Key Takeaway
New York court clarifies that generic delay letters don't toll statutory payment deadlines—only specific verification requests can extend an insurer's time to pay or deny claims.
No-fault insurance cases often hinge on timing requirements and the specific language insurers use when communicating with healthcare providers. Under New York’s no-fault law, insurance companies have strict deadlines to pay or deny claims, but they can extend these deadlines by requesting additional verification from providers.
The critical distinction lies in what constitutes a proper verification request versus a mere delay notice. Generic letters that simply inform providers about payment delays carry no legal weight, while specific requests for additional documentation can effectively toll the statutory time periods. This difference can determine whether an insurer loses its right to raise defenses against a claim.
Jason Tenenbaum’s Analysis:
New Way Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co., 2015 NY Slip Op 51706(U)(App. Term 2d Dept. 2015)
“A review of defendant’s letters reveals that they merely notified plaintiff that defendant was delaying payment, but they did not request any specific verification. As a result, these delay letters did not toll the statutory time period within which defendant was required to pay or deny the claims at issue (see Points of Health Acupuncture, P.C. v Lancer Ins. Co., 28 Misc 3d 133, 2010 NY Slip Op 51338 ). Since defendant did not establish that it had otherwise tolled its time to pay or deny the claims, defendant failed to establish, as a matter of law, that it is not precluded from raising its proffered defense that the fees sought exceeded the amount permitted by the workers’ compensation fee schedule (see Presbyterian Hosp. in City of NY v Maryland Cas. Co., 90 NY2d 274, 282 ).”
This tests the classic delay letter v. verification letter distinction.
Key Takeaway
Insurance companies cannot extend their payment deadlines with vague delay notifications. Only letters that specifically request additional verification or documentation can toll the statutory time periods. When insurers fail to make proper verification requests, they may lose their right to challenge claims on substantive grounds, including fee schedule compliance issues or verification non-receipt defenses.
Legal Update (February 2026): Since this post’s publication in 2015, New York’s no-fault insurance regulations and fee schedules have undergone multiple revisions, including updates to verification request procedures and statutory timeframes. The specific regulatory provisions governing delay letters versus verification requests may have been modified through subsequent regulatory amendments or court decisions. Practitioners should verify current provisions under 11 NYCRR Part 65 and recent case law developments when advising on verification request compliance and tolling requirements.
