Understanding New York No-Fault Insurance Verification Timing: When 30 + 10 + 5 = Timely

The “30 + 10 + 5” in this note concerns an insurer’s late follow-up request, not an extra five days for a provider to answer. Triangle R upheld tolling on a record of unanswered requests and undisputed mailing dates.

Historical note: Triangle R v Praetorian, 30 Misc 3d 129(A), is a December 2010 Appellate Term, First Department decision. It predates the 2013 additions to § 65-3.5(o)–(p). The verification hub explains the later rules; this case does not create a general grace period.

Last reviewed: September 2026.

The dates behind the title

Triangle R Inc. v Praetorian Insurance Co., decided December 3, 2010, concerned a claim received on August 13, 2007. The insurer sent its initial verification request the next day. It sent an early follow-up on August 28 and another on September 28.

The September 28 follow-up was 15 days after expiration of the initial 30-day period. It was therefore five days beyond the next ten-day follow-up window. The provider did not dispute the mailings or supply the requested verification.

The Appellate Term reversed the Bronx Civil Court’s denial of the insurer’s motion. Under those limited circumstances, it held that the late follow-up did not defeat the toll. The earlier, premature follow-up did not invalidate the later request.

The opinion does not describe a provider that answered five days late, and it does not announce an unrestricted power to excuse missed deadlines.

Read Jason’s reaction as commentary

Jason’s original analysis below calls the result an apparent exercise of interest-of-justice jurisdiction and questions its consistency with other decisions. Those are his observations. The opinion itself should be cited for its stated facts and holding.

His discussion also refers to the old Dan Medical formulation of a provider’s prima facie case. For the later Court of Appeals treatment, see Viviane Etienne Medical Care v Country-Wide, 25 NY3d 498 (2015). Etienne required admissible proof of mailing and receipt of the statutory claim forms and that benefits were overdue. It did not make every unpaid bill an automatic summary-judgment award.

The follow-up rule remains a rule

Section 65-3.6(b) calls for follow-up within ten calendar days if verification remains missing 30 calendar days after the original request. It also addresses written identification of the missing information and the party asked to supply it.

Triangle R is a reason to examine the full chronology when a timing defect is argued. It is not a reason to plan a late follow-up. Its facts included a prompt initial request, multiple mailings and no response.

For comparison, Infinity Health Products v Eveready, 67 AD3d 862 (2009), dealt with a follow-up three days early and a provider that ignored both requests. The Second Department rejected the provider’s effort to obtain judgment on that defect and dismissed without prejudice as premature. The two decisions involved different timing errors.

What changed after these cases

Section 65-3.5(p), applicable to the specified services and expenses from April 1, 2013, says that technical or immaterial defects and failures to comply with prescribed time frames do not negate the applicant’s obligation to comply with a request or notice. The neighboring 120-day provision has separate conditions and excludes prescribed forms, IMEs and EUOs.

Those provisions require a current claim analysis, not a retroactive rewrite of the 2007 request history. The Elite objection decision illustrates why a written explanation or objection must be distinguished from silence.

For an actual disputed bill, preserve each dated request and response. Count calendar and business days according to the provision being applied. The original notice of claim, submission of medical proof, additional request and follow-up do not all run from the same event.

Frequently Asked Questions

Q: What happens if my healthcare provider submits verification late?

Triangle R did not decide a provider’s late response. It addressed the insurer’s follow-up. The effect of a late provider submission depends on the request, the applicable rule and the evidence explaining what was provided and when.

Q: How long does an insurance company have to pay my no-fault claim?

The ordinary payment or denial period is 30 calendar days after receipt of complete proof of claim, including properly requested relevant verification. Whether that period was tolled requires the actual request and response history.

Q: What should I do if my no-fault claim is denied?

Keep the denial, the claim forms and all verification correspondence. Identify the stated ground and the dates before choosing a challenge. This historical decision does not extend a filing or response deadline in an individual dispute.

Q: Can insurance companies delay payment indefinitely by requesting verification?

No blanket permission follows from Triangle R. A supported verification dispute can affect when payment becomes due, but the requests, follow-ups and later response provisions have to be evaluated. Merely labeling a bill pending does not prove tolling.

Q: How does this decision affect accident victims on Long Island?

The case came from the Bronx and was decided by the Appellate Term, First Department. Its facts can help explain a timing dispute, but the forum and other controlling authority matter in a Long Island case. It does not itself determine an accident victim’s entitlement to payment.

Jason’s original commentary

The contemporaneous comments below are preserved as historical commentary, with the case-specific and current-law qualifications explained above.

The Appellate Term, in exercising what appears to be its interest in justice jurisdiction, has found that a follow-up verification that is 5-days late is sufficient to toll the 30-day pay or deny clock. Borrowing from the logic that a premature follow-up verification should not, in the interest of justice, estop an insurance carrier from demanding the sought after verification, the Appellate Term held that an untimely follow-up verification should have the same effect.

The logic to arrive at this result is interesting. In principle, I agree with the court that a provider or injured person should not be rewarded for its stubborn recalcitrance. Either provide the information or object to it similarly to what happened in Omega Diagnostic Imaging, P.C. v MVAIC, 2010 NY Slip Op 51779(U)(App. Term 1st Dept. 2010) and litigate the underlying issue. In reality, the court is probably disregarding Presbyterian. But what I see is a back lash against the form over substance jurisprudence, common to our practice, which appears to be bothering the Appellate Term, First Department bench. This cuts both ways, mind you. The carriers’ attorneys are upset that a provider can walk into court with an NF-10 and say, prove your defense. I have no problem with this because Dan Medical is a contrived legal fiction at best. The providers’ are unhappy that “mailing” has been deconstructed and strict adherence to time lines, except for a true 30-day pay or deny issue, has been obviated.

I am just puzzled.

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:

• Leica: a delay notice without a specific verification request.
• Elite Medical: a timely pricing objection in master arbitration.
• GLM: EUO notices, nonappearance proof and the ADA-comment limit.
• TAM Medical: disputed receipt before the later Chapa ruling.
• First Aid: an unsupported unbundling defense and separate verification claims.

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.