Key Takeaway
Court rules partial response to verification requests insufficient, requiring complete verification before claim payment or denial under NY no-fault law.
Compas Med., P.C. v Travelers Ins. Co., 2016 NY Slip Op 51441(U)(App. Term 2d Dept. 2016)
“Contrary to plaintiff’s contention, defendant was not required to pay or deny plaintiff’s claims upon receipt of a “partial response” to defendant’s verification requests (see 11 NYCRR 65-3.8 ; ; New York & Presbyt. Hosp. v Progressive Cas. Ins. Co., 5 AD3d 568, 570 [“A claim need not be paid or denied until all demanded verification is provided”]). To the extent that plaintiff asserts that certain of defendant’s requests were inappropriate, that argument also lacks merit, as plaintiff did not allege, much less demonstrate, that it objected to such requests during claims processing (see Rogy Med., P.C. v Clarendon Natl. Ins. Co., 43 Misc 3d 133, 2014 NY Slip Op 50629, *2 [“inaction is an improper response to a verification request, and therefore plaintiff’s objections regarding the requests will not now be heard”]).”
Consider two examples where this plays out. Example one: Plaintiff says: I do not have these records search somewhere else and the defendant failed to search. This would be a loser to the carrier.
Example two: The carrier sought verification directly from the correct parties and following this Plaintiff says: “I do not have these records search somewhere else and the defendant failed to search.” This would be at best a partial response or a non response since the carrier has done everything it is supposed to do.
I raise these two issues because they play out often. AAA gets example #1 correct. AAA often gets example #2 incorrect.
Related Articles
- Understanding Verification Requests in New York No-Fault Insurance Claims
- The 120-day rule
- The Verification Process in No-Fault Insurance: When Technical Requirements Override Common Sense
- Procedural Fairness in No-Fault Insurance Litigation: Is It Fair?
- New York No-Fault Insurance Law
Legal Update (February 2026): The no-fault verification requirements under 11 NYCRR 65-3 have undergone several amendments since 2016, including updates to verification request procedures and response timeframes. Additionally, subsequent appellate decisions may have refined the standards for what constitutes adequate partial responses and appropriate verification objections. Practitioners should verify current regulatory provisions and recent case law developments when advising on verification compliance strategies.
