MVAIC should have sought the information through verification

W.W. Med., P.C. v MVAIC, 2014 NY Slip Op 50093(U)(App. Term 1st Dept. 2014)

“The court properly determined that defendant failed to meet its burden of establishing that plaintiffs’ assignor was not a “qualified person” entitled to no-fault coverage (see Matter of MVAIC v Interboro Med. Care & Diagnostic PC, 73 AD3d 667 ). In challenging the assignor’s status as a qualified person, defendant relied principally, if not exclusively, on several claimed omissions from the notice of intention to make claim (timely) filed by the assignor. However, defendant may not seek refuge from liability based on any such omissions, having failed to timely object to the adequacy of plaintiff’s notice or seek additional information in connection with any omitted items by way of verification and, indeed, having previously written to the assignor to inform him that the notice was “received” and “completed in full.”

On this case, Defendant sought to challenge inadequacies in the coverage defense based upon holes in the proof of verification.  The court noted that Plaintiff should have sought the disputed information through the verification  protocol, and through failing to do this, Defendant could not assert a coverage based defense, whose genesis would be from the information that should have been obtained through verification.

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Legal Update (February 2026): The verification requirements and procedures for no-fault insurance claims discussed in this 2014 decision may have been modified by subsequent regulatory amendments to 11 NYCRR Part 65 or changes to Insurance Department guidelines. Practitioners should verify current verification protocols and notice requirements, as procedural changes to the claims process have occurred since this decision was issued.