Mirza v. Allstate Ins. Co

In Mirza v. Allstate Ins. Co., 185 A.D.2d 303 (2nd Dep't 1992), the insurer, following receipt of all necessary records, sent the records to an independent medical reviewing agency. Thirty-four days thereafter, the insurer received a report from the reviewing agency, and on that same date issued a denial of the claim on the ground that the insured was intoxicated at the time of the motor vehicle accident. When the insured's assignee sought summary judgment for no-fault benefits pursuant to Insurance Law 5106 on the ground that the denial of coverage came more than 30 days after submission of the claim, the insurer opposed, arguing that its delay was based upon the delay by the independent reviewing agency. The Second Department affirmed (as modified) a lower court decision denying the plaintiff's motion for summary judgment, holding that "issues of fact exist as to whether [the insurer's] delay was reasonable." (185 A.D.2d at 304.)