Nonsensical appeal

The 15-Day Rule: When Verification Requests Become Nullities

New York’s no-fault insurance regulations establish strict timeframes governing when insurers can request additional verification from healthcare providers. These temporal limitations serve a critical purpose: preventing insurers from indefinitely delaying claim adjudication while simultaneously protecting providers’ ability to receive timely payment. The Neptune Medical Care case demonstrates what happens when insurance companies fail to respect these regulatory boundaries.

This decision represents more than just another timing dispute—it illustrates a fundamental principle in no-fault law: regulatory deadlines are not mere suggestions but jurisdictional prerequisites that, when violated, render subsequent actions nullities. The court’s analysis provides crucial guidance on the interplay between the 15-business-day verification request window under 11 NYCRR 65-3.5 and the broader 30-day payment deadline under 11 NYCRR 65-3.8.

Understanding these timing requirements is essential for both insurers seeking to preserve their rights to request verification and providers challenging untimely verification demands. The stakes are high: an untimely verification request cannot toll the payment deadline, meaning insurers who miss the 15-day window may find themselves obligated to pay claims they would have otherwise denied.

Case Background

Ameriprise Auto & Home Insurance received medical bills from Neptune Medical Care, P.C. for no-fault services rendered to an assignor. Rather than paying or denying these bills within the required 30-day period, Ameriprise attempted to request verification through Examination Under Oath (EUO) scheduling letters. However, these letters were not sent until more than 15 business days—and even more than 30 calendar days—after Ameriprise received the medical bills at issue.

Neptune Medical Care moved for summary judgment, arguing that the untimely EUO requests were nullities that could not support a denial. The Civil Court granted plaintiff’s motion, and Ameriprise appealed to the Appellate Term. Despite the insurance company’s arguments, the Appellate Term affirmed, finding that the regulatory framework left no room for late verification requests to preserve coverage defenses.

Jason Tenenbaum’s Analysis:

Neptune Med. Care, P.C. v Ameriprise Auto & Home Ins., 2015 NY Slip Op 51220(U)(App. Term 2d Dept. 2015)

I would recommend reading this one carefully. This case (again) lays out the parameters of what a timely IME or EUO letter is. Contrarily, it tells us what is not timely and should be settled. Considering that this Court cannot follow Unitrin (that would be the Progressive case from the Appellate Division a few months ago), there was not where to go in this case. “Pursuant to the No-Fault Regulations, “any additional verification required by the insurer to establish proof of claim shall be requested within 15 business days of receipt of the ” (11 NYCRR 65-3.5 ). Defendant did not request that plaintiff appear for an EUO until more than 15 business days, and even more than 30 calendar days (see generally 11 NYCRR 65-3.8 ), after it had received the bills at issue. Thus, even if the EUO scheduling letters were timely with respect to any other pending claims which may exist but are not before us, they were untimely with respect to the bills at issue. Indeed, this would be true even if defendant had tolled the 30-day period within which it was required to pay or deny the bills at issue, by timely requesting verification pursuant to 11 NYCRR 65-3.8 (a), as the Regulations do not provide that such a toll grants an insurer additional opportunities to make requests for verification that would otherwise be untimely. Consequently, the EUO scheduling letters were nullities with respect to the bills at issue and, therefore, defendant’s motion for summary judgment was properly denied

Legal Significance

The Neptune Medical Care decision reinforces the mandatory nature of the 15-business-day verification request window established by 11 NYCRR 65-3.5. This regulation uses the word “any” to describe additional verification requests, indicating that all such requests—whether for medical records, EUOs, IMEs, or other documentation—must be made within this timeframe. Courts interpret this language strictly, rejecting arguments that certain types of verification fall outside the temporal restriction.

The decision’s most significant holding addresses a common insurer misconception: that tolling the 30-day payment period through an initial verification request somehow extends the deadline for making additional verification requests. The court rejected this argument categorically, finding that the regulations create separate, independent timeframes. Even if an insurer timely tolls the payment deadline through an initial verification request, any subsequent verification demand—such as an EUO letter—must still comply with the 15-business-day rule measured from receipt of the original bills.

This interpretation creates important strategic considerations for insurance companies. An insurer that requests medical records within 15 business days (tolling the payment deadline) cannot later discover additional issues and request an EUO if more than 15 business days have passed since receiving the initial bills. The regulatory framework forces insurers to comprehensively evaluate claims and request all necessary verification within the initial 15-day window.

Jason Tenenbaum’s reference to Unitrin highlights an important jurisprudential tension. The Appellate Division’s decision in Progressive Casualty Insurance Co. v Infinite Medical Services, PLLC held that insurers could issue broader denials not limited to specific claims when verification issues affected the entire claim relationship. However, as Jason notes, the Appellate Term cannot follow Appellate Division precedent that conflicts with its prior holdings, creating divergent standards depending on which court hears the case.

Practical Implications

For insurance companies, this decision mandates front-end diligence in claims processing. Adjusters must immediately evaluate incoming medical bills to identify all potential defenses and necessary verification. Waiting to see how claims develop or requesting verification piecemeal risks rendering subsequent requests untimely. Insurance companies should implement systems ensuring that comprehensive verification requests go out well before the 15-business-day deadline, allowing for processing delays and mail time.

The decision also counsels insurers against attempting to cure untimely verification through creative interpretations of the tolling provisions. The court made clear that tolling the payment period does not extend the window for additional verification requests. Once the 15-business-day period expires, verification requests become nullities—legal non-events that cannot support claim denials or coverage defenses.

For healthcare providers, this ruling provides a powerful tool for challenging insurance company delaying tactics. Providers should carefully track when insurers receive their bills and when verification requests are sent. Any verification demand arriving more than 15 business days after bill receipt is untimely and cannot form the basis for denial. Providers can and should move for summary judgment in such cases, as Neptune Medical Care successfully did here.

The timing analysis requires careful calculation of business days rather than calendar days. Providers should maintain calendars excluding weekends and recognized holidays to accurately compute the 15-business-day period. Documentation showing when bills were mailed and received becomes critical evidence in disputes over verification timeliness.

Key Takeaway

Verification requests in New York no-fault cases must be made within 15 business days of receiving medical bills, regardless of whether insurers have tolled the payment deadline through earlier verification requests. Untimely verification requests are nullities that cannot support claim denials, and insurers who miss this deadline must pay the claims or face summary judgment.

Related Articles

• Understanding EUO Requirements in New York No-Fault Insurance Cases
• New York EUO Requirements: When Examination Under Oath Demands Are Untimely
• How to Challenge EUO No-Show Denials: When Improper Notice Can Reverse Insurance Denials in New York
• Validity of EUO, Appellate Term, 2d Dept: Take two
• New York No-Fault Insurance Law

Legal Update (February 2026): The regulatory provisions governing EUO and IME scheduling timeframes under 11 NYCRR 65-3.5 and 65-3.8 may have been subject to amendments since this 2015 analysis. Practitioners should verify current procedural requirements and timing provisions in the No-Fault Regulations, as well as review any subsequent appellate decisions that may have clarified or modified the standards for timely verification requests.