Medical Imaging of Bronx, P.C., Inc. v MVAIC
The provider failed to justify the four-month delay between another insurer's denials and submission of its claims to MVAIC. The parties stipulated that MVAIC timely denied the claims under the 45-day rule and limited trial to reasonable justification under 11 NYCRR 65-3.3 (e). The provider's witness could not recall or document when the referring physician was contacted about other coverage. Cover letters describing prior submission to another insurer did not explain the subsequent delay, and the provider did not respond to MVAIC's invitation to supply justification. General public policy considerations could not displace the filing requirements. The Appellate Term, First Department, reversed the judgment after nonjury trial and directed judgment dismissing the complaint.