Key Takeaway
Multiple 2016 New York appellate cases highlight ongoing disputes over insurance companies' claims of receiving additional verification requests in no-fault insurance disputes.
Pattern of Verification Receipt Disputes in No-Fault Insurance Cases
The New York no-fault insurance system requires insurance companies to pay legitimate medical claims promptly, but they can request additional verification when claims appear questionable. However, a troubling pattern has emerged in recent appellate cases where insurance carriers consistently claim to have received verification requests that healthcare providers insist they never sent.
This issue represents a significant challenge in New York No-Fault Insurance Law, where the burden of proof regarding verification receipt can determine whether a claim gets paid or denied. The stakes are particularly high given the 120-day rule and fee schedule requirements that govern these transactions.
Jason Tenenbaum’s Analysis:
TAM Med. Supply Corp. v National Liab. & Fire Ins. Co., 2016 NY Slip Op 51532(U)(App. Term 2d Dept. 2016)
TAM Med. Supply Corp. v National Liab. & Fire Ins. Co.. , 2016 NY Slip Op 51533(U)(App. Term 2d Dept. 2016)
Renelique v American Tr. Ins. Co., 2016 NY Slip Op 51495(U)(App. Term 2d Dept. 2016)
Mollo Chiropractic, PLLC v Farmington Cas. Co., 2016 NY Slip Op 51496(U)(App. Term 2d Dept. 2016)
TAM Med. Supply Corp. v American Tr. Ins. Co., 2016 NY Slip Op 51505(U)(App. Term 2d Dept. 2016)
TAM Med. Supply Corp. v National Liab. & Fire Ins. Co., 2016 NY Slip Op 51506(U)(App. Term 2d Dept. 2016)
TAM Med. Supply Corp. v American Tr. Ins. Co., 2016 NY Slip Op 51507(U)(App. Term 2d Dept. 2016)
TAM Med. Supply Corp. v American Tr. Ins. Co., 2016 NY Slip Op 51513(U)(App. Term 2d Dept. 2016)
LMS Acupuncture, P.C. v Nationwide Ins., 2016 NY Slip Op 51537(U)(App. Term 2d Dept. 2016)
(and 3 others)
What are the odds off all these insurance carriers stating verification was received and that not being the case? Just wondering.
Key Takeaway
The frequency of these verification receipt disputes raises important questions about documentation and communication protocols in no-fault insurance claims processing. Healthcare providers should maintain detailed records of all correspondence and consider implementing tracking systems to address these additional verification non-receipt challenges effectively.
Legal Update (February 2026): Since this post’s 2016 publication, New York’s no-fault fee schedules have been subject to multiple regulatory updates and amendments. Additionally, procedural requirements for verification requests and receipt documentation may have been modified through regulatory changes or updated Department of Financial Services guidelines. Practitioners should verify current fee schedule provisions and verification procedures when handling these disputes.
