Judge Fred Hirsh
Provider Garden State Anesthesia Associates (GSAA) provided anesthesia services to its assignee and submitted its claims for payment to insurer Progressive Casualty Insurance for various dates of service. Progressive advised GSAA its claim was being delayed pending the assignee’s appearance for an examination under oath (EUO). Progressive proceeded to send various letters informing GSAA of delays pending receipt of various documents, some unrelated to the instant matter. The court noted issuance of a delay letter that did not request verification did not toll the statutory time in which a claim must be paid or denied. It also stated an insurer did not obtain an extension of time to pay a no-fault claim when the verification requested and was outstanding was not related or relevant to the insurer’s review and evaluation of the specific provider’s claim. The court questioned how information relating to a April 28, 2011 motor vehicle accident could be relevant to evaluations of claims submitted for treatment on dates preceding the accident, finding Progressive’s position lacked merit. Yet, it found questions of fact existed if the letters Progressive relied on were verification requests or delay letters, denying its motion for summary judgment.
