not shown.
Med-Tech Prods., Inc. v Geico Ins. Co. (2009 NY Slip Op 52111(U)) Appellate Term, Second Department, October 13, 2009The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held any deficiency in the provider's proof of mailing the claim forms was cured by the insurer's denial forms acknowledging receipt, as the insurer conceded.
A.B. Med. Servs., PLLC v American Tr. Ins. Co. (2009 NY Slip Op 52067(U)) Appellate Term, Second Department, October 6, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the providers' challenge and held the insurer established that the EUO notices were mailed, giving rise to the presumption of receipt.
DVS Chiropractic, P.C. v Mercury Cas. Co. (2009 NY Slip Op 51887(U)) Appellate Term, Second Department, September 1, 2009The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's papers failed to show the IME scheduling letters were timely mailed under the standard practice and procedure of the office that mailed them.
Vega Chiropractic, P.C. v Clarendon Natl. Ins. Co. (2009 NY Slip Op 52536(U)) Appellate Term, Second Department, August 31, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the IME scheduling letters were shown timely sent pursuant to a standard office practice designed to ensure proper addressing and mailing.
Urban Radiology, P.C. v American Tr. Ins. Co. (2009 NY Slip Op 51734(U)) Appellate Term, Second Department, July 31, 2009Different mailing results for different documents or claims in one decision (also decides)On a motion to vacate a default, held the claims representative's and mail room supervisor's affidavits showed one claim was timely denied, a meritorious defense, but did not show the verification requests on the other claims were timely.
D.S. Chiropractic, P.C. v Country-Wide Ins. Co. (2009 NY Slip Op 51584(U)) Appellate Term, Second Department, July 14, 2009The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held any deficiency in the provider's proof of mailing the claim forms was cured by the insurer's claims representative's affidavit conceding receipt of the claims.
D.S. Chiropractic, P.C. v Country-Wide Ins. Co. (2009 NY Slip Op 51579(U)) Appellate Term, Second Department, July 14, 2009The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held any deficiency in the provider's proof of mailing its claim forms was cured by the insurer's claims representative's affidavit conceding receipt.
Delta Diagnostic Radiology, P.C. v Integon Natl. Ins. Co. (2009 NY Slip Op 51502(U)) Appellate Term, Second Department, July 9, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected the provider's challenge and held the claims representative's affidavit sufficiently established timely mailing of the denial under the insurer's standard office practice.
Pan Chiropractic, P.C. v Mercury Ins. Co. (2009 NY Slip Op 51495(U)) Appellate Term, Second Department, July 9, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims representative's affidavit established timely mailing because it described in detail, on personal knowledge, the standard practice ensuring the denial was properly addressed and mailed.
AKS Med., P.C. v Progressive Ins. Co. (2009 NY Slip Op 51494(U)) Appellate Term, Second Department, July 9, 2009The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld no presumption of receipt arose because the billing manager's affidavit contradicted the post office ledger on which she relied, so the provider did not prove mailing of the claim.
Davydov v Progressive Ins. Co. (2009 NY Slip Op 29299) Appellate Term, Second Department, July 9, 2009The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer, which called no witnesses and offered no evidence that its denials were timely mailed, failed to show its defenses were not precluded.
Fiveborough Chiropractic & Acupuncture, PLLC v American Employers' Ins. Co. Div. of Onebeacon Am. Ins. Co. (2009 NY Slip Op 51395(U)) Appellate Term, Second Department, June 29, 2009The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the provider's principal's affirmation insufficient to show actual mailing of the claim forms or a standard office practice ensuring proper addressing and mailing, and counsel's affirmation without personal knowledge had no probative value.
Westchester Neurodiagnostic, P.C. v Allstate Ins. Co. (2009 NY Slip Op 51385(U)) Appellate Term, Second Department, June 29, 2009The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to submit an affidavit by one with personal knowledge showing timely mailing of its denial under a standard office practice, so its medical-necessity defense was precluded.
Careplus Med. Supply, Inc. v AutoOne Ins. Co. (2009 NY Slip Op 51372(U)) Appellate Term, Second Department, June 29, 2009The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits insufficient to establish proper mailing of the IME scheduling letters, so no presumption of receipt arose.
Inwood Hill Med., P.C. v Metropolitan Prop. & Cas. Ins. Co. (2009 NY Slip Op 51264(U)) Appellate Term, Second Department, June 18, 2009The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to allege, let alone establish, that its denial form, dated two years after the services, was timely mailed, so it was precluded from its defense.
Bronze Acupuncture, P.C. v Mercury Ins. Co. (2009 NY Slip Op 51219(U)) Appellate Term, Second Department, June 12, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected the provider's challenge and held the claim representative's affidavit established timely mailing of the IME-based denials under a standard office practice.
Focus Radiology, P.C. v New York Cent. Mut. Ins. Co. (2009 NY Slip Op 51218(U)) Appellate Term, Second Department, June 12, 2009The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the claims examiner's affidavit failed to show the verification requests and denial were timely mailed under a standard office practice designed to ensure proper addressing and mailing, so timely denial was not established.
Bath Med. Supply, Inc. v Country Wide Ins. Co. (2009 NY Slip Op 51145(U)) Appellate Term, Second Department, June 8, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's litigation supervisor's detailed description of standard office practice established timely mailing of its verification requests and denials, so the 30-day period was tolled and the denials were timely.
Advanced Med., P.C. v Utica Mut. Ins. Co. (2009 NY Slip Op 51023(U)) Appellate Term, Second Department, May 22, 2009The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer failed to establish that its EUO scheduling letters were timely mailed, so the claim determination period was not shown to be tolled.
AVA Acupuncture, P.C. v GEICO Gen. Ins. Co. (2009 NY Slip Op 51017(U)) Appellate Term, Second Department, May 19, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims employee's affidavit sufficiently established that the partial denials were timely mailed in accordance with the insurer's standard office practice and procedure, rejecting the provider's challenge.
A.B. Med. Servs., PLLC v Country-Wide Ins. Co. (2009 NY Slip Op 51016(U)) Appellate Term, Second Department, May 19, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the litigation supervisor's affidavit describing the standard office practice for generating and mailing denials sufficient to show timely denial of a claim, defeating the provider's motion on it.
Vista Surgical Supplies, Inc. v Liberty Mut. Ins. Co. (2009 NY Slip Op 52500(U)) Appellate Term, Second Department, May 8, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's argument that the claims specialist's affidavit lacked personal knowledge or a description of standard office practice, holding it sufficiently established mailing of the verification requests.
St. Vincent Med. Care, P.C. v Country-Wide Ins. Co. (2009 NY Slip Op 29508) Appellate Term, Second Department, May 8, 2009The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held that any deficiency in the provider's proof of mailing its claim forms was cured by the insurer's denial forms and its claims representative's affidavit conceding receipt.
Bongiorno v State Farm Ins. Co. (2009 NY Slip Op 50860(U)) Appellate Term, Second Department, April 28, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims support supervisor's affidavit showed the claims were properly and timely denied, as part of the insurer's unopposed prima facie showing.
St. Vincent Med. Care, P.C. v Mercury Cas. Co. (2009 NY Slip Op 50810(U)) Appellate Term, Second Department, April 24, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claim representative's affidavit established timely mailing of the denials because it described the insurer's standard office practices and procedures designed to ensure that denials were properly addressed and mailed.
Velen Med. Supply, Inc. v GEICO Ins. Co. (2009 NY Slip Op 50735(U)) Appellate Term, Second Department, April 16, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims employee's affidavit established timely mailing of the peer-review-based denial under the insurer's standard office practice, in opposition to the provider's motion.
Ortho-Med Surgical Supply, Inc. v Mercury Cas. Co. (2009 NY Slip Op 50731(U)) Appellate Term, Second Department, April 14, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims representative's affidavit showed the claims were properly and timely denied, giving rise to proof of mailing of the denials.
Rogy Med., P.C. v Mercury Cas. Co. (2009 NY Slip Op 50732(U)) Appellate Term, Second Department, April 14, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's claims representative's affidavit established that the denials were timely mailed, but the result rested on the insufficiency of its medical-necessity and fee schedule proof.
Metropolitan Med. Supplies, LLC v Eveready Ins. Co. (2009 NY Slip Op 50586(U)) Appellate Term, Second Department, April 3, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeReversing the lower court's finding that mailing was not shown, held the no-fault supervisor's affidavit established the claim was properly and timely denied.
A.B. Med. Servs., PLLC v Country-Wide Ins. Co. (2009 NY Slip Op 50583(U)) Appellate Term, Second Department, April 1, 2009The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits insufficient to establish proper mailing of the IME scheduling letters, so no presumption of receipt arose.
PLP Acupuncture, P.C. v Progressive Cas. Ins. Co. (2009 NY Slip Op 50491(U)) Appellate Term, Second Department, March 17, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected the provider's challenge and held the insurer showed timely mailing of the denial through its standard office practice designed to ensure proper addressing and mailing.
Audobon Physical Med & Rehab, P.C. v GEICO Ins. Co. (2009 NY Slip Op 50456(U)) Appellate Term, Second Department, March 16, 2009Different mailing results for different documents or claims in one decisionFound the insurer's office-practice proof established timely mailing of verification requests for one claim, but held its scheduler's affidavit insufficient to show the IME requests were mailed for the other.
Park Slope Med. & Surgical Supply, Inc. v New York Cent. Mut. Fire Ins. Co. (2009 NY Slip Op 50441(U)) Appellate Term, Second Department, March 12, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims examiner's affidavit, with the peer review, established that the claims were properly and timely denied, though the motion failed on the medical-necessity rebuttal.
Daras v GEICO Ins. Co. (2009 NY Slip Op 50438(U)) Appellate Term, Second Department, March 10, 2009Different mailing results for different documents or claims in one decisionHeld the insurer's acknowledgment of receipt cured gaps in the provider's proof of mailing its claims, but the insurer failed to prove by admissible evidence that its IME requests were timely mailed.
Great Wall Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2009 NY Slip Op 50294(U)) Appellate Term, Second Department, February 20, 2009The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held any gap in the provider's proof of mailing the claim forms was cured because the insurer's denial forms and its examiner's affidavit conceded receipt of the claims.
Richard Morgan Do, P.C. v State Farm Mut. Auto. Ins.Co. (2009 NY Slip Op 50242(U)) Appellate Term, Second Department, February 13, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the scheduling company employee's affidavit was sufficient to establish mailing of the initial and follow-up IME requests to the assignor.
Top Choice Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2009 NY Slip Op 50230(U)) Appellate Term, Second Department, February 11, 2009The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the litigation examiner's affidavit insufficient to prove timely mailing of the denial because it merely stated the denial was mailed without setting forth the steps of the insurer's mailing practice, so the medical-necessity defense was not shown unprecluded.
Great Wall Acupuncture, P.C. v New York Central Mutual Insurance Company (2009 NY Slip Op 50224(U)) Appellate Term, Second Department, February 10, 2009The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held any deficiency in the provider's proof of mailing the claim forms was cured by the insurer's denial forms and examiner's affidavit conceding receipt of the claims.
AJS Chiropractic, P.C. v Mercury Ins. Co. (2009 NY Slip Op 50208(U)) Appellate Term, Second Department, February 9, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer showed timely mailing of the denials through its standard office practice designed to ensure items are properly addressed and mailed; the dispute centered on the IME report.
Gashinskaya v State Farm Mut. Auto. Ins. Co. (2009 NY Slip Op 51283(U)) Appellate Term, Second Department, January 26, 2009The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the claims representative's affidavit neither showed actual mailing of the denials nor described the standard office mailing practice used, so the insurer was precluded from its medical-necessity defense.
Complete Orthopedic Supplies, Inc. v State Farm Mut. Auto. Ins. Co. (2009 NY Slip Op 29014) Appellate Term, Second Department, January 9, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the mailing affidavits established timely mailing under a standard office practice, disregarding the jurat's missing year as a nonprejudicial technical defect to which the provider never objected.
All Mental Care Medicine, P.C. v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 52588(U)) Appellate Term, Second Department, December 31, 2008The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer did not establish by proof in admissible form that the IME requests were timely mailed to the assignor.
Vincent Med. Servs., P.C. v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 52442(U)) Appellate Term, Second Department, December 2, 2008The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer failed to establish prima facie that its claim denials were timely, so it could not interpose precludable late-notice defenses; the cross motion also failed on the merits of those defenses and on coverage.
A.B. Med. Servs., PLLC v Country-Wide Ins. Co. (2008 NY Slip Op 52651(U)) Appellate Term, Second Department, November 26, 2008The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the litigation supervisor's affidavit describing the standard office practice for generating and mailing denials sufficient to show timely denial of a claim, defeating the provider's motion on it.
Avenue N Med., P.C. v Travelers Prop. Cas. Ins. Co. (2008 NY Slip Op 52174(U)) Appellate Term, Second Department, October 31, 2008The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer, through its claims representative's affidavit, established that the claims were timely denied; also held its concession of receipt cured the provider's mailing proof.
Mary Immaculate Hosp. v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 52046(U)) Appellate Term, Second Department, October 9, 2008The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the litigation examiner's affidavit proved mailing of the initial and follow-up requests for one assignor's assignment form, while the hospital's matching certified-mail and return receipts raised an unrebutted presumption the other assignor's records were received.
Infinity Health Prods., Ltd. v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 51870(U)) Appellate Term, Second Department, September 10, 2008The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove timely mailing of its verification requests and denials because its examiner's affidavit did not sufficiently describe a standard office mailing practice, so its cross motion was denied.
Eagle Surgical Supply, Inc. v Progressive Cas. Ins. Co. (2008 NY Slip Op 28342) Appellate Term, Second Department, September 10, 2008The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer proved timely mailing of the EUO scheduling letters by describing the standard office practices used to ensure such items are properly addressed and mailed.
Ying E. Acupuncture, P.C. v Global Liberty Ins. (2008 NY Slip Op 51863(U)) Appellate Term, Second Department, September 3, 2008The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove timely mailing of most denials because its claims manager neither mailed them personally nor described a standard office practice ensuring proper addressing and mailing, so its defenses were precluded.
Align for Health Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 51862(U)) Appellate Term, Second Department, September 3, 2008The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to demonstrate that it timely mailed its verification and follow-up verification requests.
