Navigating New York No-Fault Additional Verification Challenges: Long Island Healthcare Providers

All Boro showed that its claim had not been paid, but the court found that it had not established entitlement to summary judgment. The insurer, meanwhile, established timely verification requests and an uncontroverted failure to respond. The appellate court granted the insurer dismissal even though it had not cross-appealed.

Legal Update (September 2026): Read All Boro (2013) with the later prima facie standard in Viviane Etienne, 25 NY3d 498 (2015), and the 2026 Chapa verification update. The old note’s “resetting” language is replaced with a qualified explanation of tolling.

Last reviewed: September 2026.

What the lower court and appellate court did

All Boro Psychological Services v Allstate Insurance, 38 Misc 3d 134(A), was decided January 14, 2013. The provider moved for summary judgment. The insurer cross-moved for dismissal or, alternatively, discovery. The Civil Court denied the provider’s motion and granted discovery.

On the provider’s appeal, the Appellate Term removed the discovery direction and granted the insurer summary judgment on a search of the record. The insurer had not cross-appealed, but its summary-judgment request and the relevant record were before the court.

The insurer proved timely initial and follow-up requests. The failure to respond was uncontroverted. The court therefore found that the payment period had not begun to run and the insurer was entitled to dismissal.

Jason Tenenbaum’s 2013 commentary

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:

Jason returned to the problem after quoting the then-used prima facie formulation:

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.

The opening shorthand that the bill was “overdue” must be qualified by the decision: nonpayment was shown, but the provider did not establish the necessary denial-related aspect of its motion, and the uncontroverted verification proof supported dismissal. The later explanation should not repeat that shorthand as a judicial finding.

Unpaid and overdue are not interchangeable

A balance can be unpaid while a properly supported verification issue affects the payment period. Conversely, an insurer cannot establish tolling merely by calling the claim “in verification.”

The later Court of Appeals decision in Viviane Etienne states the provider’s prima facie standard for overdue benefits: admissible evidence that the statutory billing forms were mailed to and received by the insurer and that payment was overdue. It rejected a broader requirement to establish the truth of the underlying medical contents through a business-record foundation at that stage.

That standard does not eliminate a supported verification defense. It directs attention to what the parties’ evidence shows, instead of treating either an unpaid balance or a claims-system label as decisive.

A search of the record is not an automatic reversal of fortunes

CPLR 3212(b) permits relief to a nonmoving party when the evidence warrants it. All Boro applied record-search authority to a nonappealing insurer whose summary-judgment request had been made below. It does not establish that an appellate court may grant any relief on any unraised issue.

The Elmont Open MRI decision provides the necessary contrast. There, a factual verification dispute prevented judgment for both sides, so the provider’s award on a search of the record was removed.

Before relying on All Boro, identify the issue actually placed before the court and the evidence establishing it. Losing one motion does not invariably mean that the opponent must win.

Tolling is not an unlimited reset button

Additional verification is not an unrestricted means of restarting the 30-day payment period. The governing rules distinguish initial requests, follow-up obligations, completed proof and the effect of delays.

The DFS regulations set out those procedures. For a particular file, examine the receipt of the completed prescribed forms, the request dates, the missing information, any response, and the denial. A new letter does not by itself prove entitlement to a fresh payment period.

All Boro involved proven requests and an uncontroverted failure to respond. It did not decide the effect of an endless series of repetitive demands, a sufficient response already supplied, or a properly supported objection.

A recordkeeping approach for provider disputes

Retain the bill, request and follow-up correspondence, the response packet, and evidence identifying the mailing or transmission. If the dispute is nonreceipt, determine which document is said not to have arrived: the insurer’s request or the provider’s response.

The New Way mailing case shows that suitable employee evidence can create a receipt issue. It does not require expert testimony about postal systems in every case. Nor does All Boro require certified mail as the exclusive means of documenting a response.

For applicable current document requests, the Chapa hub also explains the reasonable-justification alternative. That later rule should be distinguished from All Boro’s old, unanswered-request record.

Frequently Asked Questions About Additional Verification

Q: What constitutes proper additional verification under New York no-fault law?

A: The request must be evaluated under the applicable claim-processing rules and the information needed to establish the claim. All Boro found timely requests and an uncontroverted response failure; it did not approve every possible demand or decide that every partial response is insufficient.

Q: How can providers protect themselves from verification status denials?

A: Preserve the actual request, response and transmission evidence, and identify any item that remains unavailable or disputed. A “verification” status label does not itself establish a defense. All Boro does not impose certified mail as the exclusive method of proof.

Q: What happens if a provider never receives a verification request?

A: The evidence matters. Identify the insurer’s mailing proof and the basis for any nonreceipt account. A bare denial of receipt does not necessarily defeat a supported mailing presumption, but expert testimony about postal systems is not a universal prerequisite. The cited mailing cases illustrate why the specific record controls.

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:

• Chapa in 2019: the 150-day cutoff reversed in 2026.
• Exoto: the withdrawn online opinion and NF-3 form questions.
• Ambrister: an explained second-notice exhibit.
• Viviane Etienne in 2013: separate verification and fee-schedule outcomes.
• New Way: mailing evidence and two different claim results.
• Elmont Open MRI: a factual issue prevented judgment for either side.

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.