Opinion
23432
February 13, 2003.
Parker Law Firm, Farmingdale (Michael Baglio of counsel), for plaintiff.
Jaffe Nohavicka, New York City (Jabari O. Gray of counsel), for defendant.
DECISION AND ORDER
Plaintiff brought suit to recover payment from defendant insurance company for medical services rendered to its assignor. Pursuant to No Fault Law, plaintiff submitted a notice of claim to defendant on June 6, 2002, which was received by defendant on June 11, 2002. Defendant issued a denial dated July 11, 2002, which was mailed to plaintiff on July 17, 2002.
Plaintiff moves for summary judgment, arguing that as defendant submitted an untimely denial, defendant can present no defense against plaintiff, thereby leaving no issues of fact in dispute. Defendant argues that the claim was timely denied within thirty days of receipt, and therefore summary judgment is not warranted.
The sole issue in this matter is whether defendant timely submitted its denial. Defendant argues that its notice of denial is timely because it is dated July 11, 2002, exactly thirty days from the date of receipt of plaintiff's claim. Plaintiff argues that, while defendant's denial is dated July 11, 2002, defendant did not mail the denial until July 17, 2002, thereby making it untimely. Therefore, the Court must determine whether the No Fault statute requires the issuance of a denial to be generated within thirty days or to be mailed within thirty days.
Under the No Fault Law, an insurance carrier is required to either pay or deny a claim for benefits within thirty days from its receipt of the claim. (11 NYCRR § 65.15[g][3].) Therefore, for defendant to properly deny a claim, it must issue its denial within thirty days from receipt of the claim. To decide this motion, then, the Court must determine what the term "issue" means under the statute. To believe plaintiff, issue would include the mailing of the denial, while defendant's argument finds issue to mean the existence, drafting or generating the denial.
Upon reviewing the Insurance Regulations, legislative history and case law, it must be inferred that the issuance of a denial included the generation and mailing of the denial. While there is no law defining "issue" in this matter, it is clear that the generation of a denial form and its mailing are separate and distinct aspects of "issuing" a denial. ( See Hospital for Joint Diseases, et.al. v. Nationwide Mutual Insurance Co., 284 A.D.2d 374 [2nd Dept. 2001][defendant insurance company presented evidence regarding whether denial of claim forms were mailed on the date issued].) While defendant may consider the generation of a denial form to be its issuance, there is no authority to support its conclusion that the mere generation of a denial is sufficient to comply with statutory regulations.
Therefore, to issue a timely denial, defendant must generate its denial and mail it to plaintiff within thirty days. Any other interpretation of the statute would render the time limit meaningless, as defendant could backdate its denial and mail it days or weeks later, and still have issued a timely denial. The purpose of having the time requirement is to foster the expeditious processing of claims by the insurance carrier, a purpose that would be thwarted if defendant's position were accepted. By finding that defendant issued a timely denial simply by generating the document belies logic and any reasonable interpretation of the law.
The evidence indicates that defendant generated its denial on July 11, 2002, but did not mail its denial until July 17, 2002. Therefore, since defendant did not issue its denial until July 17, 2002, it failed to comply with the thirty day statutory requirement. As defendant has presented no other defenses to plaintiff's claim, there are no issues of fact in dispute.
Therefore, plaintiff's motion for summary judgment is granted. Judgment is awarded to plaintiff in the amount of $879.73, with statutory interest, costs and fees.
This constitutes the decision and order of the Court.