Midisland Med., PLLC v Allstate Ins. Co. (2008 NY Slip Op 51861(U)) Appellate Term, Second Department, September 3, 2008Different mailing results for different documents or claims in one decisionHeld the insurer's analyst affidavit proved timely mailing of two denials under its standard office practice, but not of two others it did not address, so those defenses were precluded.
Orthotic Surgical & Med. Supply, Inc. v GEICO Ins. Co. (2008 NY Slip Op 51858(U)) Appellate Term, Second Department, September 2, 2008The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims representative's affidavit sufficient to raise a presumption that the denial was mailed in accordance with the insurer's standard office practice and procedure.
A.T. Med., P.C. v American Tr. Ins. Co. (2008 NY Slip Op 51853(U)) Appellate Term, Second Department, September 2, 2008The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the provider's corporate officer's affidavit and annexed post office ledger insufficient to show the claims were mailed, and counsel's affirmation without personal knowledge was hearsay without probative value.
Crossbridge Diagnostic Radiology, P.C. v Progressive Ins. Co. (2008 NY Slip Op 51761(U)) Appellate Term, Second Department, August 19, 2008The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held any defect in the provider's proof of mailing its claim forms was cured by the insurer's denial forms and litigation representative's affidavit conceding receipt of the claims.
Quality Health Prods., P.C. v Progressive Ins. Co. (2008 NY Slip Op 51757(U)) Appellate Term, Second Department, August 19, 2008The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit sufficient to establish timely mailing of the verification and follow-up requests and the denials, because it described in detail the standard office practice for addressing and mailing them.
NYC East-West Acupuncture, P.c. v Maryland Cas. Co. (2008 NY Slip Op 51762(U)) Appellate Term, Second Department, August 19, 2008The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's no-fault specialist's affidavit established that the claims were timely denied, the out-of-state notarization defect being waived because the provider did not object.
Horton Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 51682(U)) Appellate Term, Second Department, July 30, 2008The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the litigation examiner's affidavit failed to establish timely mailing of verification requests under a standard office practice designed to ensure items are properly addressed and mailed.
Boro Med. Supplies, Inc. v Country Wide Ins. Co. (2008 NY Slip Op 52698(U)) Appellate Term, Second Department, July 25, 2008The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's unsigned supervisor affidavit had no probative value, so it failed to prove timely denial within 30 days and was precluded from its 45-day defense.
Uptodate Med. Servs., P.C. v Lumbermens Mut. Cas. Co. (2008 NY Slip Op 51502(U)) Appellate Term, Second Department, July 18, 2008The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the no-fault examiner's affidavit did not establish timely mailing of verification requests or denials because it did not sufficiently describe a standard office practice ensuring proper addressing and mailing, so the insurer was precluded.
Eagle Surgical Supply, Inc. v Progressive Cas. Ins. Co. (2008 NY Slip Op 51538(U)) Appellate Term, Second Department, July 10, 2008The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely mailing of its denials pursuant to a standard office practice designed to ensure items are properly addressed and mailed.
Vista Surgical Supplies, Inc. v Autoone Ins. Co. (2008 NY Slip Op 51460(U)) Appellate Term, Second Department, July 8, 2008The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits sufficient to establish that the verification requests and IME scheduling letters were timely sent under a standard office practice designed to ensure proper addressing and mailing.
Health Plus Med., P.C. v American Mfrs. Mut. Ins. Co. (2008 NY Slip Op 51444(U)) Appellate Term, Second Department, July 8, 2008The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurers' examiner's affidavit neither showed personal mailing nor raised a presumption of timely mailing of verification requests and denials under a standard office practice, so their motion failed.
Med-Tech Prod., Inc. v Liberty Mut. Ins. Co. (2008 NY Slip Op 51469(U)) Appellate Term, Second Department, April 29, 2008The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the provider's papers did not prove mailing of the claim form, but the insurer's acknowledgment of receipt in its affidavit and denial cured the defect; the insurer's timely denial was also established.
A Khodadadi Radiology, P.C. v Travelers Prop. Cas. Ins. Co. (2008 NY Slip Op 50910(U)) Appellate Term, Second Department, April 25, 2008The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge and held the claims representative's affidavit sufficiently established timely mailing of the denial pursuant to the insurer's standard office practice and procedure.
Bath Med. Supply, Inc. v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 50347(U)) Appellate Term, Second Department, February 26, 2008The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer showed timely mailing of its denials through a standard office practice designed to ensure items are properly addressed and mailed.
Be Well Med. Supply, Inc. v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 50346(U)) Appellate Term, Second Department, February 21, 2008The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the litigation examiner's affidavit raised a presumption that the verification requests and denials were mailed under standard office practice, though one admitted mailing date made that denial untimely.
Infinity Health Prods., Ltd. v Progressive Ins. Co. (2008 NY Slip Op 50345(U)) Appellate Term, Second Department, February 21, 2008The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld no presumption of timely mailing of the follow-up verification request arose because both requests bore the same date stamp, contradicting the insurer's described date-stamping practice.
Stracar Med. Servs., P.C. v State Farm Mut. Auto. Ins. Co. (2008 NY Slip Op 50277(U)) Appellate Term, Second Department, February 6, 2008The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's documentary proof insufficient to raise a presumption that its denials were timely mailed under a standard office practice, so it showed no meritorious defense to vacate its default; it also lacked a reasonable excuse.
Delta Diagnostic Radiology, P.C. v Farmers New Century Ins. Co. (2007 NY Slip Op 52284(U)) Appellate Term, Second Department, November 21, 2007The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove timely mailing of its denials because its representative neither stated he personally mailed them nor described a standard office practice to ensure proper addressing and mailing.
Allstate Social Work & Psychological Servs., P.L.L.C. v Utica Mut. Ins. Co. (2007 NY Slip Op 52042(U)) Appellate Term, Second Department, October 19, 2007The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer did not establish mailing of its verification and follow-up requests because it neither proved actual mailing nor described a standard office practice ensuring proper addressing and mailing.
AVA Acupuncture, P.C. v GEICO Gen. Ins. Co. (2007 NY Slip Op 27371) Appellate Term, Second Department, September 14, 2007The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer sufficiently showed timely mailing of its denials based on its standard office practice or procedure.
Delta Diagnostic Radiology, P.C. v Chubb Group of Ins. (2007 NY Slip Op 27345) Leading case Appellate Term, Second Department, August 20, 2007The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer showed timely mailing of its denials through a standard office practice; the affiant need only have personal knowledge of the mailing or describe the practice, not a duty to ensure compliance.
Andrew Carothers, M.D., P.C. v New York Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 51613(U)) Appellate Term, Second Department, August 16, 2007The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer sufficiently showed timely mailing of the denials based on its standard office practice or procedure.
Prestige Med. & Surgical Supply, Inc. v Clarendon Natl. Ins. Co. (2007 NY Slip Op 27344) Appellate Term, Second Department, August 16, 2007The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's office-practice affidavit gave rise to no presumption of mailing because the practice relied on a handwritten mailing date that did not appear on the annexed denial copies, so the insurer was precluded.
PDG Psychological, P.C. v Lumbermans Mut. Cas. Co. (2007 NY Slip Op 51343(U)) Appellate Term, Second Department, July 3, 2007The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove timely mailing of its denial because its claims representative neither stated she mailed it nor described office practices ensuring proper addressing and mailing, so it was precluded.
East Acupuncture, P.C. v Electric Ins. Co. (2007 NY Slip Op 51281(U)) Appellate Term, Second Department, June 25, 2007Different mailing results for different documents or claims in one decisionHeld the provider's proof of mailing insufficient for one assignor's claims and unadmitted sums, but found the insurer's denial forms and claims examiner's affidavit conceding receipt cured the defect for four assignors' claims.
Triboro Chiropractic & Acupuncture, PLLC v New York Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 51175(U)) Appellate Term, Second Department, June 8, 2007The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit insufficient to establish mailing of the IME notices.
I & B Surgical Supply v New York Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 27159) Appellate Term, Second Department, April 25, 2007Different mailing results for different documents or claims in one decisionHeld the examiner's detailed office-practice affidavit proved timely mailing of the denials of two claims, but the record did not show when the verification request on the third claim was mailed.
Mega Supply & Billing, Inc. v AIU Ins. Co. (2007 NY Slip Op 50687(U)) Appellate Term, Second Department, April 2, 2007The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the administrative assistant's affidavit that requests were 'forwarded' insufficient because she neither stated she mailed the EUO letters nor described an office practice ensuring proper addressing and mailing.
Fair Price Med. Supply Corp. v Clarendon Natl. Ins. Co. (2007 NY Slip Op 50639(U)) Appellate Term, Second Department, March 30, 2007The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits established timely mailing of the initial and follow-up verification requests and the denial because they described in detail the standard office practice ensuring proper addressing and mailing.
A.B. Med. Servs., PLLC v American Tr. Ins. Co. (2007 NY Slip Op 50680(U)) Appellate Term, Second Department, March 28, 2007The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the billing manager's affidavit of personally mailing the claim forms raised a presumption of receipt that the insurer's mere denial of receipt did not rebut, so the provider won summary judgment on that claim.
Impulse Chiropractic, P.C. v Kemper Ins. Co. (2007 NY Slip Op 50665(U)) Appellate Term, Second Department, March 28, 2007The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer offered no evidence from anyone with personal knowledge of the mailing of the IME scheduling notices.
A.B. Med. Servs. PLLC v State-Wide Ins. Co. (2007 NY Slip Op 50663(U)) Appellate Term, Second Department, March 28, 2007The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the affidavit of an employee of the insurer's IME scheduling vendor sufficient to establish that the IME notices were mailed, rejecting the provider's hearsay challenge, so summary judgment for the provider was properly denied.
SZ Med., P.C. v Trumbull Ins. Co. (2007 NY Slip Op 50499(U)) Appellate Term, Second Department, March 15, 2007The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to submit adequate proof that it mailed its claimed verification requests, so the claim period was not tolled and its fraud denials were untimely.
DSL Med. Practice, P.C. v American Tr. Ins. Co. (2007 NY Slip Op 50398(U)) Appellate Term, Second Department, March 5, 2007The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits, stating the affiants' knowledge of preparing and issuing the verification letters and detailing standard office mailing procedure, gave rise to the presumption of mailing.
Wei Wei Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2007 NY Slip Op 50394(U)) Appellate Term, Second Department, March 5, 2007The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld that counsel's conclusory allegation, without personal knowledge, that EUO requests were sent did not establish their mailing, so no toll of the 30-day period was shown.
Great Wall Acupuncture v Utica Mut. Ins. Co. (2007 NY Slip Op 50389(U)) Appellate Term, Second Department, March 2, 2007The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the claims representative's and investigator's affidavits insufficient because neither showed personal knowledge of mailing the IME requests or described a standard office mailing procedure creating a presumption of mailing.
V.S. Med. Servs., P.C. v One Beacon Ins. (2007 NY Slip Op 50369(U)) Appellate Term, Second Department, February 27, 2007The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer submitted no evidence from someone with personal knowledge of the timely mailing of its denials, so its cross motion for dismissal should have been denied.
Delta Diagnostic Radiology, P.C. v Republic W. Ins. Co. (2007 NY Slip Op 27088) Appellate Term, Second Department, February 27, 2007The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld that denials timely on their face were not shown to have been mailed within 30 days because the insurer offered no documentary proof or affidavit showing actual mailing or a standard office practice, precluding its medical-necessity defense.
Celtic Med. P.C. v New York Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 27057) Appellate Term, Second Department, February 6, 2007The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits sufficiently established that the IME requests and follow-up requests were mailed within the regulatory time periods, rejecting the provider's challenge.
A.B. Med. Servs. PLLC v State-Wide Ins. Co. (2007 NY Slip Op 50260(U)) Appellate Term, Second Department, February 1, 2007The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the affidavit of an employee of the insurer's IME scheduling vendor sufficient to establish that the IME notices were mailed, rejecting the provider's hearsay challenge, so summary judgment for the provider was properly denied.
Vista Surgical Supplies, Inc. v New York Cent. Ins. Co. (2007 NY Slip Op 50165(U)) Appellate Term, Second Department, January 31, 2007The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's examiner's affidavit insufficient to prove mailing of the IME request letters because the vendor, not the examiner, was responsible for scheduling and mailing the notices.
Vista Surgical Supplies, Inc. v State Farm Mut. Ins. Co. (2007 NY Slip Op 50163(U)) Appellate Term, Second Department, January 31, 2007The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer failed to prove timely denial because no affidavit from a person with knowledge stated that the denials were mailed or described a detailed standard office mailing procedure.
Englinton Med., P.C. v MVAIC (2007 NY Slip Op 50164(U)) Appellate Term, Second Department, January 31, 2007The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Held MVAIC failed to establish by competent evidence that it sent its letters requesting information about the assignor's qualified-person status, so they could not extend its time.
Vista Surgical Supplies, Inc. v Electric Ins. Co (2007 NY Slip Op 50150(U)) Appellate Term, Second Department, January 26, 2007The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the claims processor's affidavit neither alleged a mailing nor described the standard office mailing procedure, and reply affidavits that might have proved mailing were properly disregarded, so the insurer was precluded from its defense.
Olympic Chiropractic, P.C. v American Tr. Ins. Co. (2007 NY Slip Op 50011(U)) Appellate Term, Second Department, January 2, 2007The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the insurer's admissions of receipt cured any deficiencies in the provider's proof that it mailed its claims.
Mid Atl. Med. P.C. v GEICO (2007 NY Slip Op 50014(U)) Appellate Term, Second Department, January 2, 2007The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the claims examiner's detailed description of standard office mailing practice raised a presumption that the verification request and denial were timely mailed, so the insurer was not precluded.
Vista Surgical Supplies Inc. v Allstate Ins. Co. (2006 NY Slip Op 52520(U)) Appellate Term, Second Department, December 28, 2006The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the provider's officer's affidavit and the certified mail receipt did not prove mailing because nothing tied the claim to that receipt number, and counsel's affirmation was hearsay; the insurer's proof of non-receipt stood unrebutted.
