The verification affidavits again

An owner’s affidavit can raise a factual issue about whether a provider sent requested verification. That is what happened in Great Health Care Chiropractic v Hereford Insurance Co., decided June 6, 2016. But the opinion does not say that any owner’s bare assertion is enough. It found the particular affidavit sufficient to support a presumption of mailing and receipt.

Historical note: Great Health Care found this owner’s affidavit sufficient to raise a receipt issue but did not publish its full text or eliminate a factual foundation. Compare the inadequate qualified affidavit in Burke (2022) and the trial-stage burden in Island Life (2019).

Last reviewed: September 2026.

The signer’s knowledge and the affidavit’s contents matter. Ownership of the practice does not establish either, and opposing affidavits do not automatically require a trial.

How the motion reached the appellate court

The provider sought assigned no-fault benefits and moved for summary judgment. Hereford cross-moved for dismissal, arguing that verification remained outstanding and the action was premature.

Civil Court denied the provider’s motion and granted the insurer’s cross-motion. The provider appealed. The Appellate Term modified the order by denying the insurer’s cross-motion while leaving the denial of the provider’s own motion in place.

Neither party received summary judgment after the appeal. The surviving issue was whether the action was premature because requested verification had not been supplied.

The insurer’s showing came first

Hereford established timely mailing of its initial and follow-up verification requests. It also made a sufficient initial showing that it had not received the requested material.

Those were two separate parts of the defense. Showing that requests were mailed does not, by itself, establish that no answer arrived. Conversely, proof that a response could not be found does not itself establish that the insurer properly requested it.

The court accepted both parts of Hereford’s initial motion showing. It then turned to the provider’s opposition. That sequence should not be shortened into a statement that an insurer’s denial of receipt always loses to a provider’s mailing claim.

What the owner’s affidavit accomplished

The owner’s affidavit was sufficient to give rise to a presumption that the requested verification had been mailed to and received by the insurer. That created a triable factual issue and prevented dismissal on the insurer’s cross-motion.

The opinion does not reproduce the full affidavit. It does not state that the owner merely uttered “we mailed it,” that no explanation of the office’s procedure was supplied, or that supporting records were unnecessary. Any template drawn from those supposed details would rest on facts the published decision does not give.

The result also did not establish actual receipt conclusively. The provider had enough evidence to dispute the insurer’s position, not an adjudication that its version of events was true. The distinction is between requiring a trial and deciding that trial.

Compare the cases by what the evidence addressed

In E4 Services, the provider denied receiving the insurer’s requests without sufficiently rebutting the mailing proof. That case concerned the inbound request. Great Health Care concerned evidence that a response had been sent back.

In Burke Physical Therapy, an owner’s assertion was qualified by whether the requested response was proper and the materials possessed. The court found it insufficient to establish production or a reasonable justification. Its result shows why the content of the assertion matters more than whether the signer owns the practice.

In Excel Surgery, the facility actually wrote to the insurer, but the response failed to address particular requested items. Proving transmission would not cure that separate problem with the response’s contents.

These decisions answer related but different questions: Was the request sent? Was it received? Was a response sent? What did the response contain? Which items remained outstanding? A useful affidavit should address the question genuinely disputed in that file.

Build a foundation the witness can support

A witness with personal knowledge of a mailing should identify the event the witness actually observed. A witness relying on a regular office practice should explain that practice and the basis for knowing it. A witness relying on records should identify the records and how they connect to the claim. Those are evidentiary distinctions, not interchangeable ways of restating a conclusion.

The response itself matters. Keep the cover letter and the documents transmitted with the mailing or electronic record. A date on a response can show when it was prepared without establishing when it was sent; a delivery record can show an arrival without proving the contents. Neither gap should be filled with speculation.

If documents went through a billing company, clarify which entity created, stored and transmitted them. Do not attribute every step to the practice owner merely because the claim belongs to the practice. Evidence should describe the actual process rather than an idealized office procedure.

These are practical preparation points. The appellate opinion does not prescribe a mandatory form of affidavit or a required delivery service. Nor does it authorize an insurer to impose certified mail as a universal condition of a sufficient verification response.

What happens when the issue reaches trial

Island Life Chiropractic v Travelers addresses a limited trial after a motion order established timely mailing of requests but left receipt unresolved. The insurer still had to present its nonreceipt evidence first. The order did not shift that initial burden to the provider merely because the provider had raised the factual issue.

That trial-stage decision is the next step in the library’s account. Great Health Care explains why the insurer’s motion failed; Island Life explains why a surviving factual question still needs proof under the correct burden. Neither guarantees the provider a final recovery.

The current verification guide supplies the broader claim-handling timetable. This historical note supplies the narrower evidentiary lesson: examine the affidavit’s foundation and the issue it addresses, rather than treating an owner’s signature as the rule.

Jason’s original commentary

The original comments below are retained as historical commentary. The case-specific corrections and later developments are explained above.

No further comment.

Connect to the Encyclopedia

Start with the no-fault verification hub and 2026 Chapa update for the governing framework and case directory. Related case notes:

• E4 Services: denying receipt of the insurer’s requests.
• NYU Hospital-Tisch: final response dates and timely denial.
• Burke Physical Therapy: a qualified response affidavit.
• Island Life: proof at a limited verification trial.
• Excel Surgery: answering the specific requested items.
• Mount Sinai: the NF-5 after a defective UB-04.
• Lida’s Medical Supply: preserving a subsection (p) argument.

For review of a particular no-fault verification dispute, request a Free Case Review. Keep the requests, responses and relevant claim dates available for that review.