The EIP does NOT need to be notified when the carrier is seeking verification from a provider of medical services

Historical note: Triangle R upheld requests properly sent to the provider despite misaddressed copies to the assignor. It did not eliminate every injured-person or attorney notification requirement or decide the full consequences of an assignment. The direct first-party insurance claim discussed in the original comment is against the insurer, not the provider.

Last reviewed: September 2026.

A mistake in copies sent to the injured person did not invalidate the verification requests in Triangle R v Clarendon National Insurance Co. The December 10, 2010 decision concerned information requested from the medical provider itself. The insurer proved proper mailing of those requests and follow-ups to the provider, which had not answered them.

The address problem concerned copies, not the operative requests

The insurer supported its motion with proof that the initial and follow-up verification requests were properly mailed to the provider. The requested material remained outstanding. The provider’s billing manager offered a bare denial of receipt that did not defeat the insurer’s showing.

The copies sent to the assignor used an incorrect address. The Appellate Term held that this did not nullify the otherwise proper requests directed to the provider from whom the information was sought. It upheld dismissal of the assigned-benefits action as premature.

The court distinguished the properly addressed requests from the misaddressed copies. This was not a case where the only request had been sent to the wrong provider address. Nor did the court say that every document in a claim file can be misaddressed without consequence.

Whose information was being requested?

The notice question under section 65-3.6(b) depends in part on the source of the outstanding verification. Here, the relevant request sought information from the plaintiff provider.

The result should not be extended to an injured person’s own EUO request, an item sought from a separate third party, or service requirements after litigation begins. Those situations involve different recipients and obligations.

The related Recover Medical Services note explains a later attorney-notice argument and the Advantage Radiology decision behind it. Neither case supplies a general excuse to stop communicating with counsel. Each identifies why a particular notice objection did not defeat properly directed claims-processing requests.

An assignment and an authorization are not identical

Jason’s original commentary below distinguishes a provider suing on assigned benefits from an injured person retaining rights under an authorization to pay. That distinction is worth preserving, but the comment’s broader statements about patient liability should not be mistaken for the holding in Triangle R.

Section 65-3.11(b) distinguishes an authorization to pay from an assignment. An authorization does not itself transfer all of the injured person’s rights to the provider. The precise form and its language matter.

Triangle R did not determine every circumstance in which a provider may seek payment from a patient, resolve an assignment’s validity, or announce that any policy breach automatically transfers liability back to the patient. Those questions require the governing documents and applicable law.

The final original paragraph also refers to a direct first-party action “against the provider.” For the insurance-benefits claim being discussed, the intended defendant would be the insurer. That wording is retained only within the clearly labeled historical quotation, with this correction.

What the mailing comparison adds

Healing Health Products supplies a useful contrast. Its provider offered detailed evidence about incoming-mail records sufficient to raise an issue, rather than the bare denial rejected here. The outcomes do not establish inconsistent universal rules that nonreceipt either always or never matters.

For review of a similar dispute, retain the addressed requests, mailing proof, copied notices, assignment or authorization, and the provider’s response records. Those materials show whether the complaint concerns the operative request or only a duplicate sent to someone else. A mistake in a copied notice may present a different problem from a request that never reached the proper addressee.

Jason’s original commentary

The original comments below are retained as historical commentary. The case-specific corrections and later developments are explained above.

In a case that appears to go against the grain of 65-3.6(b), the Appellate Term observed, and I suspect properly (but see my thoughts below) the following:

The above being said, there is no reason in an assigned claim why the assignor or his attorney needs to be on notice of any outstanding verification requests seeking information from someone other than the assignor.  The provider, through accepting an assignment, has relinquished its right to hold the assignor responsible for the cost of the medical services unless the assignor himself breaches a policy condition.

In the situation where an assignor does not treat on an assignment or treats through an authorization, the logic of this case would be wanting, however, since the injured person would be liable to the provider for the services for which no-fault would not reimburse him.  In essence, the injured person, in this paradigm, would need to demonstrate the provider’s compliance with the verification request or a reason for the invalidity of the verification request, in order to prevail in a direct first-party action or arbitration against the provider.

Connect to the Encyclopedia

Start with the no-fault verification hub and 2026 Chapa update for the governing framework and case directory. Related case notes:

• Mount Sinai v Dust Transit: the NF-5 and the missing follow-up.
• Recover Medical Services: attorney notice and late EUO requests.
• The recalled AIG opinion and its November replacement.
• Healing Health Products: detailed incoming-mail evidence.
• SS Medical Care: letter copies and an unopposed cross-motion.

For review of a particular no-fault verification dispute, request a Free Case Review. Keep the requests, responses and relevant claim dates available for that review.