Boai Zhong Yi Acupuncture Servs., P.C. v Travelers Ins. Co. (2006 NY Slip Op 52516(U)) Appellate Term, Second Department, December 28, 2006The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the provider's officer's affidavit and annexed mailing proof did not show mailing, counsel lacked personal knowledge, and the insurer's delay letter did not prove receipt because it did not state the claim amount.
Magnezit Med. Care, P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 52515(U)) Appellate Term, Second Department, December 27, 2006The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the principal's bare averment that bills were mailed on given dates, with no standard mailing practice described, did not prove mailing; unexplained discrepancies kept the insurer's denials and letters from proving receipt.
Mega Supply & Billing, Inc. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 52504(U)) Appellate Term, Second Department, December 15, 2006The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the provider did not prove mailing of its claim, which the insurer's unspecific denial form did not cure, and the insurer's claims representative's affidavit likewise failed to prove timely mailing of its denial.
Vista Surgical Supplies, Inc. v Travelers Ins. Co. (2006 NY Slip Op 52502(U)) Appellate Term, Second Department, December 15, 2006The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the insurer's denial forms stating the receipt dates established that the provider sent and the insurer received the claims; the insurer's standard-practice affidavit also raised a presumption its denials were mailed.
Starrett Med. L.C.P.C. v GEICO Cas. Ins. Co. (2006 NY Slip Op 52493(U)) Appellate Term, Second Department, December 13, 2006The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the provider's papers did not prove mailing of the claim forms, but the insurer's denial forms cured the deficiency by establishing receipt.
Vista Surgical Supplies, Inc. v American Tr. Ins. Co. (2006 NY Slip Op 52470(U)) Appellate Term, Second Department, December 12, 2006The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the provider's papers did not prove the claim form was ever submitted, and refused to consider a verification request offered for the first time in reply to show receipt.
Impulse Chiropractic P.C. v Travelers Ins. Co. (2006 NY Slip Op 52469(U)) Appellate Term, Second Department, December 12, 2006The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the officer's affidavit did not prove mailing, counsel's affirmation lacked personal knowledge, and delay letters omitting the claim amounts did not establish that the insurer received the claims.
Oleg Barshay, D.C., P.C. v State Farm Ins. Co. (2006 NY Slip Op 26496) Appellate Term, Second Department, December 8, 2006The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the provider's inadequate proof that it submitted the claim was cured by the insurer's denial of claim form, annexed to the insurer's opposition, acknowledging receipt of the claim.
Forrest Chen Acupuncture Servs., P.C. v Nationwide Mut. Ins. Co. (2006 NY Slip Op 52270(U)) Appellate Term, Second Department, November 17, 2006The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the provider failed to prove mailing of its claims, while the insurer's counsel's conclusory affirmation was no admissible proof of non-receipt or late submission.
Dilon Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2006 NY Slip Op 52266(U)) Appellate Term, Second Department, November 17, 2006The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer submitted no evidence that its EUO verification requests were mailed, so its time to deny was not tolled and its denial was untimely.
Bath Med. Supply, Inc. v Allstate Indem. Co. (2006 NY Slip Op 52273(U)) Appellate Term, Second Department, November 17, 2006The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove timely mailing of its denials because its employee's affidavit, notarized out of state without a CPLR 2309 (c) certificate of conformity, was inadmissible.
AVA Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 52256(U)) Appellate Term, Second Department, November 15, 2006The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the no-fault specialist's affidavit insufficient to prove mailing of the IME request letters because she neither claimed personal knowledge of the mailing nor described a detailed standard office mailing practice.
Executive MRI Imaging, P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 52250(U)) Appellate Term, Second Department, November 13, 2006The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held any deficiency in the provider's proof of mailing its claims was cured by the insurer's acknowledgment of receipt on its denial form annexed to the provider's papers.
New Century Chiropractic, P.C. v State Farm Mut. Ins. Co. (2006 NY Slip Op 52236(U)) Appellate Term, Second Department, November 2, 2006The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the provider's moving papers did not prove mailing of the claim forms, but the insurer's denial form covering all claims adequately established that they were sent and received.
Post Traumatic Med. Care P.C. v Travelers Home & Mar. Ins. Co. (2006 NY Slip Op 52222(U)) Appellate Term, Second Department, October 27, 2006The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the provider's affidavit failed to show when the claim was mailed or describe a standard mailing practice, and the certified-mail return receipt was not shown to relate to this claim.
Bell Air Med. Supply LLC v State Farm Ins. Claim Off. (2006 NY Slip Op 52218(U)) Appellate Term, Second Department, October 27, 2006Different mailing results for different documents or claims in one decision (also decides)Held the provider's papers did not prove mailing of either claim, but the insurer's denial form acknowledging receipt cured the defect for one claim, leaving the other unproved.
SpineAmericare Med., P.C. v State Farm Mut. Auto. Ins. Co. (2006 NY Slip Op 52035(U)) Appellate Term, Second Department, October 5, 2006Different mailing results for different documents or claims in one decisionHeld the officer's affidavit and certified mail receipts did not prove mailing, but the insurer's own letters established receipt of 10 of the 12 claims; a reply affidavit of actual mailing was disregarded.
Delta Diagnostic Radiology, P.C. v Allstate Ins. Co. (2006 NY Slip Op 52034(U)) Appellate Term, Second Department, October 5, 2006Different mailing results for different documents or claims in one decisionHeld the insurer's explanation of benefits, stating the date of receipt, established that the provider sent the claim, while the insurer failed to establish that it mailed a timely denial, so it was precluded.
Triboro Chiropractic & Acupuncture P.L.L.C v Allstate Ins. Co. (2006 NY Slip Op 51740(U)) Appellate Term, Second Department, September 14, 2006The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer offered neither proof of actual mailing of the IME request letters nor an affidavit describing a standard office practice ensuring proper addressing and mailing.
Prestige Med. & Surgical Supply, Inc. v Clarendon Natl. Ins. Co. (2006 NY Slip Op 51672(U)) Appellate Term, Second Department, August 18, 2006The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the adjusters' affidavits merely stated the claims were timely denied without personal knowledge of mailing or facts creating a presumption, so the insurer did not prove timely mailing of its denials.
A.M. Med. Servs., P.C. v New York Cent. Mut. Ins. (2006 NY Slip Op 51662(U)) Appellate Term, Second Department, August 15, 2006Different mailing results for different documents or claims in one decisionHeld the insurer's standard-practice affidavit proved mailing of the denial on one claim, but was insufficient to prove actual or presumed mailing of the verification requests on four other claims.
IVB Med. Supply, Inc. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 51660(U)) Appellate Term, Second Department, August 14, 2006The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the officer's affidavit and post office ledger did not prove mailing, counsel lacked personal knowledge, and a denial form showing a different claim amount did not establish receipt.
Delta Diagnostic Radiology, P.C. v GEICO Ins. Co. (2006 NY Slip Op 51557(U)) Appellate Term, Second Department, July 26, 2006The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the claims examiner's affidavit established that the denials were timely mailed pursuant to the insurer's routine office practice and procedures, rejecting the provider's contrary contention.
Vista Surgical Supplies, Inc. v Nationwide Mut. Ins. Co. (2006 NY Slip Op 51556(U)) Appellate Term, Second Department, July 26, 2006The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the certified mail receipt was not tied to the claims, counsel's affirmation was hearsay, and a denial form with blank receipt fields did not establish that the insurer received the claims.
Accessible & Advance Med. P.C. v Allstate Ins. Co. (2006 NY Slip Op 51599(U)) Appellate Term, Second Department, July 19, 2006The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the provider's deficient mailing affidavit was cured by the insurer's denial forms showing receipt of the claims; also found the insurer proved timely mailing of its denials, which did not avoid preclusion.
Fair Price Med. Supply Corp. v Liberty Mut. Ins. Co. (2006 NY Slip Op 51438(U)) Appellate Term, Second Department, July 18, 2006The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove timely mailing of its denial because it offered neither an affidavit with personal knowledge of the mailing nor a detailed description of its standard mailing procedure.
Magnezit Med. Care, P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 51434(U)) Appellate Term, Second Department, July 18, 2006The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the providers' failure to prove mailing was cured by the insurer's claims examiner affidavit and denial forms acknowledging the dates the claim forms were received.
PDG Psychological P.C. v Progressive Cas. Ins. Co. (2006 NY Slip Op 51432(U)) Appellate Term, Second Department, July 17, 2006Different mailing results for different documents or claims in one decisionHeld the insurer's denial of one claim not proved mailed for lack of personal knowledge or a detailed office-practice description, and two of the provider's claims not proved mailed, while receipt of the third was shown by the denial.
Bronxborough Med., P.C. v New Hampshire Ins. Co. (2006 NY Slip Op 51354(U)) Appellate Term, Second Department, July 7, 2006The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to raise a triable issue because its conclusory affidavit by one without personal knowledge did not describe the office practice used to ensure IME requests were properly addressed and mailed.
Psychological Practice, P.C. v Kemper Auto & Home Ins. Co. (2006 NY Slip Op 51289(U)) Appellate Term, Second Department, July 3, 2006The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer proved mailing of its denial through an affidavit of a person with personal knowledge alleging the form's actual mailing.
M.G.M. Psychiatry Care P.C. v Utica Mut. Ins. Co. (2006 NY Slip Op 51286(U)) Appellate Term, Second Department, July 3, 2006The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove by proper mailing that it ever asked the assignor to sign and return his EUO transcript, so no toll arose and its denials were untimely.
Fair Price Med. Supply Corp. v ELRAC Inc. (2006 NY Slip Op 26269) Appellate Term, Second Department, July 3, 2006The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the provider's affidavit insufficient to prove mailing of the claim forms, but the insurer's acknowledgment of receipt on its denial form cured that deficiency.
Vista Surgical Supplies, Inc. v Liberty Mut. Ins. Co. (2006 NY Slip Op 26276) Appellate Term, Second Department, June 30, 2006The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld mailing not proved because the officer did not state he mailed the claims and the proof of mailing he cited was not annexed; an unsigned stipulation could not establish receipt.
Contemporary Acupuncture P.C. v Travelers Ins. Co. (2006 NY Slip Op 51278(U)) Appellate Term, Second Department, June 29, 2006The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the provider showed neither actual mailing nor a standard office mailing practice, and a denial form not referable to these claims did not establish the insurer's receipt.
Amol, Inc. v Travelers Ins. Co. (2006 NY Slip Op 51271(U)) Appellate Term, Second Department, June 28, 2006The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the provider's owner's affidavit failed to prove the earlier claim submission was mailed, lacking proof of actual mailing or a standard office practice, so the insurer's acknowledged later receipt made its denial timely.
Boai Zhong Yi Acupuncture Servs., P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 51202(U)) Appellate Term, Second Department, June 23, 2006The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the claims examiner's affidavit, from one with personal knowledge of and responsibility for enforcing the practice of same-day mailing to the billing address, established timely mailing of the verification requests.
Vista Surgical Supplies, Inc. v State Farm Mut. Ins. Co. (2006 NY Slip Op 51189(U)) Appellate Term, Second Department, June 15, 2006The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the provider's affidavit insufficient to prove mailing, but the insurer's denial of claim forms adequately established that the claims were sent and received, curing the defect.
Colonia Med., P.C. v Travelers Ins. Co. (2006 NY Slip Op 51186(U)) Appellate Term, Second Department, June 8, 2006The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the claims representative's affidavit did not prove mailing of verification requests because the affiant asserted neither personal knowledge of actual mailing nor facts creating a presumption of mailing.
Vista Surgical Supplies, Inc. v Metropolitan Prop. & Cas. Ins. Co. (2006 NY Slip Op 51047(U)) Appellate Term, Second Department, June 2, 2006The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the provider's moving papers did not establish mailing of the claim forms but the deficiency was cured by the insurer's acknowledgment of receipt in its adjuster's affidavit.
Dilon Med. Supply Corp. v State Farm Mut. Ins. Co. (2006 NY Slip Op 51344(U)) Appellate Term, Second Department, May 25, 2006The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the provider's deficient proof of mailing its claim form was cured by the insurer's acknowledgment of receipt in its denial of claim form and in its employee's affidavit.
Vista Surgical Supplies, Inc. v Statewide Ins. Co. (2006 NY Slip Op 51118(U)) Appellate Term, Second Department, May 24, 2006The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the provider did not prove mailing because the officer only possessed proofs of mailing, and certified-mail receipts and return cards were not related to the claims in the record.
A.M. Med. Servs., P.C. v Progressive Cas. Ins. Co. (2006 NY Slip Op 51036(U)) Appellate Term, Second Department, May 19, 2006The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the litigation specialist's affidavit did not prove mailing of the follow-up verification request because she did not mail it herself and gave no sufficiently detailed standard office mailing procedure.
Dilon Med. Supply Corp. v Progressive Cas. Ins. Co. (2006 NY Slip Op 50908(U)) Appellate Term, Second Department, May 17, 2006The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the officer's statement of the usual certified-mail billing procedure plus signed, date-stamped post office ledgers listing the insurer as addressee proved mailing of the claims.
SZ Med. P.C. v Country-Wide Ins. Co. (2006 NY Slip Op 26194) Appellate Term, Second Department, May 17, 2006The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the insurer's acknowledgment of receipt on the 45th day after treatment necessarily conceded that the claim was timely submitted, that is, mailed, defeating the late-submission denial.
Amaze Med. Supply Inc. v General Assur. Co. (2006 NY Slip Op 50910(U)) Appellate Term, Second Department, May 17, 2006The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the IME scheduling supervisor's affidavit describing a standard office practice designed to ensure IME requests were properly addressed and mailed adequate proof of mailing in opposition.
A.B. Med. Servs. PLLC v Specialty Natl. Ins. Co. (2006 NY Slip Op 50810(U)) Appellate Term, Second Department, April 28, 2006The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the billing manager's statements that he issued and billed out the claims did not show personal knowledge of mailing or a detailed standard office mailing procedure, so submission was not established.
AT Med. P.C. v Utica Mut. Ins. Co. (2006 NY Slip Op 50739(U)) Appellate Term, Second Department, April 14, 2006Different mailing results for different documents or claims in one decision (also decides)Held the insurer's denial forms established that the provider sent and the insurer received the claims, but the insurer offered no proper proof of mailing its request to execute the EUO transcript, so that request could not toll the 30 days.
