The Rogak Report: 22 Sep 2008 (Part I) ** No Fault - Verification Requests **
NO FAULT INSURERS IGNORE UNSATISFACTORY SECOND VERIFICATION RESPONSE AT THEIR OWN RISK
Media Neurology, P.C. a/a/o Justin Harris v. Countrywide Ins. Co. 2008 NY Slip Op 51902(U) Decided on September 15, 2008 Civil Court Of The City Of New York, Kings County Ash, J. Edited by Lawrence N. Rogak
In this no fault suit, Defendant insurer contended that Plaintiff's claim was premature because Plaintiff failed to comply with an additional verification request. Plaintiff argued that it responded to Defendant's verification request. Defendant argued that the response failed to fully comply with the request.
The Court held, "There is no dispute that Plaintiff responded to the additional verification request. There is also no dispute that upon receipt, Defendant did not request any further response from Plaintiff. The issue before the Court is whether Defendant was obligated to notify Plaintiff that its response to their additional verification request was insufficient and/or incomplete. In All Health Medical Care, P.C. v. Government Employees Insurance, 2 Misc 3d 907, the Court reasoned that while '... the regulations are silent as to what, if anything, the insurance company must do if it receives insufficient verification, that it is clear that the insurance company must affirmatively act once it receives a response to its verification request.' (see also Westchester County Medical Center v. NY Central Mutual Fire Ins Co., 262 AD2d 553)."
"In the case at Bar, once Plaintiff submitted its response to Defendant's additional verification request, it was then incumbent on Defendant to inform Plaintiff that said response was insufficient and/or incomplete. Any confusion or disagreement on the part of the Defendant as to what was being sought should have been addressed by further communication, not inaction (see Westchester County Medical Center v. NY Central Mutual Fire Ins Co., supra). Neither party may ignore communications from the other without risking its chance to prevail in the matter (see All Health Medical Care, P.C. v. Government Employees Insurance Co., supra)."
"Accordingly, Plaintiff motion is hereby granted, judgment in favor of plaintiff for $2,118.33 plus interest , attorney's fee, costs and disbursements."