She really was not an EIP

The Burden of Providing Accurate Information on No-Fault Claim Forms

New York’s no-fault insurance system requires healthcare providers to submit NF-2 claim forms identifying the insured party and other essential information. While minor errors may be excusable, the burden remains on the claimant to provide sufficient information for insurers to properly determine coverage. The case of Lenox Hill Radiology v Government Employees Insurance Co. explores where that burden lies when a clerical error lists the wrong person as the insured.

This decision addresses a fundamental question in New York No-Fault Insurance Law: when a healthcare provider submits claim forms with incorrect insured information, must the insurance carrier conduct an exhaustive investigation to identify the actual insured party? The Appellate Term, First Department answered this question with significant implications for both providers and insurers.

The ruling also highlights important jurisdictional differences between New York’s appellate departments. The First Department has historically taken a more carrier-friendly approach on coverage issues compared to the Second Department, creating variations in how similar cases are resolved depending on venue.

Case Background

Lenox Hill Radiology provided medical services and submitted no-fault claim forms to Government Employees Insurance Company (GEICO). However, the claim forms identified “Higginbotham” as the insured party. GEICO apparently could not locate any policy covering a person by that name in connection with the accident in question.

The healthcare provider argued that despite this clerical error, GEICO should have conducted further investigation to determine whether the injured party was covered under a policy held by someone else. Lenox Hill’s position was that the insurer had an affirmative duty to search its records exhaustively to rule out all possibilities of coverage before denying the claim.

GEICO countered that it had no obligation to engage in speculative searches when the claimant failed to provide accurate information about the insured party. The central legal question became whether the burden of identifying the correct insured party rests with the healthcare provider submitting claims or with the insurance company receiving potentially erroneous submissions.

Jason Tenenbaum’s Analysis:

Lenox Hill Radiology v Government Empls. Ins. Co., 2010 NY Slip Op 51638(U)(App. Term 1st Dept. 2010)

“Plaintiff’s listing of Higginbotham as the insured party on its claim form — an apparent clerical error — did not obligate defendant to conduct an exhaustive search to exclude the possibility that Higgingbotham was defendant’s insured, a status she never asserted to hold….  he obligation remains upon the claimant, in the first instance, to supply sufficient information to an insurer in an NF-2 form to permit an insurer to determine whether the injured party is actually an insured.”

This is an extremely important case.  I am not sure how many of you out there can read between the lines on this one.  I will say that Lenox Hill’s argument was definitely reasonable, but the rules of no-fault practice and that of standard liability coverage cases can at times diverge.  Remember what the Appellate Division held in Utica v. Timms, before you cast judgment on this court’s holding.

I also must reiterate something I stated in a post last week that the Appellate Term, First Department, tends to side with the carriers on issues involving coverage, exclusion and conditions precedent to coverage.  I also tend to think that the Appellate Term, Second Department may have come to a different conclusion on a similar set of facts.  See e.g.,  Psych. & Massage Therapy Assoc. v. Progressive Cas. Co., 12 Misc.3d 140(A)(App. Term 2d Dept. 2006).

What do the 200 readers a day who read this think?

Legal Significance and Departmental Differences

The Lenox Hill decision reinforces that healthcare providers cannot shift the burden of investigation to insurance carriers when submitting incomplete or inaccurate claim information. This principle aligns with the fundamental structure of New York’s no-fault system, which places initial responsibilities on claimants to provide accurate information that enables carriers to process claims efficiently.

The First Department’s approach differs markedly from cases decided by the Second Department, where courts have sometimes shown more willingness to require insurers to conduct reasonable investigations even when claim forms contain errors. This jurisdictional split creates strategic considerations for practitioners, as venue can significantly impact outcomes in coverage disputes.

The decision also implicates broader questions about the balance between administrative efficiency and access to no-fault benefits. While requiring accurate claim submissions promotes system efficiency, overly strict application of this principle could deny benefits to legitimately injured parties based on minor clerical errors. The court’s reference to Utica v. Timms suggests awareness of these competing considerations, though ultimately the court sided with administrative clarity.

Practical Implications

Healthcare providers must exercise extreme care when completing NF-2 forms, particularly when identifying the insured party. Even apparent clerical errors can provide grounds for coverage denials if the erroneous information prevents carriers from locating the relevant policy. Providers should implement quality control procedures to verify insured information before submitting claims.

When clerical errors do occur, providers should promptly submit corrected forms rather than arguing that carriers must conduct exhaustive searches to identify the correct insured. While some courts may require minimal investigation efforts from insurers, relying on this possibility is risky, especially in the First Department.

Insurance carriers facing claim forms with questionable insured information should document their search efforts and clearly communicate with providers about information deficiencies. While Lenox Hill establishes that carriers need not engage in speculative searches, reasonable efforts to identify the insured may still be prudent to avoid disputes over bad faith denial claims.

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• New York No-Fault Insurance Law

Legal Update (February 2026): Since this 2010 decision, New York’s no-fault regulations and claim processing requirements may have been modified through regulatory amendments or updated Department of Financial Services guidance. Practitioners should verify current provisions regarding insurer obligations for coverage determinations and the sufficiency standards for NF-2 form submissions, as procedural requirements for establishing eligible injured person status may have evolved.