Staten Is. Chiropractic Assoc., P.C. v Long Is. Ins. Co. (2006 NY Slip Op 50588(U)) Appellate Term, Second Department, April 7, 2006The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the provider's assertion that claims were submitted in the ordinary course of business failed to show a standard office mailing practice, and a generic denial form did not concede receipt of these claims.
Rigid Med. of Flatbush, P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 50582(U)) Appellate Term, Second Department, April 6, 2006The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer failed to prove mailing of the EUO notices because no one with personal knowledge alleged mailing and no standard office mailing procedure was described.
A.B. Med. Servs. PLLC v Prudential Prop. & Cas. Ins. Co. (2006 NY Slip Op 50504(U)) Appellate Term, Second Department, March 27, 2006The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove mailing of its EUO and IME scheduling requests because it produced no documentary proof and its affiant asserted no personal knowledge of mailing or facts creating a presumption of mailing.
Delta Diagnostic Radiology, P.C. v Progressive Cas. Ins. Co (2006 NYSlipOp 50491(U)) Appellate Term, Second Department, March 27, 2006The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held submission of the claim was established by the annexed denial of claim form stating that the insurer received it.
Magnezit Med. Care, P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 50473(U)) Appellate Term, Second Department, March 27, 2006The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the principal's affidavit lacked any standard mailing practice or personal knowledge, and the insurer's denial forms could not prove receipt because they did not match the claim forms.
Magnezit Med. Care, P.C. v Allstate Ins. Co. (2006 NY Slip Op 50293(U)) Appellate Term, Second Department, February 28, 2006The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the principal's affidavit, giving mailing dates but no standard office mailing practice or personal knowledge of mailing, did not prove the claim forms were mailed.
Fair Price Med. Supply Corp. v ELRAC Inc. (2006 NY Slip Op 50860(U)) Appellate Term, Second Department, February 28, 2006The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer offered no proof of mailing and created no presumption of mailing for its examination requests, so it failed to show it timely mailed them.
Fair Price Med. Supply Corp. v ELRAC Inc. (2006 NY Slip Op 50861(U)) Appellate Term, Second Department, February 28, 2006Different mailing results for different documents or claims in one decision (also decides)Held the insurer's denial forms acknowledging receipt established submission of two claims, but the officer's bare statement that mailing proofs were in his possession did not prove mailing of two others.
Amaze Med. Supply Inc. v General Assur. Co. (2006 NY Slip Op 50307(U)) Appellate Term, Second Department, February 27, 2006The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the no-fault supervisor's affidavit, as the person overseeing IME scheduling and the mailing of notices, showed a standard office practice ensuring the IME requests were properly addressed and mailed.
A.B. Med. Servs. PLLC v Utica Mut. Ins. Co. (2006 NY Slip Op 26068) Appellate Term, Second Department, February 17, 2006The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer did not prove timely denial because no affiant with personal knowledge stated the denial was mailed or described a sufficiently detailed standard office mailing procedure.
PDG Psychological P.C. v Utica Mut. Ins. Co. (2006 NY Slip Op 50246(U)) Appellate Term, Second Department, February 14, 2006The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to establish it mailed its denials within the 30-day period, so it was precluded from its defenses.
Vista Surgical Supplies, Inc. v Allstate Ins. Co. (2006 NY Slip Op 51332(U)) Appellate Term, Second Department, February 6, 2006The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the provider's officer affidavit, saying only that the file held proofs of mailing, showed neither actual mailing nor a standard office practice, so mailing of the claim form was not proved.
Modern Psychiatric Servs. P.C. v Progressive Ins. Co. (2006 NY Slip Op 50143(U)) Appellate Term, Second Department, February 3, 2006The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove timely mailing of its verification requests, offering neither an affidavit of personal knowledge of mailing nor an adequate description of standard mailing procedures.
Delta Diagnostic Radiology, P.C. v GEICO Ins. Co. (2006 NY Slip Op 50137(U)) Appellate Term, Second Department, February 2, 2006The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer did not prove timely mailing of its denial because it offered no documentary proof, no affiant with personal knowledge, and no description of standard mailing procedures.
Star Med. Servs. P.C. v Allstate Ins. Co. (2006 NY Slip Op 50129(U)) Appellate Term, Second Department, February 1, 2006The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer did not prove mailing of the EUO request letters because its claims representative and counsel showed no personal knowledge of the mailing and described no standard office practice ensuring proper addressing and mailing.
Gribenko v Allstate Ins. Co. (2005 NYSlipOp 52201(U)) Appellate Term, Second Department, December 30, 2005The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld that treating providers' statements that their offices mailed claim forms within five business days did not describe a standard practice ensuring proper addressing and mailing, nor show duty or knowledge of compliance, so mailing was unproved.
Careplus Med. Supply Inc. v State-Wide Ins. Co. (2005 NY Slip Op 25545) Appellate Term, Second Department, December 15, 2005The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the insurer's identical denial form, submitted without objection or denial of receipt, established that the provider sent and the insurer received the claims, effectively conceding receipt.
A.B. Med. Servs. PLLC v Liberty Mut. Ins. Co. (2005 NY Slip Op 51902(U)) Appellate Term, Second Department, November 21, 2005The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer failed to proffer competent proof in admissible form that it mailed the IME scheduling requests, so its no-show defense raised no triable issue.
A.B. Med. Servs. PLLC v American Tr. Ins. Co. (2005 NYSlipOp 51316(U)) Appellate Term, Second Department, August 17, 2005Different mailing results for different documents or claims in one decisionHeld the insurer's denial forms stating receipt dates established that the providers sent and the insurer received the claims, but found no competent proof the insurer mailed the IME notices to one assignor, so its no-show opposition failed.
Amaze Med. Supply Inc. v State Farm Mut. Auto. Ins. Co. (2005 NYSlipOp 51315(U)) Appellate Term, Second Department, August 17, 2005The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld counsel's and the claims representative's averments insufficient because neither showed personal knowledge that the IME requests were mailed or described a standard office practice ensuring proper addressing and mailing.
S&M Supply Inc. v Progressive Ins. Co. (2005 NYSlipOp 51312(U)) Appellate Term, Second Department, August 17, 2005The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the litigation examiner's affidavit did not prove mailing of the verification request because no one with personal knowledge said the letters were mailed and the office mailing procedure was not described in enough detail.
Fair Price Med. Supply Corp. v Travelers Indem. Co. (2005 NY Slip Op 25343) Appellate Term, Second Department, August 11, 2005The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the billing manager's affidavit, made on personal knowledge and stating that he mailed the letters of medical necessity with the address and mailing date, sufficiently proved mailing of the verification response.
A.B. Med. Servs. PLLC v Allstate Ins. Co. (2005 NYSlipOp 51270(U)) Appellate Term, Second Department, July 28, 2005The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's adjuster affidavit insufficient to show timely mailing of its denials because it neither alleged actual mailing nor described a standard office practice ensuring proper addressing and mailing.
A.B. Med. Servs. PLLC v USAA Gen. Indem. Co. (2005 NY Slip Op 25297) Appellate Term, Second Department, July 21, 2005The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the insurer's denial forms stating receipt dates established that the claims were sent and received, and the providers submitted proper proof of mailing for the undenied claims.
Ocean Diagnostic Imaging P.C. v New York Cent. Mut. Fire Ins. Co. (2005 NY Slip Op 51772(U)) Appellate Term, Second Department, July 7, 2005The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove mailing of the IME request letters and verification requests because no affiant with personal knowledge attested to mailing and no detailed standard office mailing procedure was described.
Ocean Diagnostic Imaging P.C. v Travelers Prop. Cas. Corp. (2005 NY Slip Op 51047(U)) Appellate Term, Second Department, July 6, 2005The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseUpheld the finding that the provider failed to prove it mailed one assignor's claim, which defeated summary judgment on that claim. Certificates of mailing and return receipts proved the mailing of two other claims, but those failed on the founded-belief ground.
Summit Psychological, P.C. v General Assur. Co. (2005 NY Slip Op 25263) Appellate Term, Second Department, June 28, 2005The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's submissions failed to establish timely mailing of the denials and, alternatively, that the claims examiner's affidavit failed to prove mailing of the IME requests, lacking personal knowledge of mailing or any standard office procedure.
Amaze Med. Supply Inc. v General Assur. Co. (2005 NY Slip Op 50960(U)) Appellate Term, Second Department, June 9, 2005The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to raise a triable issue because its attorney's conclusory allegation of sending IME requests lacked personal knowledge and described no standard addressing and mailing practice.
Struhl v Progressive Cas. Ins. Co. (2005 NYSlipOp 50864(U)) Appellate Term, Second Department, June 3, 2005The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's litigation specialist, lacking personal knowledge and offering no proof of mailing, failed to prove its verification requests were mailed.
Ocean Diagnostic Imaging P.C. v Lumbermens Mut. Cas. Co. (2005 NY Slip Op 50743(U)) Appellate Term, Second Department, May 19, 2005The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove mailing of the IME demand letters because counsel's affirmation was hearsay and no papers set forth facts creating a presumption of mailing.
Careplus Med. Supply Inc. v Travelers Home & Mar. Ins. Co. (2005 NYSlipOp 50648(U)) Appellate Term, Second Department, April 29, 2005The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to raise an issue on its verification requests because there was no documentary proof of mailing or admission of receipt and its claims examiner claimed no personal knowledge of mailing or office practice.
D.A.V. Chiropractic P.C. v American Tr. Ins. Co. (2005 NYSlipOp 50609(U)) Appellate Term, Second Department, April 22, 2005The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the affidavits of the IME scheduling company's operations manager and the insurer's claims representative showed a standard office practice designed to ensure the IME letters were properly addressed and mailed.
A.B. Med. Servs. PLLC v Electric Ins. Co. (2005 NYSlipOp 50542(U)) Appellate Term, Second Department, April 13, 2005The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld one provider's proof of mailing a $100 claim insufficient because it showed a post date before the bill's date and the discrepancy was unexplained, so no prima facie showing for that claim.
Capio Med., P.C. v Progressive Cas. Ins. Co. (2005 NYSlipOp 50526(U)) Appellate Term, Second Department, April 13, 2005The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the insurer's denial forms, indicating the dates the claims were received, adequately established that the provider sent and the insurer received the claims.
King's Med. Supply Inc. v Kemper Auto & Home Ins. Co. (2005 NYSlipOp 50450(U)) Appellate Term, Second Department, March 31, 2005The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's proof of mailing its two verification request letters sufficed to raise a triable issue on their timely mailing, defeating summary judgment on the unpaid claim.
Careplus Med. Supply Inc. v General Assur. Co. (2005 NY Slip Op 50429(U)) Appellate Term, Second Department, March 31, 2005The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the IME schedulers' affidavits insufficient to prove mailing because no one with personal knowledge alleged actual mailing, no detailed office procedure was described, and receipts showed mailing only to the assignors' attorneys.
Ocean Diagnostic Imaging P.C. v General Assur. Co. (2005 NY Slip Op 50435(U)) Appellate Term, Second Department, March 31, 2005The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld neither counsel's affirmation nor the team leader's affidavit showed personal knowledge of mailing the IME notices or a standard practice; vendor affidavits submitted only with the appellate brief were not considered.
Contemp. Med. Diag. & Treatment, P.C. v Government Employees Ins. Co. (2005 NY Slip Op 50254(U)) Appellate Term, Second Department, March 2, 2005The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the claims examiner's assertion that documents were customarily mailed the day generated conclusory, as it neither showed personal knowledge of mailing nor described a standard practice ensuring proper addressing and mailing.
Fair Price Med. Supply Corp. v General Assur. Co. (2005 NY Slip Op 50256(U)) Appellate Term, Second Department, March 2, 2005The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to raise a triable issue because its conclusory allegation of sending IME requests, by one without personal knowledge, did not describe a standard practice ensuring proper addressing and mailing.
A.B. Med. Servs. PLLC v Motor Veh. Acc. Indem. Corp. (2005 NY Slip Op 50088(U)) Appellate Term, Second Department, February 1, 2005The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld MVAIC's examiner's denial of receipt insufficient to rebut the presumption of receipt arising from the provider's proof of proper mailing of its claims.
A.B. Med. Servs. PLLC v Prudential Prop. & Cas. Ins. Co. (2005 NY Slip Op 25032) Appellate Term, Second Department, January 20, 2005The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the insurer's delay letters acknowledging receipt established that one provider sent and the insurer received its bills, and found proper proof of mailing of another provider's claim.
A.B. Med. Servs. PLLC v USAA Cas. Ins. Co. (2004 NY Slip Op 51682(U)) Appellate Term, Second Department, December 22, 2004Different mailing results for different documents or claims in one decisionHeld the billing manager's affidavit that she personally mailed one claim form raised an unrebutted presumption of receipt, but the insurer, relying only on counsel's affirmation, failed to prove actual or standard-practice mailing of the IME letters for two other claims.
Amaze Med. Supply Inc. v New York Cent. Mut. Ins. Co. (2004 NY Slip Op 51680(U)) Appellate Term, Second Department, December 22, 2004The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the affidavits of the insurer's manager and its IME scheduling vendor's employee sufficiently showed a standard office practice ensuring the IME request letters were properly addressed and mailed.
Ocean Diagnostic Imaging, P.C. v Lancer Ins. Co. (2004 NY Slip Op 24501) Appellate Term, Second Department, December 8, 2004The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer submitted no proof in admissible form that its alleged verification requests were mailed, so they did not extend its 30-day period to deny.
King's Med. Supply, Inc. v Hereford Ins. Co. (2004 NY Slip Op 24343) Appellate Term, Second Department, September 20, 2004The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld a triable issue existed on timely mailing of the denial because the insurer's adjuster described a standard office practice showing mailing on the last day while the provider produced an envelope postmarked six weeks later.
Comprehensive Mental v Lumbermens Mut. Ins. Co. (2004 NY Slip Op 50745(U)) Appellate Term, Second Department, July 1, 2004The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the provider failed to prove timely mailing of the late-received claim because its manager's affidavit described no standard office mailing practice and its bare averment that all bills were timely mailed showed no personal knowledge.
S&m Supply Inc. v Lancer Ins. Co. (2004 NY Slip Op 50695(U)) Appellate Term, Second Department, June 30, 2004The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's opposition lacked an affidavit of someone with personal knowledge of the mailing or describing standard procedures to ensure proper addressing and mailing, so timely mailing of verification requests was not shown.
