Key Takeaway
Court ruling clarifies that mere denial of receiving verification requests cannot overcome legal presumption of proper mailing in no-fault insurance cases.
No-fault insurance verification requests are a critical part of the claims process in New York. Insurance companies routinely send verification demands to healthcare providers to obtain additional documentation supporting treatment claims. However, disputes frequently arise when providers claim they never received these verification requests, arguing that the insurer’s failure to provide proper notice invalidates any denial based on non-compliance.
This case highlights an important legal principle: establishing that verification requests were properly mailed creates a presumption of receipt that cannot be overcome by simple denials. For healthcare providers dealing with verification non-receipt issues, understanding this burden of proof is essential when challenging insurance company denials.
The court’s decision reinforces existing precedent regarding the mailing presumption in New York No-Fault Insurance Law, which governs how verification demands must be handled between insurers and medical providers.
Jason Tenenbaum’s Analysis:
Triangle R, Inc. v Tri-State Consumer Ins. Co., 2013 NY Slip Op 50256(U)(App. Term 2d Dept. 2013)
“The affidavits submitted by defendant established that defendant had timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 ; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 ) its initial and follow-up requests for verification to plaintiff (see Insurance Department Regulations §§ 65-3.5 ; 65-3.6 ). The mere denial by plaintiff’s [*2]office manager of receipt of the verification requests did not overcome the presumption that proper mailing had occurred and that plaintiff had received the verification requests”
Key Takeaway
Healthcare providers cannot rely solely on office staff denials to challenge insurance company verification demands. Once an insurer demonstrates proper mailing through affidavits, the legal presumption of receipt stands. Providers must present stronger evidence beyond simple denials when arguing they never received additional verification requests from insurers.
Legal Update (February 2026): Since this 2013 analysis, New York’s no-fault regulations under 11 NYCRR § 65-3.5 governing verification demands may have been amended, potentially affecting mailing procedures, notice requirements, and the presumption of receipt standards. Practitioners should verify current regulatory provisions and recent case law developments regarding verification demand protocols and burden of proof requirements.
