Presbyterian Hosp. v. Aetna Cas. & Sur. Co

In Presbyterian Hosp. v. Aetna Cas. & Sur. Co. (233 AD2d 431, 432 [2d Dept 1996], lv denied 90 NY2d 802 [1997]) the insurer was precluded by a violation of the "thirty day rule" from advancing an intoxication exclusion defense. The Court stated (90 NY2d at 280-281) that the insurer, because no request for verification was made within the allotted 10 days, had failed to obtain an extension of the 30 days: "In order for the insurer to have properly and timely requested the blood alcohol test results, it had to forward prescribed verification forms to the appropriate parties within 10 days after receipt of the completed application (see, 11 NYCRR 65.15 [d] [1]). The insurer utterly and flatly failed to do so and, thus, chose [not] or neglected to take advantage of its prescribed extension of time opportunity for considering denial of the hospital's claim ... "Since Maryland neither denied the claim within 30 days after receiving it nor properly sought to extend that time frame by requesting verification, using the prescribed forms, within 10 days after receipt of the hospital's completed application, it failed to comply with its obligation to timely deny or disclaim Presbyterian's no-fault claim." The Appellate Division stated that the regulatory requirement that if a request for verification is not responded to within 30 days it must be "followed up" within 10 days "must be strictly construed," and imposed preclusion against an insurer who failed to follow up within the allotted 10-day period.