Amaze Med. Supply Inc. v Allstate Ins. Co. (2004 NY Slip Op 50447(U)) Appellate Term, Second Department, May 20, 2004The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld a signed, date-stamped post office ledger bearing the insurer's name, plus the president's affidavit that he mailed the bills that day, proved the provider's actual mailing and raised the presumption of receipt.
King'S Med. Supply v Progressive Ins. (2004 NY Slip Op 50311(U)) Appellate Term, Second Department, April 14, 2004The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the provider entitled to judgment on one claim because its proof of proper mailing raised a presumption of receipt that the insurer's bare assertion of non-receipt did not rebut.
Amaze Med. Supply v Colonial Penn Ins. Co. (2004 NY Slip Op 50471(U)) Appellate Term, Second Department, March 3, 2004The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove it timely mailed IME requests because its counsel's affirmation showed no personal knowledge of the mailing and did not describe a standard office mailing procedure, so its defenses were precluded.
S & M Supply v Geico Ins. (2004 NY Slip Op 50502(U)) Appellate Term, Second Department, February 26, 2004The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the claim examiner's affidavit insufficient because she neither claimed personal knowledge that a verification request was mailed nor described standard operating procedures ensuring proper mailing, so no presumption of mailing arose.
A.B. Med. Servs. v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 50387(U)) Appellate Term, Second Department, February 10, 2004The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the prima facie case failed on several bills because the providers' affidavit did not allege the claim forms were mailed and there was no proof of when the insurer received them.
A.B. Med. Servs. v GEICO Ins. (2003 NY Slip Op 23949) Appellate Term, Second Department, December 9, 2003The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Relied on the provider's unrebutted proof that it mailed the claims on a specific date to find the insurer's later verification requests untimely.
A.B. Med. Servs. PLLC Royalton Chiropractic P.C. v Lumbermens Mut. Cas. Co. (2003 NY Slip Op 51392(U)) Appellate Term, Second Department, October 21, 2003The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the provider's billing manager affidavit that she mailed the claim forms on a stated date, with an attached postmarked receipt, proved mailing despite the insurer's denial of receipt.
A.B. Med. Servs. PLLC Royalton Chiropractic P.C. v Lumbermens Mut. Cas. Co. (2003 NY Slip Op 51393(U)) Appellate Term, Second Department, October 21, 2003The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the billing manager's affidavit that she mailed the claim forms on a specific date, with a postmarked receipt attached, proved mailing despite the insurer's denial of receipt.

Trial courts in the First Department (34 decisions)

Baldwin Med. Servs., P.C. v Maya Assur. Co (2026 NY Slip Op 51329(U)) Civil Court of the City of New York, Bronx County, August 19, 2026The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the adjuster's affidavit failed to raise a presumption of mailing of the initial verification request because it did not describe the practice applied to it, and the denial's conflicting date raised a further factual issue.
SCOB, LLC v Liberty Mut. Ins. Co. (2026 NY Slip Op 51484(U)) Civil Court of the City of New York, New York County, July 13, 2026The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove proper mailing of the IME scheduling letters because they were addressed to a different town than the residence shown on the assignor's NF-2, a discrepancy left unexplained in reply.
KBJ Med. Practice, P.C. v Lancer Ins. Co. (2025 NY Slip Op 50277(U)) Civil Court of the City of New York, Bronx County, March 3, 2025The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer did not prove mailing of the EUO notices: its attorney claimed certified mailing without personal knowledge while the notices showed first-class mail only, and the examiner's boilerplate procedure did not ensure proper addressing and mailing.
Fyzio PT, PLLC v Ocean Harbor Cas. Ins. Co. (2025 NY Slip Op 50103(U)) Civil Court of the City of New York, Bronx County, January 13, 2025The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims manager's description of standard mailing procedures sufficed to presume the EUO and IME notices were duly addressed and mailed.
Williams v Kemper Independence Ins. Co. (2025 NY Slip Op 50101(U)) Civil Court of the City of New York, Bronx County, January 10, 2025The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claim representative's description of standard mailing procedures sufficient to presume the requests for a completed NF-2 were properly addressed and mailed, and its records review established non-receipt.
Van Loon DME USA, Inc v Maya Assur. Co. (2025 NY Slip Op 50102(U)) Civil Court of the City of New York, Bronx County, January 10, 2025The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the provider's mailing employee described procedures sufficient to ensure bills were properly addressed and mailed, so the bills were presumed duly mailed to both the wrong insurer and the defendant.
Kim v State Farm Ins. Co. (2024 NY Slip Op 51364(U)) Civil Court of the City of New York, New York County, June 10, 2024The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established the timely and proper mailing of its EUO scheduling letters and denial of claim forms through its claim specialist's affidavit and affidavits of mailing.
State Farm Fire & Cas. Co. v Atlantic Diagnostic, L.L.C. (2024 NY Slip Op 50436(U)) Supreme Court, New York County, April 4, 2024The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the supervising attorney's affirmation, the request letters and affidavits of mailing established prima facie that the transcript-signature requests were sent and not complied with.

Show all 34 decisions

State Farm Fire & Cas. Co. v Blackburn (2023 NY Slip Op 50745(U)) Supreme Court, New York County, July 13, 2023The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the EUO letters were mailed to the correct address, shown by mailing affidavits and an address matching the provider's own bills, rejecting the providers' wrong-address argument.
State Farm Mut. Auto. Ins. Co. v Emote Med. Servs., P.C. (2022 NY Slip Op 50818(U)) Supreme Court, New York County, August 24, 2022The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Held the conclusory verified complaint insufficient for a default declaration, noting in particular that the insurers offered no evidence the EUO requests, follow-ups and denials were correctly addressed and mailed, among several other gaps.
Liberty Mut. Ins. Co. v Brutus (2022 NY Slip Op 50799(U)) Supreme Court, New York County, August 16, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held that a claims manager's detailed affidavit of a procedure mailing denials by the next business day after their date, uncontradicted by the provider, defeated the provider's claim that the dated denials were untimely mailed.
Sabodash v Hereford Ins. Co. (2021 NY Slip Op 51099(U)) Civil Court of the City of New York, Bronx County, November 19, 2021The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the insurer's own denial forms established receipt of the provider's claim, curing the absence of provider mailing proof; the insurer's office-practice affidavit also proved timely mailing of its denials, though that did not affect the result.
Park Ave. Chiropractic & Health Care PC v Maya Assur. Co. (2021 NY Slip Op 50804(U)) Civil Court of the City of New York, Bronx County, August 18, 2021The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the affirmation of the EUO attorney, who personally verified addresses and mailed the notices, established that the provider and its counsel were properly notified of both EUOs.
Alsaad Med., P.C. v State Farm Mut. Auto. Ins. Co. (2021 NY Slip Op50532(U)) Civil Court of the City of New York, Bronx County, June 8, 2021The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the mail-room, vendor and team-manager affidavits describing the insurer's actual mailing protocol established that the EUO scheduling letters and the denial were mailed, raising a presumption of receipt.
Country-Wide Ins. Co. v Ware (2021 NY Slip Op 50506(U)) Supreme Court, New York County, May 28, 2021The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected the providers' argument that the insurer's employee affidavits were insufficient to establish timely and proper mailing of the IME requests.
Restorative Chiropractic Solutions, PC v State Farm Mut. Auto. Ins. Co. (2021 NY Slip Op 50209(U)) Civil Court of the City of New York, New York County, March 12, 2021The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's standard-office-practice affidavits established timely mailing of its delay letters and denials, and its EUO counsel's affidavit rebutted the provider's claim that EUO scheduling letters were never sent.
Country-Wide Ins. Co. v Delacruz (2021 NY Slip Op 21019) Supreme Court, New York County, February 4, 2021The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's documentary evidence showed the EUO requests were properly mailed to the address on the assignor's NF-2, with timely advance notice of the rescheduled dates.
Harvey Family Chiro PT & Acup, PLLC v Ameriprise Ins. Co. (2020 NY Slip Op 20136) Civil Court of the City of New York, Bronx County, June 15, 2020The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the provider failed to prove mailing of its bill, offering no biller's statement of mailing, no mailing date and no proof of mailing, so its cross motion failed.
Ellen Sue Ginsberg D.O.P.C. v Hertz Claim Mgt. Corp. (2020 NY Slip Op 50191(U)) Civil Court of the City of New York, Bronx County, February 5, 2020The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the adjuster's non-receipt affidavit unrebutted because the provider's mailing tracking screens were offered only through an attorney affirmation without personal knowledge, so the bills were not shown received.
HKP Physical Therapy, P.C. v Government Empls. Ins. Co. (2019 NY Slip Op 29381) Civil Court of the City of New York, New York County, December 2, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Found that the affidavits of both sides showed that the claims, verification requests, follow-ups, responses and denials were properly and timely sent, and receipt was undisputed.
Tian Shan Acupuncture PC v Global Liberty Ins. Co. (2019 NY Slip Op 50728(U)) Civil Court of the City of New York, Bronx County, May 14, 2019The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the IME vendor supervisor's affidavit describing addressing, postage and delivery to the Postal Service proved mailing of both scheduling letters, and the adjuster's description of standard practice proved timely mailing of the denial.
Global Liberty Ins. Co. of N.Y. v Otero (2018 NY Slip Op 51025(U)) Supreme Court, Bronx County, June 15, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the IME scheduling letters proved mailed because the scheduler's affidavit described the postage and USPS hand-off procedure, postal-stamped mailing ledgers corroborated it, and the letters went to the address on the no-fault application.
Acupuncture Approach, P.C. v USAA Gen. Indem. Co. (2018 NY Slip Op 50807(U)) Civil Court of the City of New York, New York County, April 24, 2018The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld an issue of fact existed whether the denials and explanations of reimbursement were properly and timely mailed because the claims adjuster's affidavit inconsistently said documents were returned undeliverable, and no proof of the provider's admitted receipt was supplied.
American Tr. Ins. Co. v Miranda (2013 NY Slip Op 52277(U)) Supreme Court, New York County, December 12, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected the challenge to mailing of the IME letters because copies were annexed and the mail-room manager described the procedure for mailing letters, unrebutted by competent evidence.
Acupuncture Approach P.C. v MVAIC (2013 NY Slip Op 50720(U)) Civil Court, New York County, January 28, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the claims representative's affidavit established mailing of the partial denial under a postal practice ensuring proper mailing, that actual mailing need not also be shown, and counsel's challenge was conclusory.
Hastava & Aleman Assoc., P.C. v State Farm Mut. Auto Ins. Co. (2009 NY Slip Op 51818(U)) Civil Court of the City of New York, Bronx County, July 2, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld affidavits of employees with knowledge of mailing procedures plus retained mail lists proved mailing of the EUO letters, and certified mail carries the same presumption of receipt as first-class mail.
Ocean Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2009 NY Slip Op 50565(U)) Civil Court, New York County, April 2, 2009The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the owner's affidavit describing the office mailing practice proved mailing of the bills, and any deficiencies were cured by the insurer's denial forms acknowledging receipt of the claims.
Lenox Hill Radiology & MIA P.C. v Global Liberty Ins. (2008 NY Slip Op 28197) Civil Court of the City of New York, New York County, May 21, 2008The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the examiner's affidavit, describing how she prepared, addressed and placed each verification and follow-up request in the outgoing mail with daily pickup, proved timely mailing, and the provider's counsel never denied receipt.
Lenox Hill Radiology MIA, P.C. v American Tr. Ins. Co. (2008 NY Slip Op 28053) Civil Court of the City of New York, New York County, February 20, 2008The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Found the insurer's examiner and mailroom affidavits established the dates the verification and follow-up requests were mailed, but the result turned on the missing date of receipt of the bill.
Ray Presutto, L.M.T., P.C. v Travelers Ins. Co. (2007 NY Slip Op 52095(U)) Civil Court of the City of New York, New York County, October 29, 2007The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge and held the mail-center director's detailed description of batching, counting, reconciliation and postal hand-off procedures sufficient to prove the denials were properly addressed and mailed.
Devonshire Surgical Facility v AIU Ins. Co. (2007 NY Slip Op 51034(U)) Civil Court of the City of New York, New York County, May 21, 2007The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the providers proved mailing of the claim forms through their office manager's sworn statement that she verified the envelopes' contents and personally mailed them, stating the mailing date.
Devonshire Surgical Facility v GEICO (2006 NY Slip Op 52450(U)) Civil Court of the City of New York, New York County, December 1, 2006The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the providers proved mailing of their claims through an employee's affidavit that she personally mailed them and a certified-mail receipt showing the insurer received them, rejecting defense counsel's unsupported contrary claims.
Chiropractic Neurodiagnosis, PC v Travelers Indem. Co. (2006 NY Slip Op 50257(U)) Civil Court of the City of New York, New York County, February 5, 2006The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the claims representative's affidavit based on office practice raised a triable issue whether the denial was timely mailed, defeating the provider's motion, but without personal knowledge of the actual mailing did not entitle the insurer to judgment.
Lumbermens Mut. Cas. Co. v Inwood Hill Med., P.C. (2005 NY Slip Op 51101(U)) Supreme Court, New York County, July 12, 2005Different mailing results for different documents or claims in one decisionHeld the insurer's proof sufficient to show its initial and follow-up EUO letters were mailed to the assignors, but found a claims representative's affidavit raised only a fact issue whether the denials were timely mailed to one provider.

Trial courts in the Second Department (133 decisions)

Burke 2 Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. PIP/BI Claims (2026 NY Slip Op 26164) Civil Court of the City of New York, Kings County, September 24, 2026The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification response (also decides)Held the owner's affidavit of mailing the verification responses insufficient because it did not show what was sent and gave an address that conflicted with both itself and the address designated in the requests, with no corroborating proof of mailing.
Medical Supply of NY Corp. v State Farm (2026 NY Slip Op 51163(U)) Civil Court of the City of New York, Kings County, July 28, 2026The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's standard-mailing-procedure affidavits established mailing, and rejected rebuttal affidavits from an unrelated case as irrelevant, unauthenticated and improper collateral impeachment, absent any personal-knowledge denial of receipt.
