Key Takeaway
Navigate NY no-fault additional verification disputes. Long Island attorney guides healthcare providers. Call 516-750-0595 free consultation.
I found this story a week before it was brought to life by a fellow blogger, but since the fellow blogger published it first, he gets deserved credit. The name of the case is: Infinity Health Prods., Ltd. v Eveready Ins. Co., 21 Misc.3d 1 (App. Term. 2d Dept. 2008).
This was the case involving a premature follow-up additional verification and the preclusion sanction due to this occurring. It is interesting to see the Second Dept taking up this issue. The dissenter at the Appellate Term observed other Appellate Division cases that found the sanction of preclusion unwarranted in this factual scenario. This is probably what lead the App. Div to grant leave as to this issue. As I have learned recently through personal experience in two recent matters, the App. Div. does not like to grant leave to no fault matters and does not like motions to reargue when a non-articulated argument, if properly preserved, would reverse their opinion and order.
Understanding Additional Verification Requirements in New York No-Fault Claims
The Infinity Health Products case represents a pivotal moment in New York no-fault insurance litigation, specifically addressing the critical timing requirements for additional verification requests. For healthcare providers and legal practitioners in Nassau, Suffolk, Queens, Kings, and New York Counties, understanding these verification procedures is essential to avoiding costly preclusion sanctions that can permanently bar otherwise valid claims.
Additional verification serves as a crucial tool in no-fault litigation, allowing insurance companies to request supplementary documentation to support medical necessity and billing accuracy. However, the timing and manner of these requests must comply with strict statutory requirements to avoid procedural challenges.
The Infinity Health Products Decision: Premature Verification and Its Consequences
In Infinity Health Prods., Ltd. v Eveready Ins. Co., the Appellate Term Second Department addressed the significant issue of premature follow-up additional verification requests. The case centered on whether an insurance company’s premature verification request could result in preclusion sanctions against the healthcare provider who failed to respond within the statutory timeframe.
The healthcare provider argued that the insurance company’s verification request was premature under New York Insurance Law § 5106(a), which establishes specific timeframes for when such requests can be made. When the provider failed to respond to what they considered an improper request, the insurance company moved for preclusion sanctions.
The Appellate Division’s Approach to No-Fault Verification Issues
What makes this case particularly significant is the dissenting opinion at the Appellate Term level, which cited other Appellate Division cases finding preclusion sanctions unwarranted in similar factual scenarios. This judicial disagreement likely prompted the Appellate Division to grant leave to appeal, recognizing the need for clarification on this important procedural issue.
The Appellate Division’s reluctance to grant leave in no-fault matters, as noted in the original commentary, makes this case even more noteworthy. When the state’s intermediate appellate court decides to hear a no-fault insurance case, it typically signals that the underlying legal principles require definitive resolution.
Practical Implications for Long Island and NYC Healthcare Providers
The verification timing requirements established through cases like Infinity Health Products have far-reaching implications for medical practices throughout the New York metropolitan area. Healthcare providers must understand both their obligations to respond to legitimate verification requests and their rights to challenge improper or premature requests.
When Verification Requests Are Proper
Under New York Insurance Law § 5106(a), insurance companies may request additional verification of medical necessity within specific timeframes after receiving initial claim submissions. These requests must be made in good faith and must seek information reasonably related to the treatment provided and billed.
For Nassau County medical practices, understanding these timing requirements is crucial. A verification request that complies with the statutory timeframe must be answered within the prescribed period, typically fifteen business days, or the provider risks preclusion from recovering benefits for the services in question.
Challenging Premature or Improper Verification Requests
The Infinity Health Products case demonstrates that not all verification requests are valid. Healthcare providers in Suffolk County and throughout Long Island should be aware that premature verification requests – those made before the statutory timeframe permits – may be challenged.
However, the challenge lies in determining whether to respond to a questionable verification request. Failing to respond to what ultimately turns out to be a proper request can result in preclusion sanctions. Conversely, responding to an improper request may waive arguments about its invalidity.
Strategic Considerations for Legal Practitioners
The evolution of verification requirements in no-fault litigation requires sophisticated legal analysis. As noted in the original commentary, the Appellate Division’s general reluctance to grant leave in no-fault matters, combined with their aversion to motions to reargue, means that practitioners must be particularly careful to preserve all arguments at the trial level.
Preservation of Arguments
The observation about properly preserved arguments that could reverse an Appellate Division opinion highlights a crucial strategic consideration. In verification disputes, practitioners must carefully articulate all potential grounds for challenging the insurance company’s conduct, including timing violations, lack of good faith, and failure to meet statutory requirements.
