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This article is part of our ongoing fee schedule coverage, with 118 published articles analyzing fee schedule issues across New York State. Attorney Jason Tenenbaum brings 24+ years of hands-on experience to this analysis, drawing from his work on more than 1,000 appeals, over 100,000 no-fault cases, and recovery of over $100 million for clients throughout Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx. For personalized legal advice about how these principles apply to your specific situation, contact our Long Island office at (516) 750-0595 for a free consultation.
The timing of insurance company denials plays a crucial role in New York no-fault insurance litigation, particularly when it comes to preserving defenses related to fee schedule limitations. Under New York’s no-fault insurance regulations, insurers have specific timeframes within which they must assert certain defenses, or risk waiving them entirely. This principle becomes especially important in fee schedule disputes, where the amount of reimbursement for medical services is at stake.
The Mercury Casualty Co. v. Encare case from 2011 illustrates a fundamental procedural requirement in no-fault insurance law: the preservation of defenses through timely action. When insurance companies fail to raise fee schedule objections within the required timeframes, they may find themselves unable to rely on those defenses later in litigation. This timing requirement is part of the broader framework of New York no-fault insurance law, which seeks to streamline the claims process while protecting the rights of all parties involved.
The case serves as a reminder that procedural compliance is often just as important as the underlying merits of a dispute. Insurance companies must be vigilant about meeting denial deadlines, whether dealing with standard medical treatments or more specialized procedures like those involving CPT codes for acupuncture or other therapeutic services. The consequences of missing these deadlines can be significant, potentially resulting in the loss of otherwise valid defenses and forcing insurers to pay claims they might have successfully contested if proper procedures had been followed.
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Mercury Cas. Co. v Encare, Inc. 2011 NY Slip Op 32166(U)(Sup. Ct. NY Co. 2011)
Do you really think I believed I was going to win this one? To quote a relatively obscure country artist: “This ain’t my last goodbye”. See you on Madison Avenue.
Key Takeaway
This decision reinforces the critical importance of procedural compliance in no-fault insurance disputes. Insurance companies must adhere strictly to denial deadlines to preserve their right to assert fee schedule limitations and other defenses. Missing these deadlines can result in waiver of otherwise meritorious defenses, leaving insurers obligated to pay claims at rates higher than the fee schedule would normally allow. For healthcare providers and their legal representatives, understanding these timing requirements helps ensure proper case strategy and maximizes the likelihood of successful claim resolution.
Legal Update (February 2026): Since this 2011 post, New York’s no-fault regulations have undergone several amendments affecting denial timeframes and fee schedule defense preservation requirements. The Insurance Department has updated various procedural rules and fee schedule provisions that may impact how insurers must assert defenses within required timeframes. Practitioners should verify current regulatory provisions and recent case law developments when advising on denial timing and defense preservation strategies.
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Legal Context
Why This Matters for Your Case
New York law is among the most complex and nuanced in the country, with distinct procedural rules, substantive doctrines, and court systems that differ significantly from other jurisdictions. The Civil Practice Law and Rules (CPLR) governs every stage of civil litigation, from service of process through trial and appeal. The Appellate Division, Appellate Term, and Court of Appeals create a rich and ever-evolving body of case law that practitioners must follow.
Attorney Jason Tenenbaum has practiced across these areas for over 24 years, writing more than 1,000 appellate briefs and publishing over 2,353 legal articles that attorneys and clients rely on for guidance. The analysis in this article reflects real courtroom experience — from motion practice in Civil Court and Supreme Court to oral arguments before the Appellate Division — and a deep understanding of how New York courts actually apply the law in practice.
About This Topic
Fee Schedule Issues in No-Fault Insurance
The New York no-fault fee schedule establishes the maximum reimbursement rates for medical treatment provided to injured motorists. Disputes over fee schedule calculations, coding, usual and customary charges, and the applicability of workers compensation fee schedules to no-fault claims are common. These articles analyze fee schedule regulations, court decisions on reimbursement disputes, and the practical challenges providers face in obtaining appropriate payment under the no-fault system.
118 published articles in Fee Schedule
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Disclaimer: This article is published by the Law Office of Jason Tenenbaum, P.C. for informational and educational purposes only. It does not constitute legal advice, and no attorney-client relationship is formed by reading this content. The legal principles discussed may not apply to your specific situation, and the law may have changed since this article was last updated.
New York law varies by jurisdiction — court decisions in one Appellate Division department may not be followed in another, and local court rules in Nassau County Supreme Court differ from those in Suffolk County Supreme Court, Kings County Civil Court, or Queens County Supreme Court. The Appellate Division, Second Department (which covers Long Island, Brooklyn, Queens, and Staten Island) and the Appellate Term (which hears appeals from lower courts) each have distinct procedural requirements and precedents that affect litigation strategy.
If you need legal help with a fee schedule matter, contact our office at (516) 750-0595 for a free consultation. We serve clients throughout Long Island (Huntington, Babylon, Islip, Brookhaven, Smithtown, Riverhead, Southampton, East Hampton), Nassau County (Hempstead, Garden City, Mineola, Great Neck, Manhasset, Freeport, Long Beach, Rockville Centre, Valley Stream, Westbury, Hicksville, Massapequa), Suffolk County (Hauppauge, Deer Park, Bay Shore, Central Islip, Patchogue, Brentwood), Queens, Brooklyn, Manhattan, the Bronx, Staten Island, and Westchester County. Prior results do not guarantee a similar outcome.
