Presbyterian Hosp. in City of New York, as Assignee of Karen DeGuisto v. Maryland Casualty Company

In Presbyterian Hosp. in City of New York, as Assignee of Karen DeGuisto v. Maryland Casualty Company (90 N.Y.2d 274 [1997]), the Court of Appeals, in a case involving a policy "exclusion," upheld a lower court ruling stating that an insurer may be precluded from interposing an intoxication exclusion defense for failure to deny a no-fault benefits claim within 30 days of receipt as required by Insurance Law 5106(a) and 11 NYCRR 65.15 (g) (3). The Court held that an insurer is precluded from raising such an affirmative defense to a no-fault first-party benefits assignee's claim where the insurer neither paid nor denied the claim within 30 days of receipt of the claim, nor sought to effectively extend the 30-day requirement by requesting verification in prescribed fashion.