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The Rogak Report: 18 Mar 2008 (Part V) ** No Fault - 45 Day Rule **

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  • Lawrence Rogak
    INSURER NEED NOT PROVE THAT 45-DAY RULE IS PRINTED IN AUTO POLICY S PIP ENDORSEMENT Eagle Chiropractic, P.C. a/a/o Annette Monk et al. v. Chubb Indem. Ins. Co.
    Message 1 of 1 , Mar 18, 2008


      Eagle Chiropractic, P.C. a/a/o Annette Monk et al. v. Chubb Indem. Ins. Co.
      2008 NYSlipOp 50525(U)
      Decided on March 10, 2008
      Appellate Term, Second Department
      Edited by Lawrence N. Rogak

      In this no fault suit, Chubb moved for partial summary judgment on the ground that the claims were submitted to defendant beyond the 45-day deadline set forth in the automobile insurance policy's PIP endorsement. The sole basis upon which plaintiff opposed defendant's motion was that defendant did not establish that the 45-day deadline was contained in the Endorsement which was part of the applicable automobile insurance policy. The District Court, Suffolk County, denied Chubb's motion, holding that defendant failed to prove that plaintiff's claims were subject to the 45-day deadline.  Chubb appealed.  The Appellate Term reversed. 

      "The Endorsement, which was required to be included in automobile insurance policies issued or renewed after April 5, 2002, reduced the time within which claims were to be submitted to insurers after the date services were rendered from 180 days to 45 days. Pursuant to Insurance Law ยง 3425 (a) (8), the policy period for newly issued and renewed automobile insurance policies is one year."

      "In the instant case, the plaintiffs' assignor was allegedly injured in an automobile accident on November 12, 2004 and defendant received plaintiff's claims for the services at issue more than 45 days after the services were rendered. Since an automobile insurance policy which contained the prior version of the Endorsement would have expired no later than in April 2003, the automobile insurance policy applicable to the claims at issue in the instant case was required to contain the current Endorsement which sets forth the 45-day time limit for the submission of claims, and defendant need not prove that the instant automobile insurance policy contained such Endorsement."

      "In view of the foregoing, defendant's motion for partial summary judgment... should have been granted since it was undisputed that defendant's timely denial of claim forms denied the subject claims based upon plaintiff's failure to submit said claims within 45 days after the date the services were rendered and the record reveals that plaintiffs failed to proffer admissible evidence demonstrating that there was a "reasonable justification" for the untimely submission of the claims."

      Comment:  I think the Court could have made it a bit clearer by stating that, since the 45 day rule is a mandatory part of the PIP endorsement, insurers don't have to prove that it is printed in the actual policy.  It is presumed to be there by law.

      Larry Rogak

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