Motion Practice Considerations
When facing verification-related disputes, legal practitioners must consider whether the issue presents a question of law suitable for motion practice or whether factual development is necessary. The Appellate Division’s approach to these cases suggests that clear legal errors may receive more favorable consideration than complex factual disputes.
The Broader Context of No-Fault Litigation Trends
The Infinity Health Products case reflects broader trends in New York no-fault litigation, where procedural requirements have become increasingly complex and technical. Insurance companies have become more aggressive in using procedural defects to deny otherwise valid claims, while healthcare providers must navigate an increasingly challenging regulatory environment.
For accident victims in Queens and Brooklyn, these procedural complexities can significantly impact their access to necessary medical care. When healthcare providers are precluded from recovering payment due to verification disputes, they may be less willing to treat no-fault patients, creating access barriers for those injured in motor vehicle accidents.
Impact on Healthcare Access
The verification requirements, while intended to prevent fraudulent billing, can create unintended consequences for legitimate healthcare access. Small medical practices may lack the administrative resources to properly manage complex verification procedures, potentially leading to preclusion sanctions that affect their willingness to treat no-fault patients.
Best Practices for Handling Verification Requests
Based on the lessons learned from Infinity Health Products and similar cases, healthcare providers should implement comprehensive protocols for handling verification requests:
- Immediate Review: All verification requests should be reviewed immediately upon receipt to determine timing compliance
- Legal Consultation: Questionable verification requests should trigger immediate consultation with no-fault litigation counsel
- Documentation: Maintain detailed records of when verification requests are received and any responses provided
- Strategic Response: Develop consistent approaches for responding to borderline verification requests
- Staff Training: Ensure administrative staff understand the importance of verification timing requirements
Frequently Asked Questions About No-Fault Verification Requirements
Q: What should I do if I receive a verification request that appears to be premature?
A: Contact experienced no-fault counsel immediately. The decision whether to respond or challenge the request can have significant consequences. Legal counsel can help you determine the proper timing under the statute and develop an appropriate response strategy that preserves your rights while minimizing the risk of preclusion.
Q: How quickly must I respond to a legitimate verification request?
A: Generally, healthcare providers have fifteen business days to respond to properly made verification requests. However, the specific timeframe can vary depending on the type of verification and the circumstances of the request. Missing this deadline can result in preclusion sanctions.
Q: Can I challenge a verification request after I’ve already responded to it?
A: Responding to a verification request may waive your right to challenge its validity. This is why it’s crucial to evaluate the propriety of the request before responding. If you believe a verification request is improper, consult with legal counsel before taking any action.
Q: What happens if I’m subject to preclusion sanctions due to a verification dispute?
A: Preclusion sanctions can permanently bar recovery for the services in question. However, there may be grounds for challenging the sanctions, particularly if the original verification request was improper or if there are procedural defects in how the sanctions were imposed.
Q: How can I protect my practice from verification-related problems?
A: Implement systematic procedures for handling verification requests, including immediate legal review of questionable requests, detailed documentation of all correspondence, and staff training on no-fault procedural requirements. Consider working with experienced no-fault counsel to develop practice-specific protocols.
Contact Jason Tenenbaum for Expert No-Fault Verification Guidance
No-fault verification disputes can have severe consequences for healthcare providers, potentially resulting in permanent preclusion from recovering payment for legitimate medical services. The complex timing requirements and procedural nuances require experienced legal counsel who understands the evolving landscape of New York no-fault litigation.
As a Long Island attorney with extensive experience in no-fault verification disputes, I have helped healthcare providers throughout Nassau and Suffolk Counties navigate these challenging procedural requirements. Whether you’re facing verification requests, preclusion motions, or appeals from adverse decisions, experienced legal representation can make the critical difference in protecting your practice’s financial interests.
Don’t let verification disputes jeopardize your ability to recover payment for legitimate medical services. The timing requirements are strict, and the consequences of procedural missteps can be severe and permanent.
Call 516-750-0595 for a free consultation to discuss your no-fault verification challenges. With proper legal guidance, you can navigate these complex requirements while protecting your practice’s interests and maintaining your ability to serve no-fault patients throughout Long Island and New York City.
Related Articles
- The first case interpreting Infinity v. Eveready
- Procedural Fairness in No-Fault Insurance Litigation: Is It Fair?
- Understanding Verification Requests in New York No-Fault Insurance Claims
- The Verification Process in No-Fault Insurance: When Technical Requirements Override Common Sense
- New York No-Fault Insurance Law
Legal Update (February 2026): Since this 2008 post, Insurance Law § 5106 and related no-fault verification procedures have been subject to multiple regulatory amendments and judicial interpretations. Practitioners should verify current additional verification timing requirements, preclusion standards, and any updates to departmental regulations that may have modified the verification framework discussed in the Infinity Health Products decision.
