Key Takeaway
Understanding New York no-fault additional verification requirements and challenges for healthcare providers. Expert legal guidance for Long Island practices. Call (516) 750-0595.
Navigating New York’s Additional Verification Requirements: A Critical Challenge for Long Island and NYC No-Fault Providers
The complex world of New York’s no-fault insurance system creates numerous challenges for healthcare providers serving patients throughout Long Island and New York City. Among the most frustrating procedural hurdles is the additional verification process, where insurance companies can effectively delay payment by claiming bills require further documentation.
For medical practices, psychological services, and other healthcare providers in Nassau County, Suffolk County, and the five boroughs, understanding the burden of proof requirements in additional verification disputes can mean the difference between timely payment and prolonged litigation. The intersection of Insurance Law § 5106(a) with summary judgment standards creates a complex legal landscape that directly impacts cash flow and operational viability.
The All Boro Psychological Services Decision: A Harsh Reality for No-Fault Providers
All Boro Psychological Servs., P.C. v Allstate Ins. Co., 2013 NY Slip Op 50069(U)(App. Term 2d Dept. 2013)
Plaintiff demonstrated that the bill was overdue. Defendant came back and said the bill was in verification status. Plaintiff moves for summary judgment and Defendant cross-moves for summary judgment or discovery. Court grants Defendant discovery. Plaintiff appeals, Defendant does not cross appeal, so what happens next?
Court grants Defendant summary judgment upon a search of the record. Furthermore, Court says the following about plaintiff’s prima facie case:
“A no-fault provider establishes its prima facie entitlement to summary judgment by proof of the submission to the defendant of a claim form, proof of the fact and the amount of the loss sustained, and proof either that the defendant failed to pay or deny the claim within the requisite 30-day period, or that the defendant issued a timely denial of claim that was conclusory, vague or without merit as a matter of law (see Insurance Law § 5106 ; Westchester Med. Ctr. v Nationwide Mut. Ins. Co., 78 AD3d 1168 ; see also New York & Presbyt. Hosp. v Allstate Ins. Co., 31 AD3d 512 ). Here, while plaintiff demonstrated that the claim had not been paid, it failed to demonstrate either that defendant had failed to deny the claim or that defendant had issued a legally insufficient denial of claim form (see Ave T MPC Corp. v Auto One Ins. Co., 32 Misc 3d 128, 2011 NY Slip Op 51292 ).”
It would seem that the provider, in order to win summary judgment, would have to prove that it never received the verification requests or that it complied with the verification requests. As that was not done here, summary judgment could not be granted.
This is just rough.
Understanding the Additional Verification Trap
The Basic Framework
New York’s no-fault system under Insurance Law § 5106(a) requires insurers to pay or deny claims within 30 days of submission. However, the law also permits insurers to request additional verification of the claim, effectively resetting the 30-day clock and creating what many providers experience as an endless cycle of documentation requests.
The Prima Facie Case Requirements
The All Boro decision clarifies the essential elements a no-fault provider must prove to establish entitlement to summary judgment:
- Submission of a proper claim form
- Proof of the fact and amount of loss sustained
- Either: The insurer failed to pay or deny within the 30-day period, OR The insurer issued a denial that was conclusory, vague, or without merit as a matter of law
Frequently Asked Questions About Additional Verification
Q: What constitutes proper additional verification under New York no-fault law?
A: Additional verification requests must be reasonable, specific, and relate to the submitted claim. However, the All Boro decision suggests that even broadly compliant verification responses may not be sufficient if any element is incomplete or missing.
Q: How can providers protect themselves from verification status denials?
A: Providers should maintain meticulous records of all communications with insurers, use certified mail for verification responses, and ensure complete compliance with every element of verification requests. However, as All Boro demonstrates, even careful documentation may not guarantee success.
Q: What happens if a provider never receives a verification request?
A: Theoretically, if a provider can prove non-receipt of verification requests, the 30-day payment deadline should apply. However, proving non-receipt is practically difficult and may require expert testimony about mail delivery systems.
The Harsh Reality of Verification Status
Why This System Is “Just Rough”
Jason’s concluding observation that “This is just rough” captures the fundamental unfairness of the current system:
- Asymmetric Burden: Providers bear the burden while insurers control the process
- Practical Impossibility: Proving complete compliance with verification requests is often impossible
- Economic Incentives: Insurers benefit from payment delays while providers suffer
- Limited Recourse: Even meritorious claims can fail on procedural technicalities
Get Expert Help with Your No-Fault Verification Disputes
If you’re a healthcare provider struggling with insurance company verification abuse, don’t navigate this complex system alone. The Law Office of Jason Tenenbaum understands the harsh realities highlighted in All Boro Psychological Services v Allstate Insurance Co. and the practical challenges facing providers throughout Long Island and New York City.
Whether you’re dealing with delayed payments, excessive verification requests, or summary judgment challenges in Nassau County, Suffolk County, or anywhere in the five boroughs, we’re here to protect your practice’s financial interests and ensure you receive the payments you’ve earned.
Call (516) 750-0595 today for a consultation about your no-fault collection challenges. Don’t let verification abuse destroy your practice’s financial stability—fight back with experienced legal representation.
Related Articles
- UB-04 billing forms alone don’t establish a prima facie case
- Understanding verification requests in New York no-fault insurance claims
- Amended motions and defects in affidavits during verification disputes
- Procedural fairness challenges in no-fault insurance litigation
- New York No-Fault Insurance Law
Legal Update (February 2026): Since this 2013 post was published, New York’s no-fault insurance regulations have undergone significant revisions, including amendments to Insurance Law § 5106 requirements, updates to additional verification procedures, and changes to summary judgment standards in no-fault disputes. Healthcare providers should verify current statutory provisions and recent case law developments that may have modified the burden of proof standards and procedural requirements discussed in this analysis.
