Fair Price Medical v. Travelers Ins

In Fair Price Medical v. Travelers Ins., 10 NY3d 556 (2008), the Court of Appeals clarified when an insurance company would not be precluded from offering a defense to its refusal to pay no - fault benefits even though it denied the claims beyond the 30 day period. There, Travelers issued its denial nearly two years after receiving the claim, based upon the assignor's statement that he had never received medical supplies from the plaintiff. The Civil Court denied plaintiff's motion for summary judgment, finding that defendant was not precluded by the 30 day rule since it had asserted fraud as a defense. The Appellate Division affirmed the Appellate Term's reversal of the lower court's order denying plaintiff summary judgment on the grounds that: "in this case, unlike a staged accident case, there was an actual automobile accident, which caused Nivelo to sustain actual injuries, for which he was treated by actual health care providers, who issued actual prescriptions for medical supplies to treat his injuries. Nivelo's undisputably real accident had resulting injuries triggered with the coverage provided for in his insurance policy with the defendant" Fair Price Med. Supply Corp. V. Travelers Indem. Co. 42 AD3d 277, 284, 837 N.Y.S.2d 350 (2d Dept. 2007) affg 9 Misc 3d 76, 803 N.Y.S.2d 337 (App. Term 2d and 11th Jud. Dist 2005)." In sum, the Appellate Division concluded that while Travelers could contest the assignor's claim as fraudulent, it must do so within the tight deadlines imposed by the no -fault system. (42 AD3d at 286.)