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.
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.
