A defeat to those who attempt to avoid responding to verification requests

D & R Med. Supply v American Tr. Ins. Co., 2011 NY Slip Op 51727(U)(App. Term 2d Dept. 2011)

I think this case shows the perils a law firm or plaintiff encounters when they attempt to challenge the veracity and necessity of verification.  This is a huge case.

“The record establishes that plaintiff’s responses to defendant’s verification requests failed to provide the information which defendant had requested, in that plaintiff merely stated that the supplies at issue had been provided pursuant to a doctor’s prescription and did not advise defendant of the name of the doctor who had issued the prescription or where the doctor was located so that defendant could try to obtain the requested information from the prescribing doctor (see Urban Radiology, P.C. v Tri-State Consumer Ins. Co., 27 Misc 3d 140, 2010 NY Slip Op 50987 ). Consequently, defendant’s cross motion for summary judgment dismissing the complaint as premature should have been granted, as defendant’s time to pay or deny the claim had not begun to run (see Insurance Department Regulations § 65-3.8 ; Hospital for Joint Diseases v New York Cent. Mut. Fire Ins. Co., 44 AD3d 903 ; Central Suffolk Hosp. v New York Cent. Mut. Ins. Co., 24 AD3d 492 ; Hospital for Joint Diseases v State Farm Mut. Auto. Ins. Co., 8 AD3d 533 ). In light of the foregoing, we reach no other issue.”

Interesting dissent but it missed the point.

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Legal Update (February 2026): Since this 2011 post, New York Insurance Department Regulation § 65-3.8 governing verification requests and claim processing timeframes may have been amended or updated. Practitioners should verify current provisions regarding verification response requirements, acceptable documentation standards, and claim payment timelines, as regulatory changes could affect the procedural requirements discussed in this case analysis.