Key Takeaway
First appellate case interpreting Infinity v. Eveready timing requirements for no-fault verification requests - Velen Medical Supply decision analysis.
New York no-fault insurance law continues to evolve through appellate decisions that shape the landscape for healthcare providers, insurance companies, and injured patients throughout Long Island and New York City. One of the most significant recent developments involves the interpretation of verification request timing requirements, particularly following the landmark Infinity v. Eveready decision. Understanding these developments is crucial for practitioners in Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, Bronx, Staten Island, and Westchester County who handle no-fault insurance disputes.
Understanding No-Fault Verification Requests
Under New York’s no-fault insurance regulations, insurance carriers have the right to request verification of medical services and expenses before approving payment. These verification requests serve as a critical component of the no-fault system, allowing insurers to investigate potentially fraudulent or excessive claims while ensuring legitimate providers receive timely payment for necessary medical services.
The timing of these verification requests has become a contentious issue in no-fault litigation, with significant implications for both healthcare providers and insurance companies throughout the greater New York metropolitan area.
The Velen Medical Supply Decision: Early Interpretation of Infinity v. Eveready
A follow-up verification that is one day premature. No problem.
Velen Med. Supply, Inc. v Country-Wide Ins. Co., 2009 NY Slip Op 52630(U)(App. Term 2d Dept. 2009):
“It is undisputed that defendant timely mailed its initial request for verification and that plaintiff failed to provide the information requested. Plaintiff also did not provide the information requested in defendant’s follow-up verification request, which was mailed on the 29th day after the initial verification request, but prior to the expiration of the full 30-day period within which plaintiff was supposed to respond to defendant’s initial request for verification. As the foregoing facts are nearly identical to those in Infinity Health Prods., Ltd. v Eveready Ins. Co. (___ AD3d ___, 2009 NY Slip Op 08585 ), “the 30-day period within which the defendant was required to pay or deny the claim did not commence to run … plaintiff’s action is premature” (id. at *2 ). In view of the foregoing, we reach no other [*2]issue.”
When an order of a lower court is reversed, wouldn’t it be nice to have the appellate court tells us if the reversal is on the law, the facts or the interest of justice? The Appellate Divisions all do this. The Court of Appeals does not, but since that is a pure law court (with the exception of direct appeals from capital murder cases where the death penalty is imposed), there is no need for that court to make that statement.
Yet, the Appellate Terms do not tell us whether their order are on the law, the facts or in the interest of justice. Thus, we are left to wonder whether the Court was saying that the order of the Civil Court should have been reversed on the law or for some other basis. Without this statement, a Civil Court is free to deny a Defendant’s motion for summary judgment and possibly grant Plaintiff’s summary judgment motion based upon a premature follow-up verification request when the court is convinced that the interests of justice would not be served by dismissing the complaint.
Crazy.
The Broader Context: No-Fault Insurance in New York
New York’s no-fault insurance system was designed to provide prompt payment for medical expenses and lost wages resulting from motor vehicle accidents, regardless of who caused the accident. This system was intended to reduce litigation and ensure faster compensation for accident victims while controlling insurance costs.
However, the system has faced significant challenges, including fraudulent billing practices, disputes over medical necessity, and complex procedural requirements that can delay or deny legitimate claims. The verification request process represents one of the key mechanisms insurers use to combat fraud while ensuring appropriate payment for valid claims.
Strategic Implications for Healthcare Providers
The Velen Medical Supply decision provides important guidance for healthcare providers throughout the New York metropolitan area who participate in the no-fault system. Understanding the timing requirements for verification responses is crucial for maintaining cash flow and avoiding unnecessary litigation.
Key Takeaways for Providers
Healthcare providers should understand several critical points from this decision:
- Timing Precision Matters: Even a one-day difference in verification request timing can affect the outcome of litigation
- Follow-up Requests Have Consequences: Insurers can effectively reset the payment timeline through properly timed follow-up verification requests
- Response Obligations Are Strict: Failure to respond to initial verification requests can lead to dismissal of payment claims
- Premature Litigation Is Costly: Filing suit before completing the verification process can result in case dismissal
Best Practices for Verification Compliance
To navigate the complex verification requirements effectively, healthcare providers should:
- Maintain Detailed Records: Document all communications with insurance carriers, including dates of verification requests and responses
- Respond Promptly: Provide requested verification materials well within the required timeframe
- Monitor Payment Deadlines: Track the 30-day payment requirement and understand when it begins running
- Consult Legal Counsel: Work with experienced no-fault attorneys when verification disputes arise
Implications for Insurance Companies
For insurance companies operating in Nassau, Suffolk, Queens, Kings, New York, Bronx, Richmond, and Westchester counties, the Velen Medical Supply decision provides important strategic advantages in managing no-fault claims.
Strategic Use of Follow-Up Requests
The decision demonstrates that insurance carriers can effectively use follow-up verification requests to extend their investigation period and avoid premature litigation. This tool allows insurers to:
- Reset Payment Timelines: Properly timed follow-up requests can restart the 30-day payment clock
- Obtain Additional Information: Follow-up requests can seek clarification or additional documentation
- Prevent Premature Suits: Strategic timing can render provider lawsuits premature and subject to dismissal
- Control Investigation Timing: Multiple verification requests allow for thorough claim investigation
The Appellate Process and Procedural Clarity
The decision also highlights an interesting procedural issue regarding appellate court orders. The author’s observation about the lack of clarity in Appellate Term decisions raises important questions about procedural transparency and its impact on lower court practice.
