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Seaside Medical P.C. v. State Farm Mutual – Case Brief Summary (New York)

In Seaside Medical P.C. v. State Farm Mutual, 12 Misc 3d 1127, 819 NYS2d 819 (Civil Ct. Richmond Cty 2006), Judge Sweeney credited the plaintiff's argument that the toll to the defendant insurer's time to pay or deny the claim was eviscerated when the defendant sent out the second verification request only 28 days after the first verification request had been mailed.

After citing to a number of cases which were not on "all fours" with the instant matter because the defendants in those cases did not do any follow up after the plaintiff had failed to comply with the first verification request, Judge Sweeney noted that here the defendant did follow up but not within the 10 day period specified in 11 NYCRR 65-3.6(b).

While the defendant acted "diligently," it did not strictly adhere to the language of the regulation which was fatal since "No -Fault Regulations are in derogation of the common law and must be strictly construed." 12 Misc 3d at 1130.

Since defendant did not comply with the clear language of 11 NYCRR 65-3.6(b) requiring it to follow up with the plaintiff for the verification at least once during the 10 day period specified in the regulation, Judge Sweeney found that the toll "occasioned by defendant's initial requests for verification dissipated ab initio." Id at 1131.