Key Takeaway
New York court ruling clarifies that insurance delay letters must request specific verification to toll statutory payment deadlines, raising questions about required detail levels.
This article is part of our ongoing additional verification coverage, with 92 published articles analyzing additional verification 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 Additional Verification Requirements in No-Fault Insurance Claims
In New York’s no-fault insurance system, insurance companies have strict deadlines to pay or deny claims. However, they can extend these deadlines by requesting additional verification from healthcare providers or other parties. A recent Appellate Term decision highlights a critical distinction between generic delay notifications and proper verification requests that actually toll the statutory time limits.
The case of Leica Supply, Inc. v GEICO Indemnity Co. demonstrates how insurance companies can lose their right to delay payment when their correspondence fails to meet legal requirements. This ruling has significant implications for both insurance carriers and healthcare providers navigating the New York No-Fault Insurance Law framework.
Jason Tenenbaum’s Analysis:
Leica Supply, Inc. v GEICO Indem. Co., 2013 NY Slip Op 50478(U)(App. Term 2d Dept. 2013)
” A review of defendant’s letters reveals that they merely notified plaintiff that defendant was delaying payment, but they did not request any specific verification. As a result, these delay letters did not toll the statutory time period within which defendant was required to pay or deny plaintiff’s claims”
An interesting question involves how specific must delay letters be? I am assuming this was for an IME or EUO. Do the letters have to state the date of the examination? If it was for a police report or DWI information, must it state the precinct and the police department that is being sought? If DWI information, must it name the court and docket number?
Just wondering.
Key Takeaway
This decision emphasizes that insurance companies must do more than simply notify providers of payment delays. To effectively toll statutory deadlines under the 120-day rule and Fee Schedule, insurers must make specific verification requests. Generic delay notifications without clear requirements may result in automatic claim approval, highlighting the importance of precise communication in no-fault insurance disputes.
The specificity requirements raised by this case connect to broader issues in verification disputes, including challenges around additional verification non-receipt and the ongoing complexities providers face in these situations.
Legal Update (February 2026): Since this post’s publication in 2013, New York’s no-fault insurance regulations and fee schedules have undergone multiple revisions, including amendments to verification procedures and reimbursement rates. Additionally, appellate decisions following Leica Supply may have further clarified the specificity requirements for valid additional verification requests. Practitioners should verify current regulatory provisions and recent case law developments when advising on additional verification compliance and statutory tolling requirements.
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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.
About This Topic
Additional Verification in No-Fault Claims
Under New York's no-fault regulations, insurers may request additional verification of a claim within specified time limits. The timeliness, scope, and reasonableness of verification requests — and the consequences of a claimant's failure to respond — are among the most litigated issues in no-fault practice. These articles examine the regulatory framework for verification requests, court decisions on compliance, and the interplay between verification delays and claim determination deadlines.
92 published articles in Additional Verification
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More Additional Verification Analysis
No Denial Required When Provider Fails to Respond to Verification Within 120 Days
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Feb 25, 2026120-day rule and Fee Schedule
New York court ruling demonstrates how healthcare providers can lose no-fault claims due to verification failures and fee schedule violations in insurance disputes.
Feb 1, 2020Non receipt of verification not proven
New York no-fault case: E4 Services v Lincoln General - court rules denial of receipt alone insufficient to rebut mailing presumption, requires proof of improper procedures.
Apr 30, 2014EUO letter need not be in large font – ADA litigation here we come
NY Appellate Term rules EUO letters need not use large fonts. Important decision for Long Island & NYC medical providers on no-fault insurance requirements. Call 516-750-0595.
Feb 21, 2011Outstanding Verification Trials: New York No-Fault Insurance Defense Guide
Master verification trial procedures in NY no-fault insurance. Expert analysis of burden of proof & defense strategies. Call 516-750-0595 for help.
Aug 18, 2019Verification non-receipt – Partial response insufficient
Court rules partial response to verification requests insufficient, requiring complete verification before claim payment or denial under NY no-fault law.
Oct 13, 2016Common Questions
Frequently Asked Questions
What is additional verification in no-fault insurance?
Additional verification is a request by the insurer for more information to process a no-fault claim, authorized under 11 NYCRR §65-3.5. When the insurer sends a verification request, the 30-day clock for claim processing is tolled (paused) until the requested information is received. This is a common insurer tactic to delay payment — but the verification request must be timely and relevant to be valid.
How long does an insurer have to request additional verification?
Under the no-fault regulations, the insurer must request initial verification within 15 business days of receiving the claim. Follow-up verification requests must be made within 10 business days of receiving a response to the prior request. If the insurer fails to meet these deadlines, the verification request is invalid and cannot be used to toll the claim processing period.
What types of additional verification can a no-fault insurer request?
Under 11 NYCRR §65-3.5, insurers may request medical records, provider licensing documentation, proof of treatment rendered, tax returns or financial records (in certain fraud investigations), authorization for release of medical records, and signed NF-3 verification forms. The verification request must be relevant to the claim and not overly burdensome. Requests for information not reasonably related to claim processing may be challenged as improper.
What happens if I don't respond to a no-fault verification request?
Failure to respond to a timely and proper verification request can result in denial of your no-fault claim. Under 11 NYCRR §65-3.5(o), if the requested verification is not provided within 120 calendar days of the initial request, the claim is deemed denied. The 120-day period runs from the date of the original request. However, if the verification request itself was untimely or improper, the denial based on non-response may be challenged.
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About the Author
Jason Tenenbaum, Esq.
Jason Tenenbaum is the founding attorney of the Law Office of Jason Tenenbaum, P.C., headquartered at 326 Walt Whitman Road, Suite C, Huntington Station, New York 11746. With over 24 years of experience since founding the firm in 2002, Jason has written more than 1,000 appeals, handled over 100,000 no-fault insurance cases, and recovered over $100 million for clients across Long Island, Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, the Bronx, and Staten Island. He is one of the few attorneys in the state who both writes his own appellate briefs and tries his own cases.
Jason is admitted to practice in New York, New Jersey, Florida, Texas, Georgia, and Michigan state courts, as well as multiple federal courts. His 2,353+ published legal articles analyzing New York case law, procedural developments, and litigation strategy make him one of the most prolific legal commentators in the state. He earned his Juris Doctor from Syracuse University College of Law.
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.
If you need legal help with a additional verification matter, contact our office at (516) 750-0595 for a free consultation. We serve clients throughout Long Island (Huntington, Babylon, Islip, Brookhaven, Smithtown, Riverhead, Southampton, East Hampton), Nassau County (Hempstead, Garden City, Mineola, Great Neck, Manhasset, Freeport, Long Beach, Rockville Centre, Valley Stream, Westbury, Hicksville, Massapequa), Suffolk County (Hauppauge, Deer Park, Bay Shore, Central Islip, Patchogue, Brentwood), Queens, Brooklyn, Manhattan, the Bronx, Staten Island, and Westchester County. Prior results do not guarantee a similar outcome.