Maxim Orthopaedics PLLC v MVAIC (2026 NY Slip Op 51282(U)) Civil Court of the City of New York, Richmond County, July 2, 2026The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the provider's billing administrator affidavit, describing addressing and hand-off to the Postal Service, together with USPS-stamped proof of mailing, established as a matter of law that the bills were properly mailed despite the insurer's claimed non-receipt.
Medical Supply of NY Direct Servs. Corp. v State Farm Ins. Co. (2026 NY Slip Op 50513(U)) Civil Court of the City of New York, Richmond County, April 13, 2026The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the claims specialist's affidavit, which described uniform company-wide procedures for addressing and mailing, enough to prove the verification requests were mailed; it did not need to explain why verification was sought, and the affiant did not need to work at the out-of-state mail facility.
Pedro Torres-Jimenez, MD PC v Nationwide Affinity Ins. Co. of Am. (2026 NY Slip Op 50073(U)) Civil Court of the City of New York, Kings County, January 13, 2026The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims manager's affidavit describing standard office practices and claim-specific dates established timely mailing of the initial and follow-up EUO verification requests.
Big Apple Delivery Supply Corp. v Plymouth Rock Assur. Corp. of N.Y. (2025 NY Slip Op 50315(U)) Civil Court of the City of New York, Richmond County, March 11, 2025The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the litigation specialist's affirmation detailing how denials were created, addressed and mailed established timely denial of both bills, with the result turning on medical necessity.
Precision Acupuncture P.C. v State Farm Mut. Auto. Ins. Co. (2025 NY Slip Op 50021(U)) Civil Court of the City of New York, Kings County, January 14, 2025The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Found the insurer established timely mailing of its EUO scheduling letters, with the dispute centered on the denial's timeliness.
AVK RX Inc v Progressive Advanced Ins. Co. (2024 NY Slip Op 51521(U)) Civil Court of the City of New York, Richmond County, November 8, 2024The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the IME vendor manager's affidavit insufficient because it did not show compliance with or steps ensuring proper addressing and mailing, and no business record such as a postal receipt evidenced the mailing.

Show all 133 decisions

Community Med. Imaging P.C. v American Tr. Ins. Co. (2024 NY Slip Op 50301(U)) Supreme Court, Kings County, March 21, 2024The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseConfirmed the arbitrator's rational finding that the provider failed to prove timely mailing of its bill, since its only evidence was a USPS certificate with an illegible postmark and no affidavit of mailing practice or actual mailing.
Renelique v Foremost Signature Ins. Co. (2023 NY Slip Op 51226(U)) Civil Court of the City of New York, Queens County, November 20, 2023The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the provider's affidavit that the billing forms were mailed, with copies of the bills and no denial of receipt by the insurer, established that the forms were mailed to and received by the insurer.
Jiang Acupuncture PC v State Farm Ins. Co. (2023 NY Slip Op 50961(U)) Civil Court of the City of New York, Queens County, September 11, 2023The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held receipt of the provider's bills established by the insurer's own denial forms acknowledging receipt.
MLG Med. P.C. v Nationwide Mut. Ins. Co. (2023 NY Slip Op 23199) Civil Court of the City of New York, Queens County, June 30, 2023The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer showed its EUO scheduling letters were timely and properly mailed; the provider did not deny receipt and in fact responded to the letters.
Glispy v Ameriprise Ins. Co. (2023 NY Slip Op 50338(U)) Civil Court of the City of New York, Kings County, April 13, 2023The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's counsel's affidavits, which described the mailing procedure he created and oversaw and his personal handling of the files, sufficient to prove mailing of the EUO letters; envelopes or proof of first-class mailing were not required.
Life Equip., Inc v Mid-Century Ins Co (2022 NY Slip Op 50877(U)) Civil Court of the City of New York, Kings County, August 9, 2022Different mailing results for different documents or claims in one decisionHeld the IME scheduling letters not proved mailed because the scheduler's affidavit was conclusory and the delivery receipts were not tied to the letters, but found the denials proved mailed through a detailed standard-practice affidavit.
Advanced Recovery Equip. & Supplies v Travelers Ins. Co. (2022 NY Slip Op 50690(U)) Civil Court of the City of New York, Queens County, July 21, 2022The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the insurer's denial of claim forms sufficed to establish its receipt of the provider's claim, though the motion failed on the overdue element.
SB Chiropractic, P.C. v GEICO Ins. Co. (2022 NY Slip Op 50316(U)) Civil Court of the City of New York, Kings County, April 20, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the claims associate's detailed affidavit describing the insurer's standard mailing procedures in place at the time established timely mailing of the denials, and the provider's technical objections did not rebut the presumption.
Optimum Health Acupuncture, P.C. v Integon Natl. Ins. Co. (2022 NY Slip Op 50068(U)) District Court of Suffolk County, Fourth District, January 5, 2022The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims supervisor's affidavit showed standard office practices for timely and proper mailing of the denials and EOBs, creating an unrebutted presumption of receipt.
Chiropractic Exam Works, P.C. v Sentry Cas. Co. (2021 NY Slip Op 51125(U)) Civil Court of the City of New York, Queens County, November 30, 2021The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Accepted the claims specialist's affidavit of regular mailing procedures, confirmed by the denial form, as showing a timely denial that preserved the misrepresentation defense.
Advanced Recovery E. & S. v MVAIC (2021 NY Slip Op 51035(U)) Civil Court of the City of New York, Queens County, November 1, 2021The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Rejected the provider's challenge and held MVAIC's two affidavits detailing its regular mailing procedures established that the verification requests for a notice of claim were properly mailed.
Jiang Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2021 NY Slip Op 50945(U)) District Court of Suffolk County, Fourth District, September 23, 2021The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld the insurer's denial forms alone did not prove the provider mailed its claims; a billing manager's affidavit of the claims' issuance was required, so the cross motion failed.
Heavenly Points Acupuncture v Integon Natl. Ins. Co. (2021 NY Slip Op 50895(U)) Civil Court of the City of New York, Queens County, September 17, 2021The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the no-fault examiner's affidavits describing the insurer's regular office mailing procedures established that the denials were timely mailed.
FJL Med. Servs. PC v Nationwide Ins. (2021 NY Slip Op 21214) Civil Court of the City of New York, Kings County, July 28, 2021The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer showed timely mailing of its four EUO scheduling letters as required for its no-show defense.
MSB Physical Therapy, P.C. v Nationwide Ins. (2021 NY Slip Op 50750(U)) Civil Court of the City of New York, Kings County, July 13, 2021The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the law firm's office-practice affidavit inadequate for the EUO letters but mailing established by the provider's counsel's acknowledging responses, and held the denials proved mailed by claims specialist and mailing-vendor affidavits describing standard practice.
Medalliance Med. Health Servs. v Travelers Prop. Cas. Ins. Co. (2021 NY Slip Op 50737(U)) District Court of Suffolk County, Fourth District, June 30, 2021Different mailing results for different documents or claims in one decisionHeld the insurer's verification requests, addressed differently from the address on the claim forms, raised no presumption of receipt, while the provider's mailing supervisor affidavit and stamped postal proof established mailing of ten claim forms despite the insurer's denial of receipt.
New York Core Chiropractic, P.C. v Ameriprise Ins. Co. (2021 NY Slip Op 50599(U)) Civil Court of the City of New York, Queens County, June 24, 2021The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's litigation examiner's affidavit described standard mailing procedures sufficient to show timely mailing of the denial, and found the follow-up EUO scheduling letter timely mailed.
Burke 2 Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. PIP/BI Claims (2021 NY Slip Op 50523(U)) Civil Court of the City of New York, Kings County, June 8, 2021The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification response (also decides)Held the owner's affidavit that he mailed verification responses insufficient, because it did not detail what was mailed and the responses were not attached, while the insurer denied receiving them; the result rested on the provider's failure to comply with verification.
Advanced Recovery v Allstate Ins. Co. (2021 NY Slip Op 21148) Civil Court of the City of New York, Queens County, May 27, 2021The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the IME scheduler's and mailing vendor's affidavits describing regular mailing procedures sufficed to show the IME letters and the denials were timely mailed.
Apazidis, M.D., P.C. v State Farm Mut. Auto. Ins. Co. (2021 NY Slip Op 50498(U)) Civil Court of the City of New York, Queens County, May 26, 2021The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held receipt of the provider's claims established by the insurer's denial forms acknowledging receipt in August 2018.
Parisien v Travelers Ins. Co. (2021 NY Slip Op 50396(U)) Civil Court of the City of New York, Kings County, April 30, 2021The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld that affidavits of service proved actual mailing of the EUO scheduling letters despite a missing suite number, and that detailed claims and mailing-center affidavits proved the denials were mailed under a standard office practice.
NY Wellness Med. P.C. v Ameriprise Ins. Co. (2021 NY Slip Op 50382(U)) Civil Court of the City of New York, Queens County, April 29, 2021The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer established timely mailing of the EUO scheduling letters, the first acknowledged by plaintiff's counsel, and of its denials, through a litigation examiner's affidavit describing standard mailing procedures.
Kings County Physicians Group v Nationwide Ins. Co. (2021 NY Slip Op 50337(U)) Civil Court of the City of New York, Queens County, April 16, 2021The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Found the insurer's law-firm and mail-processing affidavits described standard office practices establishing timely mailing of the EUO scheduling letters and the denials, and rejected the provider's general inadmissibility objection.
Sayyed DC, P.C. v Ameriprise Ins. Co. (2021 NY Slip Op 50311(U)) Civil Court of the City of New York, Queens County, April 13, 2021Different mailing results for different documents or claims in one decisionHeld counsel's mailing-procedure affidavit and the provider's acknowledgment proved mailing of the EUO letters and the insurer employee's affidavit proved timely mailing of denials, but the provider's affidavit of mailing raised a triable issue on one disputed bill.
Barakat P.T., P.C. v Progressive Ins. Co. (2021 NY Slip Op 50342(U)) Civil Court of the City of New York, Kings County, April 9, 2021The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's litigation representative's affidavit describing its centralized mailing procedure, envelope IDs and contemporaneous proof-of-mailing report established timely mailing of the denial, rejecting the provider's challenges.
Blackman Pelham Med., P.C. v MVAIC (2020 NY Slip Op 51406(U)) Civil Court of the City of New York, Kings County, November 18, 2020The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the provider's manager's detailed affidavit, supported by its mailing log, proved the fourth bill was submitted and never paid or denied, and the defendant raised no triable issue.
Bronx Chiropractic Rehabilitation, P.C. v Progressive Ins. Co. (2020 NY Slip Op 20285) Civil Court of the City of New York, Kings County, October 29, 2020The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the provider owner's affidavit established timely and proper mailing of the claim forms; the insurer's verification requests were also found mailed, but the result turned on their incomplete substance.
Longevity Med. Supply, Inc. v Progressive Ins. Co. (2020 NY Slip Op 20137) Civil Court of the City of New York, Kings County, June 17, 2020Different mailing results for different documents or claims in one decisionHeld the IME scheduler's affidavit insufficient to prove mailing of scheduling letters, but found the insurer's standard-office-procedure affidavit and mailing reports proved timely mailing of the denials; the provider's bill mailing was also established.
New Chiropractic Care, P.C. v Nationwide Ins. Co. of N.Y. (2020 NY Slip Op 50652(U)) Civil Court of the City of New York, Kings County, June 1, 2020Different mailing results for different documents or claims in one decisionHeld the insurer's standard-practice affidavits proved mailing of the EUO letters and denials, but the IME scheduler's passive-voice affidavit without the reviewed records did not prove the IME letters' mailing; the provider's defective proof was cured by acknowledged receipt.
Island Life Chiropractic Pain Care PLLC v Amica Mut. Ins. Co. (2019 NY Slip Op 51589(U)) Civil Court of the City of New York, Kings County, May 17, 2019The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the claim representative's affidavit did not show a procedure ensuring the EUO letters were correctly addressed and mailed, and the annexed notices contradicted her account of the sender and recipient.
Prompt Med. Supply, Inc. v Metropolitan Group Prop. & Cas. Ins (2019 NY Slip Op 51594(U)) Civil Court of the City of New York, Kings County, March 28, 2019The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affirmation and adjuster affidavit conclusory because they did not explain how envelopes for the EUO letters and denials were addressed or how postage was applied.
Dowd v Allstate Ins. Co. (2019 NY Slip Op 50648(U)) Civil Court of the City of New York, Queens County, March 11, 2019The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the IME vendor's affidavit conclusory because it did not describe procedures ensuring the letters were correctly addressed, and its bill-address practice could not apply to letters sent before any claim.
Longevity Med. Supply, Inc. v MVAIC (2019 NY Slip Op 50965(U)) Civil Court of the City of New York, Kings County, March 11, 2019The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld conflicting evidence on when the provider mailed its bills (insurer's office-procedure affidavit of late mailing versus the owner's affidavit of timely submission) raised triable issues, though it also found the provider's own mailing proof inadequate.
Neuro Rehab Med. Servs. of S.I., P.C. v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 50671(U)) District Court of Suffolk County, Third District, May 4, 2018The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's standard office practice proof established proper mailing of the EUO scheduling letters and timely mailing of the denial forms, and the provider did not deny receipt to rebut the presumption.
Pro-Align Chiropractic, P.C. v Travelers Prop. Cas. Ins. Co. (2017 NY Slip Op 27415) District Court of Suffolk County, Third District, December 19, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Granted the insurer partial summary judgment that its verification requests were timely mailed, based on unrebutted affidavits describing its standard office mailing practices and procedures.
Lenox Hill Radiology v Global Liberty Ins. Co. of N.Y. (2017 NY Slip Op 50978(U)) District Court of Suffolk County, Fourth District, July 6, 2017The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the adjuster's description of placing requests in a mixed outgoing mail bin conclusory, failing to show what happened afterward or tie the letters to the envelopes mailed, so no presumption of mailing arose.
Central Park Physical Medicine & Rehab., P.C. v Travelers Indem. Co. of Conn. (2017 NY Slip Op 51354(U)) District Court of Suffolk County, Fourth District, June 27, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's standard office practice proof established proper mailing of both EUO scheduling letters and NF-10 denials, creating an unrebutted presumption of receipt since the provider did not deny receipt.
