Verification defense upheld

Case Background

Additional verification requests form a critical component of no-fault insurance claims processing. When insurers receive medical bills, they may require additional documentation to verify the necessity and appropriateness of the services provided. Under Insurance Department Regulation section 65-3.8, insurers’ obligation to pay or deny claims within thirty days does not begin until they receive the requested verification materials.

Disputes frequently arise over whether insurers actually mailed verification requests and whether providers received them. In such cases, insurers must demonstrate that they sent the verification requests, while providers claiming non-receipt must establish affirmative evidence that the requests never arrived. The evidentiary standards governing these disputes can determine whether claims proceed to evaluation on the merits or face dismissal as premature.

The Appellate Term decision in Schutzstaffel Medical Care v. Eveready Insurance Co. addressed an unusual situation where the trial court required the insurance company to prove that verification letters had not been tampered with or altered. This requirement went beyond standard evidentiary burdens, imposing an affirmative obligation to disprove potential document manipulation.

Schutzstaffel Med. Care, P.C. v Eveready Ins. Co., 2014 NY Slip Op 51305(U)(App. Term 2d Dept. 2014)

“Defendant demonstrated that it had not received the requested verification. Plaintiff did not oppose defendant’s cross motion. Contrary to the Civil Court’s statement, there is nothing in the record which would require defendant to prove that the copies of the verification letters annexed to defendant’s cross motion had not been tampered with or altered (see Schozer v William Penn Life Ins. Co. of NY, 84 NY2d 639, 643 ; People v Dicks, 100 AD3d 528 ; Rotanelli v Longo, 210 AD2d 392 ). As the 30-day period within which defendant was required to pay or deny the claims did not begin to run (see Insurance Department Regulations § 65-3.8 ”

Schozer is a case that this particular Plaintiff loves to harp upon; yet, always gets it wrong. I never knew certain Civil Court Kings County judges required an affirmative showing of lack of tampering in order to preserve particular defenses.

FYI: every time I see “SS medical” I get to sick to my stomach. Like many of my generation, both sets of my grandparents escaped Nazi Germany. That said, many of my relatives did not escape. I just think it is completely offensive that someone would name their facility SS Medical, regardless of whether or not there was venal intent. If a portion of my post got you thinking, then that it is a good thing.

Legal Significance

The Appellate Term’s reversal establishes important principles regarding document authentication in no-fault litigation. The court’s citation to Schozer v. William Penn Life Insurance Co. of NY is particularly significant, as that Court of Appeals decision addressed the admissibility of copies versus original documents. The Schozer court held that copies of documents are generally admissible without requiring proof that originals have not been altered, absent specific evidence suggesting tampering.

This principle reflects the practical realities of modern litigation. If parties were required to affirmatively prove the absence of tampering for every document submitted, litigation would become impossibly burdensome. Instead, New York’s evidentiary framework presumes document authenticity absent specific challenges supported by evidence. When a party claims documents have been altered, that party bears the burden of presenting evidence supporting the allegation.

The decision also reinforces the standard for establishing verification defenses. Insurance companies need only demonstrate that they requested verification and did not receive it. Once the insurer establishes non-receipt through affidavit testimony and documentary evidence, the burden shifts to the provider to demonstrate that verification was actually provided prior to commencement of the action.

Practical Implications

For insurance companies defending no-fault claims based on verification non-receipt, this decision provides clear guidance on evidentiary requirements. Insurers should submit copies of verification requests along with affidavits from individuals with personal knowledge that the requests were mailed and that no verification was received. Absent specific allegations of document tampering supported by evidence, insurers need not include additional proof regarding document authenticity.

Medical providers facing verification defenses should understand that general suspicions about document alteration will not overcome properly supported cross-motions. If providers believe verification requests have been fabricated or altered, they must present specific evidence supporting that claim, such as expert testimony about document forensics, proof of inconsistent versions of the same letter, or evidence that the insurer’s document creation date differs from the claimed mailing date.

The trial court’s improper requirement for affirmative proof of non-tampering illustrates how individual judges may occasionally impose incorrect evidentiary standards. When facing such requirements, parties should promptly object and cite controlling authority. Failure to preserve objections to erroneous evidentiary rulings can result in waiver of appellate review rights.

Related Articles

• Understanding verification mailing requirements in New York no-fault claims
• The 120-day verification rule and timing requirements
• How technical verification requirements can override common sense
• The first case interpreting Infinity v. Eveready precedent
• New York No-Fault Insurance Law

Legal Update (February 2026): Since this 2014 post, Insurance Department Regulation § 65-3.8 governing verification requirements and payment timeframes may have been amended or revised. Practitioners should verify current regulatory provisions and recent appellate decisions interpreting verification defense standards, as procedural requirements and evidentiary standards for establishing proper verification requests may have evolved.