Additional Verification non-receipt and lack of medical necessity.

Utica Acupuncture, P.C. v Interboro Ins. Co., 2013 NY Slip Op 50643(U)(App. Term 1st Dept. 2013)

“In opposition to the defendant-insurer’s prima facie showing of entitlement to judgment dismissing plaintiff’s no-fault claims in connection with services rendered from May 11, 2009 through July 9, 2009, plaintiff failed to raise a triable issue of fact.  The affidavit of plaintiff’s principal, while explaining in general terms the office procedure followed by plaintiff in “log” verification requests into its “billing program,” failed to disclose the results of any search the affiant may have made of the billing program to ascertain whether the verification letters shown to have been sent by defendant had been logged in by plaintiff as received (see Comprehensive Neurological Servs., PA v Tri-State Consumer Ins., 35 Misc 3d 144, 2012 NY Slip Op 50950 ). Plaintiff’s bald denial of receipt of defendant’s verification requests was insufficient on this record to raise a triable issue.

Defendant also made a prima facie showing of entitlement to summary judgment dismissing plaintiff’s claims for services rendered from July 20, 2009 through September 10, 2009. In this regard, defendant submitted, inter alia, an independent medical examination report of its examining acupuncturist, which set forth a factual basis and medical rationale for the acupuncturist’s stated conclusion that the assignor’s injuries were resolved and that there was no need for further acupuncture treatment.

In opposition, plaintiff failed to raise a triable issue, relying largely on an affidavit of its principal, who, while broadly describing his approach to the practice of traditional Chinese medicine, failed to set forth any allegations as to the assignor’s claimed injuries or the medical [*2]necessity of the acupuncture treatments here at issue (see generally CPT Medical Services, P.C. v New York Cent. Mut, Fire Ins. Co., 18 Misc 3d 87 ).

(My office takes credit for this case)

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• Understanding triable issues of fact in no-fault insurance disputes
• Why conclusory affidavits fail in medical necessity summary judgment motions
• Understanding verification requests in New York no-fault insurance claims
• Procedural fairness concerns in no-fault insurance litigation
• New York No-Fault Insurance Law

Legal Update (February 2026): Since this 2013 decision, New York’s no-fault regulations have undergone several amendments affecting verification procedures and medical necessity standards. Practitioners should verify current provisions regarding verification request documentation requirements, IME report standards, and procedural obligations for both insurers and providers when asserting non-receipt defenses or medical necessity challenges.