Key Takeaway
NY Appellate Term reverses summary judgment in medical provider case, finding triable issues of fact regarding whether additional verification requests were properly responded to.
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.
In New York no-fault insurance litigation, the question of whether a medical provider has adequately responded to an insurance carrier’s additional verification request often becomes a central battleground. These disputes frequently arise when carriers deny claims, asserting that providers failed to submit required documentation or that their responses were insufficient.
The case of Elmont Open MRI & Diagnostic Radiology, P.C. v New York Cent. Mut. Fire Ins. Co. illustrates the factual complexity that can surround additional verification issues. When carriers request additional documentation to verify medical services, both the clarity of the request and the adequacy of any response become critical factors in determining whether a claim should be paid.
This decision demonstrates why summary judgment motions in verification disputes can be particularly challenging. Courts must carefully examine whether genuine issues of material fact exist regarding the verification process, including whether providers actually received verification requests and whether any responses met the carrier’s legitimate requirements.
Jason Tenenbaum’s Analysis:
Elmont Open MRI & Diagnostic Radiology, P.C. v New York Cent. Mut. Fire Ins. Co, 2014 NY Slip Op 50607(U)(App. Term 2d Dept. 2014)
It looks like there is an issue of fact as to whether Plaintiff responded to some amorphous verification or whether the response was sufficient. Cannot tell from the order of the Appellate Term. District Court granted reverse summary judgment to Plaintiff. No comment here. The Appellate Term seems to believe that there are some factual issues requiring a trial/hearing.
“The court properly denied defendant’s motion for summary judgment dismissing the complaint, but improperly granted summary judgment to plaintiff, as there is a triable issue of fact as to whether verification is outstanding (see Cassidy v Allstate Ins. Co., 63 AD3d 869 ; Mount Sinai Hosp. v Allstate Ins. Co., 25 AD3d 673 ).”
Key Takeaway
The Appellate Term’s reversal emphasizes that verification disputes under New York no-fault insurance law often involve complex factual questions that preclude summary judgment. Both medical providers and insurance carriers must be prepared to present detailed evidence regarding verification requests and responses when these cases proceed to trial.
Legal Update (February 2026): Since this 2014 post, New York’s no-fault regulations governing additional verification procedures may have been amended, including potential changes to required timeframes for carrier requests, documentation standards, and provider response obligations. Practitioners should verify current provisions in 11 NYCRR Part 65 and recent case law developments regarding verification dispute procedures.
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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
Keep Reading
More Additional Verification Analysis
No Denial Required When Provider Fails to Respond to Verification Within 120 Days
Appellate Division holds insurers need not issue a denial when a medical provider or injured person fails to respond to verification demands within 120 days. Analysis of Chapa...
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, 2020Amended motion/Admissible Reply papers/Defects in affidavits/delay letter vs. verification requests
Court ruling on amended motions, defective IME affidavits, and delay letters vs. verification requests in New York no-fault insurance litigation procedures.
Aug 6, 2013The failure to respond to ALL of the requested verification renders lawsuit premature
New York court rules that partial compliance with additional verification requests renders no-fault insurance lawsuits premature, requiring complete response to all items.
Oct 18, 2010120-day rule rebutted
Court ruling shows affidavit alone can create triable issue on verification receipt despite 120-day rule, prompting questions about documentary evidence standards.
Nov 25, 2018Delay letters v. verification requests
New York court clarifies that generic delay letters don't toll statutory payment deadlines—only specific verification requests can extend an insurer's time to pay or deny claims.
Nov 28, 2015Common 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.