Zwanger & Pesiri Radiology Group, LLP v Mapfre Ins. Co. (2017 NY Slip Op 50981(U)) District Court of Suffolk County, Third District, June 14, 2017The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the litigation supervisor's affidavit conclusory and hearsay-based, failing to describe a standard office mailing practice, so no presumption of timely mailing of the verification requests or denial arose.
Z.M.S. & Y. Acupuncture, P.C. v Geico Gen. Ins. Co. (2017 NY Slip Op 27189) Civil Court of the City of New York, Kings County, May 26, 2017The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the claims associate's affidavit describing standard office procedures established timely and proper mailing of both the EUO scheduling letters and the denials, rejecting the provider's argument that it was conclusory.
Sure Way NY, Inc. v Travelers Ins. Co. (2016 NY Slip Op 26413) Civil Court of the City of New York, Kings County, December 8, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer properly established that it generated and mailed the two EUO scheduling letters to the provider.
Golden Needle Acupuncture P.C. v MAPFRE Ins. Co. (2016 NY Slip Op 26411) Civil Court of the City of New York, Kings County, November 30, 2016The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld a question of fact existed whether the provider mailed one claim because the postal mailing form bore conflicting date stamps inconsistent with the office procedures its affiant described, sending that claim to trial.
NY Rehab Pain Mgt. & Med. Servs., PC v State Farm Auto Ins. Co. (2016 NY Slip Op 50821(U)) Supreme Court, Nassau County, May 24, 2016The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits describing how its EUO letters and denials were generated, logged on postal certificates of mailing and handed off adequately proved mailing, and rejected the provider's wrong-address challenge as the address was identical.
Tyorkin v Garrison Prop. & Cas. Ins. Co. (2016 NY Slip Op 50846(U)) Civil Court of the City of New York, Kings County, May 20, 2016The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the provider established timely mailing of its bill through its affidavit, the annexed bill and a USPS mail extract tied to that bill.
Alleviation Med. Servs., PC v Hertz Co. (2015 NY Slip Op 25285) Civil Court of the City of New York, Kings County, August 12, 2015The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the insurer's denial stating the date it received the claim, an admission against interest, created a presumption that the provider's claim was mailed and received.
AR Med. Rehabilitation v State-Wide Ins. Co. (2015 NY Slip Op 25287) Civil Court of the City of New York, Kings County, July 1, 2015The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld that the insurer's NF-10 denial, offered as an admission rather than a business record, sufficed to establish that the insurer received the provider's claim, so no proof of mailing procedure was needed.
AR Med. Rehabilitation, P.C. v State-Wide Ins. Co. (2015 NY Slip Op 50631(U)) Civil Court of the City of New York, Kings County, April 27, 2015The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld that the insurer's examiner's testimony and its denial form acknowledging receipt of the bills established submission and receipt, so the provider need not prove mailing through its own witness.
Natural Therapy Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2013 NYSlip Op 51935(U)) Civil Court of the City of New York, Kings County, November 21, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the claims representatives' affidavits describing the standard office procedure for generating and mailing EUO letters and denials, with a postal mail receipt, created a presumption of timely mailing the provider failed to rebut.
Parkview Med. & Surgical, P.C. v Commerce Ins. Co. (2013 NY Slip Op 51239(U)) Civil Court of the City of New York, Kings County, July 17, 2013The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer failed to show the insured received its reservation-of-rights letter requesting residency documents because it offered no actual proof of mailing or practice affidavit, only the adjuster's conclusory statement that she mailed it.
Stracar Med. Servs. v Nationwide Mut. Ins. Co. (2013 NY Slip Op 50633(U)) Civil Court of the City of New York, Kings County, April 22, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims specialist's and claims manager's affidavits, describing the standard mailing procedures in detail and the handling of this claim, established that the denials were mailed, and the provider's generalities did not rebut the presumption.
Quality Psychological Servs., P.C. v Hartford Ins. Co. (2013 NY Slip Op 50045(U)) Civil Court of the City of New York, Kings County, January 15, 2013The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the claims specialist's detailed description of standard mailing procedures plus the mailing courier's affidavit proved timely mailing of the EUO letters and denials; missing certified-mail receipts and certificate-of-conformity defects were not fatal.
GBI Acupuncture, P.C. v Esurance Ins. Co. (2012 NY Slip Op 52423(U)) Civil Court of the City of New York, Kings County, December 26, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the claims representative's and mailroom supervisor's affidavits, and the EUO firm's attorney and paralegal affidavits, sufficient to prove mailing of the denials and EUO notices; the exact time of mailing was unnecessary.
Advanced Neurological Care, P.C. v State Farm Mut. Auto. Ins. Co. (2012 NY Slip Op 52203(U)) District Court of Nassau County, First District, November 26, 2012The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or receivedHeld the insurer's affidavits insufficient because neither affiant knew the practices of the office that generated the verification requests, and the provider's attorney's detailed non-receipt affidavit and misaddressing left questions of fact on proper mailing.
Elmont Open MRI & Diagnostic Radiology, P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 22242) District Court of Nassau County, First District, August 17, 2012The provider's or claimant's proof established mailing of its claim form, NF-2 or verification responseHeld the provider's affidavit of actual mailing plus a postal certificate of mailing proved it mailed the requested verification, and the insurer's conclusory no-record statement did not raise a triable issue.
Back to Back Chiropractor, P.C. v State Farm Mut. Auto. Ins. Co. (2012 NY Slip Op 51088(U)) District Court of Suffolk County, Third District, June 15, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the insurer's standard office practice proof established timely mailing of the EUO notices, verification requests and denial forms.
Island Chiropractic Testing, P.C. v Nationwide Ins. Co. (2012 NY Slip Op 51001(U)) District Court of Suffolk County, Third District, June 6, 2012The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits insufficient to prove mailing of its verification and follow-up requests: one was improperly notarized, and none described how letters were addressed, safeguarded and stamped or showed personal knowledge of mailing.
Concourse Chiropractic, PLLC v State Farm Mut. Ins. Co. (2012 NY Slip Op 50676(U)) District Court of Nassau County, First District, April 16, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's proof sufficient to establish that the EUO request letters were mailed, rejecting the provider's challenge because the presumption arises from proof of actual mailing or a standard office practice.
Tarnoff Chiropractic, P.C. v GEICO Ins. Co. (2012 NY Slip Op 50670(U)) District Court of Nassau County, First District, April 12, 2012The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Faulted the insurer for not showing whether the EUO letters sent by certified mail were delivered, returned unclaimed or undeliverable, reasoning that certified mailing should be proved by actual receipts rather than office practice.
Exclusive Med. Supply, Inc. v MVAIC (2012 NY Slip Op 50616(U)) Civil Court of the City of New York, Kings County, April 11, 2012The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the provider's billing manager's attestation that he personally mailed the bills, with knowledge of office practices, was reliable and sufficient proof of mailing even though the postal records were not produced.
Total Equip. LLC v State Farm Fire & Cas. Co. (2012 NY Slip Op 22038) District Court of Nassau County, First District, February 22, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the affidavits of a claims representative and claims support supervisor established timely mailing of the denial under standard office practices, and the provider raised no triable issue on mailing.
Upper E. Side Surgical, PLLC v State Farm Ins. Co. (2012 NY Slip Op 50184(U)) District Court of Nassau County, First District, February 2, 2012The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the claims representative's and mailing supervisor's affidavits detailing standard office procedures showed the denial was timely mailed, and the provider raised no triable issue on mailing or receipt.
Lenox Hill Hosp. v Allstate Ins. Co. (2011 NY Slip Op 50800(U)) District Court of Nassau County, First District, May 3, 2011The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer did not prove mailing of its denial or its verification requests because its claims representative described no standard office practice for addressing and mailing them and no proof of actual mailing was offered.
Novacare Med. P.C. v Travelers Prop. Cas. Ins. Co. (2011 NY Slip Op 50500(U)) District Court of Nassau County, Second District, April 1, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's proof of mailing of its denials sufficient and unrebutted, so the insurer need not prove timely mailing at trial.
Chiropractic Back Care of Queens Vil., P.C. v ELRAC, Inc. (2011 NY Slip Op 50544(U)) District Court of Nassau County, First District, April 1, 2011The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeHeld the IME scheduler's detailed affidavit of standard office practice, covering addressing from the application, envelope inspection, postage and daily postal pickup, established that the IME letters were properly addressed and mailed.
Elmont Open MRI & Diagnostic Radiology, PC v New York Cent. Mut. Fire Ins. Co. (2010 NY Slip Op 51588(U)) District Court of Nassau County, Second District, August 31, 2010The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the provider needed no mailing testimony, because the insurer's admissions of the dates it received the bills established timely submission and bound the insurer.
Quality Psychological Servs., P.C. v GEICO Ins. Co. (2010 NY Slip Op 51423(U)) Civil Court of the City of New York, Kings County, August 16, 2010The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer could not rely on denials first submitted in reply papers without an affidavit showing they were timely mailed under a standard office practice, supporting preclusion of the fraud-based counterclaims.
Elmont Open MRI & Diagnostic Radiology, P.C. v State Farm Mut. Auto. Ins Co. (2010 NY Slip Op 51090(U)) District Court of Nassau County, Second District, June 4, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the provider could not contest timely mailing because it admitted receiving the denial and kept no record of receipt dates, so mailing on the denial's date was assumed without testing the insurer's affidavit.
Custis v Travelers Prop. Cas. Ins. Co. (2010 NY Slip Op 20118) District Court of Suffolk County, Third District, April 7, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the litigation examiner's and mail service's affidavits created a presumption of timely mailing of the partial payment and partial denial through a standard office practice, and the provider offered no rebuttal.
Style Acupuncture, P.C. v State-Wide Ins. Co. (2010 NY Slip Op 50089(U)) Civil Court of the City of New York, Kings County, January 22, 2010The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the provider proved mailing of its claim through its owner's detailed affidavit setting out the basis of her knowledge and the specifics of mailing the bill and NF-3 form.
Perfect Point Acupuncture, P.C. v Auto One Ins. Co. (2010 NY Slip Op 50010(U)) Civil Court of the City of New York, Kings County, January 6, 2010The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Found the insurer's submissions sufficiently demonstrated that both IME scheduling letters were mailed to the assignor on the stated dates.
Prime Psychological Servs., PC v ELRAC, Inc. (2009 NY Slip Op 52579(U)) Civil Court of the City of New York, Richmond County, December 4, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held detailed affidavits from employees with personal knowledge of the insurer's procedures for scheduling and mailing IME notices sufficient, rejecting the provider's challenge to the mailing proof.
Jesa Med. Supply, Inc. v GEICO Ins. Co. (2009 NY Slip Op 29386) Civil Court of the City of New York, Kings County, September 22, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the claims representative's affidavit describing standard office mailing practice raised a presumption that the denials were timely mailed; the provider's billing manager affidavit and proof of mailing likewise established mailing of its claims.
Lenox Hill Radiology & MIA, P.C. v Global Liberty Ins. Co. of N.Y. (2009 NY Slip Op 51620(U)) Civil Court of the City of New York, Richmond County, July 6, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Found the insurer established that it generated and mailed a timely medical-necessity denial under its established procedures and through the mail clerk's personal knowledge.
Corona Comprehensive Med. Care, P.C. v Global Liberty Ins. Co. of N.Y. (2009 NY Slip Op 51432(U)) Civil Court of the City of New York, Queens County, July 6, 2009The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove mailing of its denial because its claims manager attested to claim processing but not to when the denial was mailed or to a standard mailing practice.
Millennium Radiology, P.C. v New York Cent. Mut. Fire Ins. Co.(2009 NY Slip Op 50877(U)) Civil Court of the City of New York, Richmond County, April 30, 2009The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Found the provider's billing manager set forth the precise mailing procedure followed and personally mailed the bill and forms, supporting the provider's showing of submission.
Elmont Open MRI & Diagnostic Radiology P.C. v Progressive Cas. Ins. Co. (2009 NY Slip Op 50693(U)) District Court of Nassau County, First District, April 6, 2009The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's supervisor affidavit insufficient to prove timely mailing of denials because he lacked personal knowledge, did not show the issuing examiner knew or followed the office procedure, and stamps cast doubt on dates.
Bayside Rehab & Physical Therapy, P.C. v GEICO Ins. Co. (2009 NY Slip Op 29145) Civil Court of the City of New York, Richmond County, April 3, 2009The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Rejected the insurer's challenge to the provider's mailing proof because the billing manager personally packaged, sealed, stamped and mailed the bills.
New York Hosp. Med. Ctr. of Queens v Countrywide Ins. Co. (2009 NY Slip Op 50764(U)) Supreme Court, Nassau County, March 17, 2009The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Credited the billing representative's personal knowledge of the certified mailing of the hospital claim forms, which the insurer acknowledged receiving.
Prime Psychological Servs., P.C. v Nationwide Prop. & Cas. Ins. Co. (2009 NY Slip Op 29100) Civil Court of the City of New York, Richmond County, March 5, 2009The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the SIU investigator's and claims representative's affidavits established standard office practices ensuring the EUO scheduling letters and the denial were properly addressed and mailed.
Yklik Med. Supply, Inc. v Allstate Ins. Co. (2008 NY Slip Op 28532) Civil Court of the City of New York, Richmond County, December 31, 2008The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the provider proved mailing because its billing manager described the precise mailing procedure followed and personally packaged, stamped and mailed the bill.
Westchester Med. Ctr. v One Beacon Ins. Co. (2008 NY Slip Op 52580(U)) Supreme Court, Nassau County, December 1, 2008The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the provider made its prima facie showing of mailing through certified mail receipts, signed return receipt cards and a billing employee's affidavit that she personally mailed the claims.
Allstate Social Work & Psychological Servs., PLLC v Utica Mut. Ins. Co. (2008 NY Slip Op 28494) Civil Court of the City of New York, Kings County, November 5, 2008The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held affidavits showed the initial and follow-up IME requests and the denials were mailed pursuant to a standard office practice and procedure.
Rockman v Clarendon Natl. Ins. Co. (2008 NY Slip Op 52093(U)) Civil Court of the City of New York, Richmond County, October 17, 2008The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification responseHeld no presumption of mailing arose because the owner's affidavit did not say he mailed the claims and did not show the office practice was followed, and the purportedly mailed 2002 bill was never produced.
