There is, perhaps, no principle more sacrosanct in the field of no-fault law than the “30-day rule” which provides that a no-fault insurer must pay or deny a medical provider’s bill within 30 days of receipt. This rule is codified in both the Insurance Law1 and the implementing regulations enacted by the Superintendent of Insurance.2 In accord with this rule, a no-fault insurer will be precluded from raising most defenses to a provider’s claim, including that of lack of medical necessity, unless the insurer denies the claim within 30 days of receipt of the bill or any request for additional verification.3
However, in Central General Hospital v. Chubb Group of Insurance Companies,4 the Court of Appeals carved out an exception to the 30-day rule for cases where the insurer asserts a defense premised upon “lack of coverage.” As the Court noted in Chubb: “We are persuaded that an insurer, despite its failure to reject a claim within the 30-day period…may assert a lack of coverage defense premised upon the fact or founded belief that the alleged injury does not arise out of an insured incident.”
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