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.
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.