The Need for Clearer Appellate Guidance
Unlike the Appellate Divisions, which specify whether their reversals are based on law, facts, or the interests of justice, Appellate Terms often provide less detailed explanations. This can create uncertainty for practitioners and trial courts trying to understand the basis for appellate decisions.
This ambiguity can lead to inconsistent application of legal standards at the trial level, as judges may interpret appellate decisions differently when the reasoning isn’t clearly specified.
Practical Impact on No-Fault Litigation Strategy
The principles established in Velen Medical Supply have significant implications for litigation strategy in no-fault cases throughout the New York area.
For Healthcare Provider Attorneys
Attorneys representing healthcare providers should:
- Carefully Review Verification Timelines: Ensure all verification requirements have been properly completed before filing suit
- Document Insurer Communications: Maintain detailed records of all verification requests and responses
- Challenge Improper Follow-up Requests: Object to follow-up requests that appear designed solely to delay payment
- Consider Settlement Opportunities: Explore resolution options before engaging in costly litigation
For Insurance Defense Attorneys
Attorneys representing insurance carriers should:
- Utilize Strategic Timing: Carefully time follow-up verification requests to maximize investigative opportunities
- Document Verification Compliance: Ensure all verification requests comply with regulatory requirements
- Raise Prematurity Defenses: Identify and assert premature litigation defenses when appropriate
- Maintain Detailed Case Records: Document the timeline of all verification requests and responses
The Evolution of No-Fault Jurisprudence
The Velen Medical Supply decision represents part of the ongoing evolution of New York no-fault jurisprudence. As courts continue to interpret and refine the verification request requirements, practitioners must stay current on developing legal standards.
This area of law continues to evolve through appellate decisions that address the balance between preventing fraud and ensuring prompt payment for legitimate medical services. The interplay between regulatory requirements and court interpretations creates a complex legal landscape that requires careful navigation.
Regional Considerations for New York Practitioners
Practitioners in different regions of New York may encounter varying approaches to no-fault verification disputes. Understanding local court practices and judicial attitudes can be crucial for effective advocacy.
Long Island Practice Considerations
In Nassau and Suffolk counties, where no-fault cases are common due to high traffic volume and population density, courts have developed considerable expertise in these matters. Practitioners should be familiar with local rules and judicial preferences regarding verification disputes.
New York City Practice Considerations
The high volume of no-fault cases in New York City’s five boroughs means that efficiency and procedural compliance are particularly important. Courts in Queens, Brooklyn, Manhattan, Bronx, and Staten Island may have less patience for procedural defects or premature litigation.
Technology and Modern Verification Practices
As the healthcare and insurance industries continue to embrace digital technologies, verification practices are evolving. Electronic health records, digital document transmission, and automated processing systems are changing how verification requests are handled.
These technological advances may require updates to existing legal standards and procedures, potentially affecting how courts interpret timing requirements and communication standards in verification disputes.
Frequently Asked Questions
What happens if an insurance company sends a follow-up verification request one day before my response is due?
Based on Velen Medical Supply, this timing can reset the 30-day payment period, potentially making any lawsuit premature until you respond to the follow-up request and the insurer has time to process it.
Can I ignore a follow-up verification request if I already responded to the initial request?
No. Failure to respond to follow-up verification requests can result in dismissal of your claim, even if you properly responded to the initial request.
How can I tell if a verification request is legitimate or just a delay tactic?
Legitimate verification requests should seek specific information related to the medical services provided. Consult with an experienced no-fault attorney if you suspect improper delay tactics.
What should I do if I think an insurance company is abusing the verification process?
Document all communications and consult with a no-fault attorney. There may be regulatory remedies available for improper verification practices.
How long do I have to respond to a verification request?
Typically 30 days, but check the specific language of the verification request and relevant regulations, as requirements may vary depending on the type of verification requested.
Looking Forward: Future Developments in No-Fault Law
The no-fault insurance system continues to face pressure for reform, with ongoing debates about fraud prevention, payment timeliness, and administrative efficiency. Future legislative and judicial developments may affect verification requirements and timing standards.
Practitioners should stay informed about proposed regulatory changes and emerging case law that may affect verification practices and litigation strategies.
Conclusion: Navigating the Complex World of No-Fault Verification
The Velen Medical Supply decision demonstrates the critical importance of understanding timing requirements in no-fault verification disputes. Even seemingly minor procedural details, such as the timing of follow-up requests, can have significant legal and financial consequences.
For healthcare providers, insurance companies, and their attorneys throughout the greater New York area, staying current on these developing legal standards is essential for effective practice in the no-fault arena.
The intersection of complex regulatory requirements, evolving technology, and active appellate interpretation creates a challenging but manageable legal landscape for those who understand the key principles and stay current on developments.
Dealing with no-fault insurance verification disputes or payment delays? Contact an experienced no-fault attorney who understands the latest legal developments and can protect your rights. Call 516-750-0595 for expert guidance on your no-fault insurance case.
Related Articles
- Understanding verification requests timing and mailing requirements
- Procedural fairness challenges in no-fault litigation
- The 150-day verification rule compliance requirements
- When technical verification requirements override common sense
- New York No-Fault Insurance Law
Legal Update (February 2026): Since this post’s publication in 2010, New York no-fault insurance regulations have undergone several amendments, including updates to verification request procedures, timing requirements, and fee schedules. Additionally, subsequent appellate decisions may have further clarified or modified the interpretation of verification timing standards discussed in this analysis. Practitioners should verify current regulatory provisions and recent case law developments when handling no-fault verification disputes.
