"Pending Adjuster's Review" Doesn't Toll 30-Day Pay or Deny Period for No-Fault Billing

NO-FAULT – VERIFICATION – DELAY LETTER – INSURANCE LAW § 5106(A) – 30-DAY PAY OR DENY RULE
NYU-Hospital for Joint Diseases v American Intl. Group, Inc.
(2nd Dept., decided 11/1/2011) 

You knew this already.  A delay letter stating that payment of the provider's bill was being delayed "pending adjuster's review" and "investigation" does not serve to toll the 30-day pay or deny period of New York Insurance Law § 5106(a) and 11 NYCRR § 65-3.8.  Without a timely denial of PIP benefits, the insurer was precluded from asserting that intoxication of the insured was a contributing cause of the accident and injuries.  Summary judgment for the plaintiff hospital.