Submitting A Claim To The Wrong Insurance Company Is Not A Reasonable Excuse For Untimely Submission Of A Claim
If an insured sends a claim form to the wrong insurer, that error is not a reasonable justification for failing to submit a claim to the proper insurer within the time limit enforced by the policy of insurance.
In New Millennium Medical Imaging, P.C. v. 21st Century Insurance Company, 2022 WL 2525553 (2nd Dep’t 2022), a defendant insurer disclaimed coverage for a first-party no-fault claim after the plaintiff insured failed to submit a claim form within 45 days of services rendered, as required by the subject policy of insurance. As such, the insured initiated a lawsuit against the insurer to recover the first-party no-fault benefits. At the close of discovery, both parties moved for summary judgment. The insured conceded that it failed to submit the claim form within 45 days because it accidently sent the claim form to a different insurance company. It argued that this error was a reasonable justification for its breach of the policy, and that it was entitled to recover the first-party no-fault benefits. The Civil Court granted the insured’s motion for summary judgment and denied the insurers motion to dismiss the complaint. In response, the insurer appealed the Civil Court’s decision.
On appeal, the Appellate Term for the Second Department reversed the Civil Court’s decision and granted the insurers motion for summary judgment, holding that the insured did not establish a reasonable justification for initially submitting the claim form to the wrong insurance company, given the claim form which the insured submitted to the wrong insurance company bore the proper insurer’s name and address. A harsh result maybe, but the court’s decision gave weight to the insurance policy provisions on notice.
Thanks to Drew Fryhoff for his contribution to this post. Should you have any questions, please contact Tom Bracken.