The Highest Court

Where a carrier fails to timely request verification of an assignment of benefits, that carrier is precluded from contesting the validity of the assignment. Even when the assignment lacks the signature of the assignor. So sayeth the Court of Appeals today in Hospital for Joint Diseases v. Travelers Prop. Cas. Ins. Co., 2007 NY Slip Op 09067 (Ct. of App., 2007). While The Hon. Eugene F. Pigott, Jr. offers a dissent, six other Judges on the Court side with the majority opinion. The opinions serve as a concise primer on both sides of the issue.

This is, to be sure, a rather extreme result of the line of thinking originally set down by the Court of Appeals in Presbyterian Hosp. in City of N.Y. v. Maryland Cas. Co., 90 N.Y.2d 274 (1997). Nevertheless, the Court has obviously looked into the abyss of the last 10 years and still hasn't blinked.

D'oh-shi

On March 16, 2007, the Appellate Term, 2d Department issued its decision in Doshi Diagnostic Imaging Servs. v State Farm Ins. Co., 16 Misc.3d 42 (App. Term, 2d Dep't, 2007). In sum, the Court held that, where timely claim verification requests are made to a third party, and such verification is never supplied, a provider's suit for reimbursement of such a claim remains premature.

On August 21, 2007, the App. Term denied Doshi Diagnostic's application for leave to appeal to the Appellate Division. See Doshi Diagnostic Imaging Servs. As Assignee of Laticia Vazquez v State Farm Ins. Co., 2007 NYSlipOp 76290(U) (App. Term, 2d Dep't, 2007).

Now, on November 14, 2007, the Appellate Division has likewise denied Doshi Diagnostic's application for leave to appeal. See Doshi Diagnostic Imaging Services v State Farm Insurance, 2007 NYSlipOp 83478(U) (App. Div., 2d Dep't, 2007).

D'oh!

In other news, the App. Div., 2d Dep't also recently issued its decision in Westchester Med. Ctr. v Countrywide Ins. Co., 2007 NY Slip Op 09024 (App. Div., 2d Dep't, 2007). The decision reads as a basic cut-and-paste of various other App. Div. no-fault decisions, containing standard holdings regarding the sufficiency of proof of mailing and waiver of defenses related to assignments of benefits. In the typical fashion of no-fault appellate decisions, without the benefit of seeing the record on appeal, the holding is rather worthless in a vacuum.

Edwards Nofaulthands

New York City Civil Court, Kings County Judge, the Honorable Genine D. Edwards, has had two no-fault trial decisions from this week picked up for publication today by the NYS Law Reporting Bureau.

All-Boro Med. Supplies, Inc. v Progressive Northeastern Ins. Co., 2007 NY Slip Op 27458 (Civ. Ct., Kings Cty., 2007), which will be published in the Miscellaneous Reports, concerns EUO requests and also touches on a carrier's burden in proving a lack of medical necessity. Judge Edwards comes to the conclusion that EUO request letters must be sent out within thirty (30) days of receipt of a bill for treatment. Since it seems that the patient actually appeared for the EUO, it's a much tougher call to make than the more often litigated situation of an EUO no-show where non-compliance vitiates coverage.

Delta Diagnostic Radiology, P.C. v MVAIC, 2007 NY Slip Op 52143(U) (Civ. Ct., Kings Cty., 2007), which will not be published in the Miscellaneous Reports, concerns the situation where a carrier issues a proper denial based on a provider's failure to submit a timely claim, containing the requisite language informing the provider that the untimeliness will be excused for reasonable justification, but the provider never actually bothers to submit such information. It appears that the Plaintiff did attempt to submit written justification one month prior to trial, but presumably this would not avoid the conclusion that the Complaint itself remains premature.

FWIW, now might be as good a time as any to mention that I began operations of Law Offices of Damin J. Toell, P.C. a few months ago. For the most part, I'm currently handling no-fault cases on behalf of providers. The business contact info is as follows:

Law Offices of Damin J. Toell, P.C.
P.O. Box 245112
Brooklyn, New York 11224
516-204-4775 (phone)
516-394-0855 (fax)

Business-related email should be directed to: djtoellpc @ gmail . com

Have a good weekend, all.