Key Takeaway
Court ruling on additional verification non-receipt in NY no-fault insurance claims, highlighting burden of proof requirements before litigation begins.
Jesa Med. Supply, Inc. v Progressive Ins. Co., 2011 NY Slip Op 51603(U)(App. Term 2d Dept. 2011)
Nothing new here, but I liked the language from the Court regarding the non-receipt of the verification:
“Defendant demonstrated that it had not received the requested verification, and plaintiff did not show that the verification had been provided to defendant prior to the commencement of the action. Consequently, the 30-day period within which defendant was required to pay the $1,205.50 and $1,675 claims did not begin to run (see Insurance Department Regulations § 65-3.8 ; Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492 ; Hospital for Joint Diseases v State Farm Mut. Auto. Ins. Co., 8 AD3d 533 ), and, thus, plaintiff’s action with respect to the $1,205.50 and $1,675 claims is premature.”
The lack of medical necessity of the portion of the opinion was unremarkable.
I do not often see the portion of an additional verification non-receipt opinion discussing the non-receipt of the requested items prior to the commencement of litigation or arbitration. In Mount Sinai Hosp. v Chubb Group of Ins. Cos., 43 AD3d 889 (2d Dept 2007), the Appellate Division explicitly laid this rule out.
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Related Articles
- Understanding verification mailing requirements in no-fault claims
- When technical verification requirements override common sense
- The 150-day verification rule implications
- Equitable considerations in no-fault verification disputes
- New York No-Fault Insurance Law
Legal Update (February 2026): Since this 2011 post, Insurance Department Regulation § 65-3.8 governing additional verification procedures may have been amended, and related procedural requirements for demonstrating non-receipt of verification materials could have been modified. Practitioners should verify current regulatory provisions and recent case law interpretations regarding verification timelines and burden of proof requirements before relying on these precedents.
