Follow the NF-5

Mount Sinai Hosp. v Dust Tr., Inc., 2014 NY Slip Op 03667 (2d Dept. 2014)

“contrary to the defendant’s contention, this action is not premature, and the 30-day period in which the defendant must pay or deny the claim has not been indefinitely tolled. “; request for verification that precedes a no-fault insurer’s receipt of the prescribed N-F 5 claim form does not trigger the tolling of the 30-day period within which an insurer must determine whether to pay or deny such a claim” (Sound Shore Med. Ctr. v New York Cent. Mut. Fire Ins. Co., 106 AD3d 157, 164). Here, the defendant sent two letters requesting verification, one dated March 15, 2010, and another dated April 15, 2010. The defendant’s verification request dated March 15, 2010, was sent after the defendant received an “interim bill” from the plaintiff, which was sent solely for the purpose of notifying the defendant of the claim, and preceded the defendant’s receipt of the N-F 5 form. Thus, the March 15, 2010, verification request did not trigger the tolling of the 30-day period within which an insurer must determine whether to pay or deny the claim. Consequently, the only effective request for verification was the one dated April 15, 2010, six days after the defendant’s receipt of the plaintiff’s N-F 5 form (see id.).”

This is the ultimate in form over substance.  Strangely, the carrier that receives the UB-04 prior to NF-5 gets penalized for reacting to the UB-04 while implicitly ignoring the NF-5

Related Articles

• Understanding verification requests in New York no-fault insurance claims
• The 120-day rule for verification in no-fault insurance
• When technical verification requirements override common sense in no-fault insurance
• The first case interpreting Infinity v. Eveready on verification timing
• New York No-Fault Insurance Law

Legal Update (February 2026): The procedural requirements and timing provisions for no-fault verification requests discussed in this 2014 post may have been modified through subsequent regulatory amendments or Department of Financial Services updates. Practitioners should verify current N-F 5 form requirements and tolling provisions under 11 NYCRR 65, as verification procedures and associated time periods are subject to periodic regulatory revision.