Non receipt and verification

Longevity Med. Supply, Inc. v Praetorian Ins. Co., 2015 NY Slip Op 50401(U)(App. Term 2d Dept. 2015)

(a) As to non-receipt

“efendant’s mere denial of receipt of was insufficient to rebut the presumption of receipt established by plaintiff’s proof of mailing” (see Compas Med., P.C. v Farm Family Cas. Ins. Co., 38 Misc 3d 142, 2013 NY Slip Op 50254, *2 ). Thus, defendant failed to raise a triable issue of fact with respect to plaintiff’s first cause of action.”

The law requires a detailed discussion as to how the conclusion of non-receipt was reached.

(b) As non-receipt of verification

“Defendant demonstrated prima facie that it had not received the requested verification and thus that plaintiff’s second cause of action is premature (see 11 NYCRR 65-3.8 ; Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492 ). However, in opposition to the cross motion, plaintiff submitted an affidavit from one of plaintiff’s employees, which affidavit was sufficient to give rise to a presumption that the requested verification had been mailed to and received by defendant”

This is conclusory affidavit where the biller says they sent the verification but never actually presents proof that the verification was complied with.  How can this document raise an issue of fact?

Legal Significance

This decision establishes different evidentiary standards for proving non-receipt depending on who bears the burden. When a carrier asserts non-receipt of the initial billing, the carrier’s “mere denial of receipt” is insufficient to rebut the provider’s proof of mailing. The court’s citation to Compas Med., P.C. v Farm Family Cas. Ins. Co. makes clear that carriers must provide detailed explanations of their mail receipt procedures and demonstrate how they determined that the specific item was not received.

This requirement reflects the burden-shifting framework in mailing disputes. When a provider establishes proof of mailing (typically through postal receipts, certified mail documentation, or affidavits describing standard mailing procedures), a presumption arises that the item was received. To rebut this presumption, the carrier cannot simply say “we didn’t get it”—the carrier must explain its procedures for receiving and logging mail and demonstrate that a search of its records reveals no evidence of receipt.

However, when the roles are reversed—when the carrier establishes that it requested verification and the provider claims to have sent it—the decision applies what appears to be a more lenient standard. The court held that “an affidavit from one of plaintiff’s employees” was “sufficient to give rise to a presumption that the requested verification had been mailed to and received by defendant.” This holding creates asymmetry: carriers must provide detailed procedural explanations, while providers need only submit an affidavit.

Jason Tenenbaum’s critique of this asymmetry is well-founded. The affidavit described as “conclusory” states that the employee sent the verification but provides no documentation showing what was sent, when it was sent, or how it was sent. How can such an affidavit “raise an issue of fact” when it offers no corroborating evidence? If the carrier must prove its procedures with detailed documentation, why should the provider be permitted to create a factual dispute with a bare assertion?

This apparent double standard may reflect judicial concern about insurance company stonewalling—courts may be skeptical of carrier claims of non-receipt and willing to credit provider assertions more readily. Alternatively, it may reflect confusion about the difference between creating a presumption of mailing versus actually proving compliance with verification requests.

Practical Implications

For insurance carriers asserting non-receipt defenses, this decision reinforces the need for detailed procedural affidavits. Carriers must be prepared to explain: (1) how incoming mail is received and logged; (2) what searches were conducted for the allegedly non-received item; (3) who conducted the searches; and (4) what the search results showed. Generic denials will not suffice.

For healthcare providers facing verification non-receipt defenses, the decision suggests that affidavits may be sufficient to defeat summary judgment, even without documentary corroboration. However, providers should recognize that what suffices at summary judgment may not suffice at trial. When the case proceeds to trial, the absence of documentation supporting the claimed mailing may prove fatal.

The decision also highlights a strategic consideration: providers should maintain proof of verification compliance, including copies of materials sent, postal receipts, and contemporaneous records. While an affidavit alone may create a factual issue sufficient to survive summary judgment, documentary proof provides far stronger protection and may enable providers to prevail on their own summary judgment motions.

Related Articles

• Again – a mere denial will not rebut proof that a verification demand was mailed
• Understanding Verification Requests in New York No-Fault Insurance Claims
• Affidavits of Non-Receipt and Default Judgment Procedures in NY Personal Injury Cases
• Mailed to the wrong address – okay
• New York No-Fault Insurance Law

Legal Update (February 2026): Since this 2015 post, 11 NYCRR 65-3 has undergone multiple amendments, particularly regarding verification procedures and documentation requirements for non-receipt claims. The regulatory framework governing billing disputes and verification protocols may have been substantially modified. Practitioners should verify current provisions of 11 NYCRR 65-3.8 and related sections, as procedural requirements for establishing non-receipt and verification standards may differ from those discussed in the cited cases.