Advanced Neurological Care v. State Farm

NASSAU COUNTY
Insurance Law

New York Law Journal

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Judge Fred Hirsh

State Farm moved for summary judgment dismissing the action, while provider Advanced Neurological Care cross-moved for summary judgment on its claim to recover first party no-fault benefits for MRIs it performed on its assignee. Advanced mailed the claims for services provided to the insurer, which acknowledged receipt. The court noted what occurred to the claims thereafter was unclear. State Farm alleged it sent verification requests to Advanced that went unanswered, hence its time to pay or deny the claim had not yet run. But the court found State Farm failed to submit affidavits from anyone with personal knowledge attesting to the preparation, addressing and/or actual mailing methods of the verification requests. It stated that in the absence of proof establishing a familiarity with the practices and procedures used by the office generating and mailing the verification requests, affidavits from others were insufficient to establish the items were properly addressed and mailed. However, the court also noted mere denial of receipt of a verification request is insufficient to overcome the presumption of mailing, and it found questions of fact existed, precluding both provider's and insurer's motions for summary judgment.

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