Additional Verification non-receipt and lack of medical necessity.

Utica Acupuncture involved two groups of bills and two different defenses. For one group, the provider failed to support its denial of receiving verification requests. For the other, its response did not address the insurer’s patient-specific medical-necessity evidence.

Historical note: Utica Acupuncture v Interboro, 39 Misc 3d 139(A) (2013), is an Appellate Term, First Department decision about the evidence on these claims. The current verification hub supplies the later response rules; the opinion is not a general ruling against acupuncture treatment.

Last reviewed: September 2026.

Two branches of one motion

Utica Acupuncture, P.C. v Interboro Insurance Co., decided April 18, 2013, arose in Bronx Civil Court. The insurer sought partial summary judgment on claims grouped by treatment dates. The Appellate Term reversed the denial of its motion and granted it in full.

The May 11 through July 9, 2009 treatment claims involved outstanding verification. The July 20 through September 10, 2009 claims involved lack of medical necessity. That separation is essential: the insurer did not win every bill on a single general assertion that acupuncture was unnecessary.

Jason identified it as his office’s case in the original note, preserved below.

The incoming-mail explanation stopped too soon

For the earlier claims, the insurer supported its requests and their outstanding status. The provider’s principal described how incoming mail was logged but did not disclose the result of a search for the particular verification requests. The court found the denial of receipt insufficient.

The distinction is concrete. “We maintain a mail log” describes a practice. It does not say whether anyone looked for these requests, what records were examined or what the search showed. Utica concerned the missing connection between the general practice and the disputed correspondence.

The opinion does not require a particular computer program or a newly invented record format. A witness’s account needs to reflect the records and knowledge that actually exist. Filling a gap with an assumed search or an unsupported date would not make the evidence more reliable.

Compare evidence offered to prove mailing

In New Way v Praetorian, the provider’s evidence supported a presumption that its responses had been received, which raised a triable issue on four claims. Utica addressed an insufficiently supported denial that requests had arrived.

These are opposite directions of correspondence. The question in one is whether the provider sent a response; in the other it is whether the provider received the insurer’s demand. A mailing ledger for outgoing material does not necessarily answer an incoming-mail dispute.

The Right Aid trial decision adds the trial-stage comparison: the insurer’s witness was credited on nonreceipt of verification. Motion sufficiency and trial credibility should remain separate in a case comparison.

The medical-necessity evidence was patient-specific

For the later treatment dates, the insurer relied on an independent medical examination by an acupuncturist. The court found that the report gave a factual basis and medical rationale for the conclusion that no further acupuncture treatment was necessary.

The provider’s principal responded with general discussion of traditional Chinese medicine. The court found that it did not address the assignor’s particular condition or answer the IME showing.

The result therefore does not announce that one treatment method is invalid. It concerns the proof supporting further treatment for the patient and dates at issue. A response that explains a discipline in general can leave a case-specific medical opinion unanswered.

Billing expertise answers another question

The archive’s First Aid unbundling decision concerns whether separately billed services should have been bundled. The carrier’s unsupported coding position failed there, while separate verification branches succeeded.

Coding and medical necessity are not interchangeable. One asks how services should be billed under the applicable rules; the other can ask whether the treatment was medically needed. A useful review identifies which proposition the witness is qualified to address and what records support it.

Neither case supplies a credential checklist that automatically qualifies a witness. Read the opinion’s assessment of the actual proof rather than converting its result into a title-based rule.

Place the current response rules beside the old dates

The medical services in Utica occurred in 2009. The later 120-day document-verification provisions apply to specified services and expenses from April 1, 2013 and exclude prescribed forms, IMEs and EUOs. See § 65-3.5(o) and § 65-3.8(b)(3).

Those later provisions do not explain the outcome of the 2009 claims. They do matter when a reader uses this old evidentiary example in a current file.

For review, separate the bills by defense and treatment date. Gather the requests and mail evidence for the verification branch, then the examination report and responsive medical evidence for the necessity branch. This avoids assuming that success or failure on one group determines the other.

Jason’s original commentary

The contemporaneous comments below are preserved as historical commentary, with the case-specific and current-law qualifications explained above.

(My office takes credit for this case)

Connect to the Encyclopedia

Start with the no-fault verification hub and 2026 Chapa update for the governing framework and case directory. Related case notes:

• New Way: disputed receipt and a split motion result.
• NF-3 and Right Aid: the official provider form and receipt evidence.
• TAM Medical: disputed receipt before the later Chapa ruling.
• First Aid: an unsupported unbundling defense and separate verification claims.

For review of a particular no-fault verification dispute, request a Free Case Review. Keep the requests, responses and relevant claim dates available for that review.