Chapa Prods., Corp. v. MVAIC

Summary

The Appellate Division, Second Department, reversed the Appellate Term and affirmed dismissal of a medical provider's action for assigned no-fault benefits. The court held that 11 NYCRR 65-3.8(b)(3) does not impose a 150-day deadline for an insurer to deny a claim based on the applicant's failure to provide requested verification within 120 days.

Holdings

1. The regulation does not impose a 30-day or 150-day deadline for an insurer to issue a denial based on the applicant's failure to provide requested verification after the initial 120-day period.
2. MVAIC was entitled to summary judgment dismissing the complaint because Chapa failed to provide requested verification within 120 days, and MVAIC was not precluded from relying on that defense merely because its denial was not issued within 30 days after the 120-day period.

Questions Presented

1. Whether 11 NYCRR 65-3.8(b)(3) requires an insurer to issue a denial within 30 days after the expiration of the 120-day period for an applicant to provide requested verification.
2. Whether MVAIC was entitled to summary judgment dismissing the action because the plaintiff failed to provide requested verification within 120 days.

Disposition

reversed