Presbyterian Hosp. in City of N.Y. v. Aetna Cas. & Surety Co

In Presbyterian Hosp. in City of N.Y. v. Aetna Cas. & Surety Co. (233 AD2d 431 [2d Dept 1996]) the court found that the follow-up requirements for verification requests, as contained in 11 NYCRR 65.15 (e) (2) (the predecessor to 11 NYCRR 65-3.6 (b)), must be "strictly construed" so that "when an insurance company has not received 'verification' within 30 days after requesting it, the insurer must, within the ensuing 10 days, 'follow up' with a second request, documenting the second request in the file and notifying the applicant or the applicant's attorney." In Presbyterian (supra) the insurer, after not receiving a response to its request for additional verification, failed to make any follow-up request and merely waited three months until it received the requested records after which it issued a denial. The Second Department found that the 30-day period within which the carrier should have paid or denied the claim had run " 'even before verification was obtained', due to the carrier's 'lack of diligence in obtaining the verification' " (233 AD2d at 433.)