Additional verification not received – MRI films from an MRI facility

Historical note: Radiology Today was decided July 27, 2011; January 2012 is this post’s publication date. It dismissed an unanswered-verification action as premature, not on medical necessity. The separate MRI reproduction-cost issue was addressed in Lenox Hill Radiology (2021).

Last reviewed: September 2026.

An MRI report and the MRI images are not the same verification item. In Radiology Today v New York Central Mutual Fire Insurance Co., the insurer established that it had requested the films and had not received them. The Appellate Term reversed the denial of its summary-judgment motion and dismissed the provider’s action as premature.

What was missing from the claim file

The July 27, 2011 decision concerns a provider’s action for assigned no-fault benefits. The insurer’s litigation examiner supplied an affidavit describing timely mailing of the initial and follow-up verification requests. Those requests sought MRI films among other items. The examiner also established that the films had not been supplied.

The provider’s opposition did not address that particular omission. It was not enough to discuss the claim generally while leaving the requested images unaccounted for. The court found no factual issue requiring a trial and granted the insurer’s motion.

Calling the result a “verification denial” misses the procedural point. This was a dismissal because the action had been brought before the claim became payable under the verification rules. The opinion did not determine that the scan was unnecessary, that the images disproved an injury, or that the patient’s condition was unrelated to the accident.

Jason’s question about why the films were requested

Jason asked whether the carrier wanted the images for causation review or to obtain them more cheaply than through personal-injury discovery. His question is preserved below. It is commentary about a possible reason for the request, not a motive the court found.

The distinction is useful when reading older no-fault case notes: an attorney’s criticism can identify a practical problem without establishing a fact about the litigants. The opinion does not say that the insurer made an improper discovery demand. Nor does it decide the current reproduction charge for an MRI film.

For the separate question of advance payment, read Lenox Hill Radiology v Hereford. That 2021 Civil Court decision considered a provider that demanded reproduction costs before releasing films. It distinguished the continuing verification toll from the provider’s entitlement to reimbursement and left a separate 120-day-denial question open.

A specific request needs a specific answer

The response file should identify the study requested, the images supplied, how they were sent and when. If the images cannot be located or are held elsewhere, the explanation should identify that problem rather than imply that a previously supplied report necessarily answered the request. Those are recordkeeping points, not findings that Radiology Today approved a particular response form. Where images are sent electronically, preserve the transfer confirmation with the claim file rather than relying solely on the imaging report.

The comparison with St. Barnabas v GEICO helps explain why a general letter may leave verification outstanding. That case concerned hospital charges rather than MRI films, but likewise turned on the information sought and the adequacy of the answer.

Mailing proof remains a separate question. In Healing Health Products, detailed evidence about the provider’s incoming-mail records raised a factual dispute. Radiology Today did not have a sufficient opposing showing about the missing films.

Reading the decision alongside today’s deadlines

The claim must be evaluated under the applicable no-fault regulations, including the nature of the request, its timing and the follow-up. A carrier does not establish a valid toll merely by naming an item it would like to receive.

Later provisions concerning qualifying verification requests also distinguish production from written reasonable justification for noncompliance. They should not be projected backward as though the 2011 court decided them. The governing hub below connects this older missing-film decision with the current timetable.

Jason’s original commentary

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

The carrier is delaying for an MRI film from an MRI facility. What is the basis? Lack of causal relationship? Seeking to obtain the film at the workers compensation rate of $5.00 per sheet, as opposed to having to pay market rate during discovery in the personal injury matter?

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:

• Lenox Hill Radiology: MRI reproduction costs and the verification toll.
• Village Medical Supply: a good reason to request manufacturer invoices.
• Right Aid: reversal over the verification-trial burden.
• St. Barnabas: an insufficient emergency-treatment response.
• 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.