Today, the New York Court of Appeals in Hospital for Joint Disease v. Travelers Prop. Cas. Ins. Co. addressed whether an No-Fault insurer can raise an issue challenging the validity of an assignment of a No-Fault recipient to a medical provider where the No-Fault insurer failed to request verification of the assignment.
The quick and dirty facts are: The No-Fault insured assigned rights to a medical provider and, in turn, the medical provider sought reimbursement pursuant to the assignment from the assignor's (the insured) insurer. The assignment form clearly stated that the insured's signature was on file. After the medical provider (assignee) submitted its claim to the No-Fault insurer, the No-Fault insurer did not deny or pay the reimbursement within the 30-day time period. In its answer to the medical provider's complaint seeking reimbursement through the New York court system, the insurer challenged the viability of the assignment (essentially arguing that the assignee did not have standing to bring the claim in the first instance).
The Majority held that the insurer (assignee) failed to request verification of the assignment in a timely fashion or to contest the assignment in a timely fashion and, therefore, was precluded from raising the assignment issue. Interestingly, the Court noted that assuming that the plaintiff was required to demonstrate the validity of the assignment to make a prima facie showing, an assignment form stating that the signature was on file sufficed to meet the initial burden. Judge Pigott dissented, stating that the insurer cannot be precluded from waiving an issue regarding assigment because the issue raised a threshold standing issue.
Comments