Manhattan Med. Imaging, P.C. v State Farm Mut. Auto. Ins. Co. (2008 NY Slip Op 51844(U)) Civil Court of the City of New York, Richmond County, September 4, 2008The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the billing manager's affidavit that she personally packaged, sealed, stamped and mailed the bill, and set out the mailing procedure, sufficient proof of the provider's mailing.
Uniondale Chiropractic Off. v State Farm Mut. Auto. Ins. Co. (2008 NY Slip Op 51687(U)) District Court of Nassau County, First District, August 7, 2008Different mailing results for different documents or claims in one decisionHeld the provider's described practice of checking addresses and posting bills proved mailing of three bills despite the insurer's denial of receipt, but the insurer's affidavits described no procedure to ensure denials were properly addressed, so denial mailing was not proved.
Lenox Hill Radiology v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 28275) District Court of Nassau County, First District, July 25, 2008The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the insurer's concessions, in its denial form and motion papers, that it timely received the claim cured any defect in the provider's proof of mailing.
Westchester Med. Ctr. v Mercury Cas. Co. (2008 NY Slip Op 28287) Supreme Court, Nassau County, June 27, 2008The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the hospital proved mailing and receipt of its bill through a certified-mail receipt, a signed return receipt card and an employee's affidavit that he personally mailed it.
Carle Place Chiropractic v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 51065(U)) District Court of Nassau County, First District, May 29, 2008The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the examiner's affidavit failed to prove mailing of the denials: her claimed personal knowledge rested on files, she showed no knowledge of the practice in the relevant year, and the procedure lacked safeguards ensuring proper addressing and mailing.
Carnegie Hill Orthopedic Servs. P.C. v GEICO Ins. Co. (2008 NY Slip Op 50639(U)) Supreme Court, Nassau County, January 29, 2008The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the providers made a prima facie showing on two claims through billing forms, certified-mail receipts, signed return-receipt cards and an affidavit of the person who personally mailed them; the result rested on preclusion of the provider-fraud defense.
Elmont Open MRI & Diagnostic Radiology, P.C. v GEICO Ins. Co. (2008 NY Slip Op 50113(U)) District Court of Nassau County, First District, January 18, 2008The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the insurer's denial form acknowledging receipt of the bill cured any defect in the provider's proof of mailing, while declining to decide the adequacy of the insurer's own mailing affidavit because the provider admitted receiving the denial.
Acupuncture Prima Care, P.C. v State Farm Mut. Auto Ins. Co. (2007 NY Slip Op 52273(U)) District Court of Nassau County, First District, December 3, 2007The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits insufficient to prove mailing of the denials because one was conclusory and the other's office practice lacked safeguards ensuring proper addressing and mailing, and neither showed the practice was followed.
All-Boro Med. Supplies, Inc. v Progressive Northeastern Ins. Co. (2007 NY Slip Op 27458) Civil Court of the City of New York, Kings County, November 6, 2007The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer offered no evidence that it timely mailed its verification requests, so its time to pay or deny was never tolled.
Westchester Med. Ctr. v Encompass Ins. Co. (2007 NY Slip Op 52475(U)) Supreme Court, Nassau County, November 2, 2007The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer failed to prove its denial was mailed because it submitted no proper affidavit of service, despite a processing manager's statement that the dated denial was mailed that day under office procedure.
KOI Med. Acupuncture v State Farm Ins. Co. (2007 NY Slip Op 51705(U)) Nassau District Court, September 10, 2007The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer did not prove mailing of the EUO notices: neither counsel nor the investigator had personal knowledge or described a standard office practice, and the certified-mail receipts bore no item, address, postmark or number.
New York Hosp. Med. Ctr. of Queens v Liberty Mut. Ins. Co. (2007 NY Slip Op 51256(U)) Nassau District Court, June 21, 2007The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's description of its mailing vendor's folding, stamping and binning routine did not raise a presumption that the denial was mailed, since no mailing record or certificate was kept and the affiant claimed no duty or knowledge of compliance.
Complete Orthopedic Supplies, Inc. v State Farm Ins. Co. (2007 NY Slip Op 27192) Civil Court of the City of New York, Queens County, May 14, 2007The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Found the insurer's denials shown to have been issued and served, so the fee schedule objection was preserved.
Friendly Physician, P.C. v Country-Wide Ins. Co. (2007 NY Slip Op 50747(U)) Civil Court of the City of New York, Kings County, April 6, 2007The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the billing manager's affidavit referring to the provider's standard office mailing practices sufficed to establish mailing of the claim forms, with receipt dates also shown by the insurer's own denial forms.
Elmont Open MRI & Diagnostic Radiology, P.C. v Country-Wide Ins. Co. (2007 NY Slip Op 27072) District Court of Nassau County, First District, February 23, 2007The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held that the insurer's denial of claim form, which admitted receipt of the bills on a stated date, cured any defect in the provider's proof of mailing.
Andrew Carothers, M.D., P.C. v Progressive Ins. Co. (2006 NY Slip Op 52479(U)) Civil Court of the City of New York, Kings County, December 21, 2006The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's witness, who relied only on file copies and lacked knowledge of procedures ensuring proper addressing and mailing, did not prove mailing of the verification request or peer review, so the denial was untimely.
Capri Med., P.C. v Auto One Ins. Co. (2006 NY Slip Op 52413(U)) Civil Court of the City of New York, Kings County, December 6, 2006The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove timely mailing of its denials because its supervisor neither mailed them nor explained how he knew they were mailed, and the mailroom affidavit did not show the denials were generated and deposited.
Lefferts Med., Inc. v Lumbermens Mut. Cas. Co. (2006 NY Slip Op 51136(U)) Civil Court, Kings County, June 20, 2006The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (also decides)Held the insurer's affidavits showed no meritorious defense because they gave no detailed description of mailing the denials or verification requests, so no presumption of mailing arose; the default was vacated on another ground.
Vinings Spinal Diagnostic v Travelers Prop. Cas. Ins. Co. (2006 NY Slip Op 50999(U)) Nassau District Court, May 30, 2006The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO noticeRejected the provider's challenge to the claims representative's affidavit, holding it described office mailing practices sufficient to ensure denials were properly addressed and mailed, with no sworn denial of receipt.
Tsai Chao v Country-Wide Ins. Co. (2006 NY Slip Op 50794(U)) Nassau District Court, May 3, 2006The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld no presumption of mailing arose for the IME notice because the insurer's affiant did not establish how or when the notice was mailed.
Harbor Med. & Diagnostic, P.C. v Allstate Ins. Co. (2006 NY Slip Op 50378(U)) Civil Court of the City of New York, Queens County, March 15, 2006The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's two employee affidavits did not prove mailing of its denials because neither affiant had personal knowledge of the mailing and both described the office mailing procedures only in conclusory terms, so the insurer was precluded.
A.B. Med. Servs. PLLC v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 26131) Civil Court of the City of New York, Kings County, March 7, 2006The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the claims representative's affidavit deficient to establish that the IME requests were timely mailed to the assignors, so no toll arose and the defense was precluded.
Multiquest PLLC v Allstate Ins. Co. (2005 NY Slip Op 52209(U)) Civil Court, Queens County, December 19, 2005The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification response (also decides)Held the provider did not establish mailing of its claim because its owner's affidavit showed no personal knowledge of this claim and only general familiarity with office procedures.
Function Supply v Progressive Ins. Co. (2005 NY Slip Op 51755(U)) Civil Court of the City of New York, Queens County, October 24, 2005The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit describing its mail-room routine conclusory because the affiant showed neither personal knowledge of the mailing nor a duty to ensure or knowledge of compliance with the procedure, so verification requests were not proved mailed.
Foster Diagnostic Imaging, P.C. v General Assur. Co. (2005 NY Slip Op 25431) Civil Court, Kings County, October 17, 2005The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Held the IME scheduler's employee, though she neither signed nor mailed the scheduling letters, created a presumption of mailing by describing the standard office practice used to address and mail them.
Mega Supply & Billing, Inc. v American Tr. Ins. Co. (2005 NY Slip Op 51569(U)) Civil Court, Kings County, October 3, 2005The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (also decides)Found the insurer's denial form was properly mailed within the statutory period, but the result turned on the denial's lack of specificity.
City Wide Social Work & Psychological Servs., P.L.L.C. v General Assur. Co. (2005 NY Slip Op 51197(U)) Civil Court of the City of New York, Kings County, July 27, 2005The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavits failed to prove timely denial because the mailroom supervisor did not address the particular denial and the litigation supervisor did not explain the source of his knowledge that procedure was followed.
Boai Zhong Yi Acupuncture Servs., P.C. v New York Cent. Mut. Fire Ins Co. (2005 NY Slip Op 51058(U)) Civil Court of the City of New York, Queens County, July 8, 2005The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer submitted no proof that it mailed its verification requests and follow-ups, so its facially untimely denials were not saved by tolling.
Advanced Med. v Progressive Cas. Ins. Co. (2005 NY Slip Op 50945(U)) District Court of Nassau County, First District, June 24, 2005The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification response (also decides)Held the provider's motion deficient in part because it furnished no proof that it mailed its claim to the insurer.
Westchester Med. Ctr. v Progressive Cas. Ins. Co. (2005 NY Slip Op 50348(U)) District Court of Nassau County, First District, March 21, 2005The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's affidavit stating only that its office mailed a verification request insufficient, because it showed no personal knowledge of the mailing, no details of when or how, and no standard office mailing practice.
Socrates Psychological Servs., P.C. v Progressive Cas. Ins. Co. (2005 NY Slip Op 25096) Civil Court of the City of New York, Queens County, March 15, 2005The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification response (also decides)Held the provider failed to show mailing of its claim because its papers included no proof of mailing and did not explain why a bill dated in January was received in June.
Delta Diagnostic Radiology, P.C. v Lumbermans Mut. Ins. Co. (2005 NY Slip Op 50326(U)) Civil Court, Kings County, February 10, 2005The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer offered no competent evidence that its verification request or denial was mailed, so its denial was untimely and all non-coverage defenses were precluded.
PDG Psychological P.C. v State Farm Mut. Ins. Co. (2005 NY Slip Op 50150(U)) Civil Court of the City of New York, Kings County, February 10, 2005The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove mailing of its verification notices because it offered no affidavit from anyone with personal knowledge of the mailing or of its mailing procedures to rebut the provider's denial of receipt.
Boai Zhong Yi Acupuncture Servs. PC v General Assur. Ins Co. (2005 NY Slip Op 50329(U)) Civil Court of the City of New York, Kings County, February 9, 2005The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer's pend letter did not extend its time to deny the second claim because it offered no proof that, when or how the letter was mailed, so that denial was untimely.
Allstate Social Work & Psychological Svcs PLLC v GEICO Gen. Ins. Co. (2005 NY Slip Op 50024(U)) Civil Court of the City of New York, Kings County, January 17, 2005The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove timely mailing of its denials because its employee's affidavit did not detail the office mailing procedures, how she knew them, or why she believed they were followed beyond a file review.
Willis Acupuncture, PC v Government Employees Ins. Co. (2004 NY Slip Op 51702(U)) Civil Court of the City of New York, Kings County, December 23, 2004The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held the provider proved mailing of its claims through the insurer's own denial forms acknowledging receipt and an affidavit of personal mailing; the insurer's proof of mailing its blanket disclaimers was also accepted absent a sworn denial of receipt.
PSG Psychological, P.C. v State Farm Ins. Co. (2004 NY Slip Op 51701(U)) Civil Court of the City of New York, Kings County, December 8, 2004The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove mailing of its verification requests because its investigator claimed no personal knowledge of the mailing and described no standard office mailing procedure, so its denial was untimely.
A.B. Med. Servs. PLLC v New York Cent. Mut. Fire Ins. Co. (2004 NY Slip Op 51847(U)) Civil Court of the City of New York, Kings County, November 10, 2004The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer did not prove mailing of the IME scheduling letters because its vendor's employee relied on a file review, lacked personal knowledge of mailing, and described no standard office mailing practice; copies of letters alone raised no presumption.
Star Med. Servs., P.C. v Allstate Ins. Co. (2004 NY Slip Op 24410) Civil Court, Kings County, October 25, 2004The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the EUO notices ineffective because the insurer mailed them to an incomplete, incorrect address for the driver although it had the correct one; mailing to his separate-action attorney did not suffice.
King's Med. Supply Inc. v Country-Wide Ins. Co. (2004 NY Slip Op 24394) Civil Court of the City of New York, Kings County, October 19, 2004The provider's or claimant's proof established mailing of its claim form, NF-2 or verification response (also decides)Held receipt of the claim was established by the insurer's own denial form stating the receipt date, noting that a postal-stamped mailing log alone without a personal-knowledge affidavit would not suffice.
A.B. Med. Servs. PLLC v Farm Family Cas. Ins. Co. (2004 NY Slip Op 24346) Civil Court of the City of New York, Kings County, September 14, 2004The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld one denial untimely because, although dated on the 30th day, its envelope was postmarked five days later, and the date the denial was actually mailed, not the date on the form, governs timeliness.
East Way Chiropractic, P.C. v Allstate Ins. Co. (2004 NY Slip Op 50642(U)) Civil Court of the City of New York, Queens County, June 23, 2004The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld after trial that the insurer failed to prove timely mailing of its denials because its adjuster lacked personal knowledge of the out-of-state mailing procedure, so denials timely on their face were insufficient.
Advanced Med. Rehabilitation, P.C. v Travelers Prop. Cas. Ins. Co. (2004 NY Slip Op 50141(U)) Civil Court of the City of New York, Kings County, March 16, 2004The provider's or claimant's proof did not establish mailing of its claim form, NF-2 or verification response (also decides)Held the provider failed to prove the bills were mailed because its office manager testified a separate billing entity prepared and mailed them and he had no personal knowledge of the mailing or that entity's practices.

Trial courts in the Fourth Department (1 decision)

Proscan Radiology of Buffalo v Progressive Cas. Ins. Co. (2006 NY Slip Op 51242(U)) City Court of Buffalo, June 27, 2006The insurer's proof did not establish mailing of its denial, verification request or IME/EUO noticeHeld the insurer failed to prove mailing of its verification requests and late denial because no affiant with personal knowledge stated they were mailed or described a standard office mailing procedure.

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