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This article is part of our ongoing florida issues coverage, with 4 published articles analyzing florida issues issues across New York State. Attorney Jason Tenenbaum brings 24+ years of hands-on experience to this analysis, drawing from his work on more than 1,000 appeals, over 100,000 no-fault cases, and recovery of over $100 million for clients throughout Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx. For personalized legal advice about how these principles apply to your specific situation, contact our Long Island office at (516) 750-0595 for a free consultation.
Understanding Fee Schedule Defense Preservation in No-Fault Insurance Claims
In New York’s no-fault insurance system, insurers must follow specific procedural requirements when denying claims to preserve their right to raise certain defenses later in litigation. One critical area involves fee schedule defenses, where insurers challenge whether medical providers are billing in accordance with statutory fee schedules. The question often arises: what constitutes sufficient notice to preserve these defenses?
The procedural requirements for claim denials are strictly enforced in New York courts. When insurers fail to properly preserve their defenses through adequate denial forms, they may find themselves unable to contest claims that could otherwise be successfully challenged. This creates significant financial exposure, particularly in cases involving policy coverage disputes where proper procedural compliance becomes even more crucial.
The Appellate Term’s recent decision provides important guidance on what constitutes adequate preservation of fee schedule defenses, specifically addressing whether simply checking a box on standard denial forms meets the legal threshold for preserving these defenses.
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Shara Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co., 2013 NY Slip Op 50255(U)(App. Term 2d Dept. 2013)
“Contrary to plaintiff’s argument on appeal, defendant’s denial of claim forms were sufficient to preserve defendant’s fee schedule defense (see Arco Med. NY, P.C. v Lancer Ins. Co., 37 Misc 3d 136, 2012 NY Slip Op 52178 ).”
The Arco-Lancer case allowed for an EBT on “billing practices” because box #18 was checked.
Key Takeaway
The Appellate Term’s ruling establishes that checking box #18 on standard denial forms provides sufficient notice to preserve fee schedule defenses. This decision offers practical guidance for insurers, confirming that they need not provide elaborate explanations when the standardized checkbox system adequately communicates the basis for denial. The ruling also reinforces that such preservation can support discovery rights, including examinations before trial regarding billing practices.
Related Articles
- Policy coverage disputes and voiding issues
- Peer report timing requirements in PIP claims determination
- Legal Encyclopedia: No-Fault Insurance
- Use and operation coverage in motor vehicle cases
Legal Update (February 2026): Since this 2013 post, New York’s fee schedules and reimbursement rates have been subject to multiple regulatory amendments and updates. Additionally, procedural requirements for preserving fee schedule defenses may have evolved through subsequent case law and regulatory changes. Practitioners should verify current fee schedule provisions and denial form requirements, as the specific checkbox procedures discussed may no longer reflect current standards.
Legal Context
Why This Matters for Your Case
New York law is among the most complex and nuanced in the country, with distinct procedural rules, substantive doctrines, and court systems that differ significantly from other jurisdictions. The Civil Practice Law and Rules (CPLR) governs every stage of civil litigation, from service of process through trial and appeal. The Appellate Division, Appellate Term, and Court of Appeals create a rich and ever-evolving body of case law that practitioners must follow.
Attorney Jason Tenenbaum has practiced across these areas for over 24 years, writing more than 1,000 appellate briefs and publishing over 2,353 legal articles that attorneys and clients rely on for guidance. The analysis in this article reflects real courtroom experience — from motion practice in Civil Court and Supreme Court to oral arguments before the Appellate Division — and a deep understanding of how New York courts actually apply the law in practice.
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Disclaimer: This article is published by the Law Office of Jason Tenenbaum, P.C. for informational and educational purposes only. It does not constitute legal advice, and no attorney-client relationship is formed by reading this content. The legal principles discussed may not apply to your specific situation, and the law may have changed since this article was last updated.
New York law varies by jurisdiction — court decisions in one Appellate Division department may not be followed in another, and local court rules in Nassau County Supreme Court differ from those in Suffolk County Supreme Court, Kings County Civil Court, or Queens County Supreme Court. The Appellate Division, Second Department (which covers Long Island, Brooklyn, Queens, and Staten Island) and the Appellate Term (which hears appeals from lower courts) each have distinct procedural requirements and precedents that affect litigation strategy.
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