Verification non-receipt – Partial response insufficient

Sending some verification does not necessarily complete a no-fault claim. In Compas Medical v Travelers Insurance Co., the insurer proved that verification remained outstanding despite a partial response. The Appellate Term affirmed dismissal of the provider’s action. It did not reverse a trial-court award to the provider.

Legal Update (September 2026): Chapa Products v MVAIC, 245 AD3d 880 (2d Dept 2026) rejected an added 150-day deadline for a qualifying verification denial. It did not excuse incomplete proof of proper requests or eliminate written reasonable justification. See the current verification guide.

Last reviewed: September 2026. Original publication date retained.

What the October 2016 decision decided

Travelers had already won summary judgment in Queens Civil Court. Compas appealed, arguing that its partial response required Travelers to pay or deny the claims. The Appellate Term, Second Department, rejected that argument on October 5, 2016. Travelers had supported the mailing of its initial and follow-up requests and shown that it had not received the requested verification.

The opinion also rejected Compas’s challenge to the propriety of certain requests. The provider had not alleged or demonstrated that it objected during claims processing. That missing response mattered. The decision does not establish that every document an insurer requests is relevant, or that a provider loses an objection merely because it has produced other documents.

The ruling concerns the claim-processing record. It makes no finding of fraud, deliberate withholding or unnecessary treatment. The published opinion does not identify an itemized list of the missing materials. A case note should not supply those facts by inference.

Incomplete production and a reasoned objection are different

A response can be incomplete in several ways. It may omit a requested document without explanation. It may identify a document that another person holds. Or it may explain why a particular demand is disputed. The response and the carrier’s next step must be read together; the label “partial response” alone does not decide all three situations.

In Orthoplus Products, the court found that verification was still missing even accepting that some documents had been sent. Counsel had authorized the requests to be mailed to counsel. In New Horizon Surgical Center, the provider’s own exhibits referred to a separate consent form, but the papers did not show that the requested form had been furnished. Those records explain why a general assertion of compliance may fail.

Compare the Burke post-EUO dispute. That note now follows the 2022 trial ruling through later appellate decisions on document scope, reasonable justification and timing. An objection is not automatically successful, but a court cannot assess it accurately if the case summary treats it as silence.

Jason’s two examples concern the source of the records

The original commentary below distinguishes asking someone who lacks the records from asking the appropriate source. These are Jason’s practical hypotheticals, not two sets of facts adjudicated in Compas. His comments about arbitration outcomes likewise describe his perspective, not a study of AAA decisions.

For an actual claim, identify who was asked, what that person possessed, what the response said and what the carrier did afterward. An assertion that records are elsewhere needs enough information to explain the problem. Conversely, a request to the right source is not proved merely by describing it that way in an attorney’s affirmation.

A response file that can be checked

Keep the request beside the response, not in separate folders that cannot be matched. An itemized cover letter can identify each document produced and each request that remains disputed. Preserve the actual enclosures and transmission evidence. A cover letter saying “everything attached” is difficult to evaluate if the saved file contains only the letter.

Proof that the package was sent is a separate issue from proof that it was complete. Pomona Medical Diagnostic rejected insufficient mailing evidence; Compas v Praetorian found an owner’s affidavit sufficient to create a factual dispute on one cause of action. Neither decision makes missing documents irrelevant.

The current timetable does not require endless silence

The DFS regulation, §§ 65-3.5(o) and 65-3.8(b)(3), permits a denial after the qualifying 120-day period where the required verification or written reasonable justification has not been supplied and the request included the required warning. The provision concerns material within the applicant’s control or possession and excludes prescribed NF forms, medical-examination requests and EUO requests themselves.

That is different from automatically denying any partly answered request. It is also different from paying a claim simply because one document arrived. The governing hub below explains the 2026 denial-timing development without erasing the request, response and proof requirements.

A partial response is not the same as a proved portion of a claim

Insurance Law § 5106(a) separately provides for payment of the amount supported by proof when proof of the entire claim has not been supplied. That language should not disappear from a discussion of partial verification. The question is what the evidence establishes about the particular benefits sought, not simply how many pages the provider sent.

For example, a response packet may contain records answering the question about one service while leaving the question about another service unresolved. Or it may contain several pages without answering the question necessary to evaluate the same disputed service. These are illustrations, not facts stated in Compas. Counting the attachments would not distinguish them.

Identify the billed service, the verification sought for it, the response and the part said to remain unproved. An insurer asserting that the whole demand remains suspended should be able to explain that connection. A provider seeking payment of a supported portion should identify that portion and the proof supporting it. Compas rejected the partial-response argument presented there; it should not be paraphrased as eliminating the statute’s separate treatment of a proved amount.

Original commentary preserved from the archive

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.

Connect to the Encyclopedia

• Verification and the 120-day rule: current guide and case directory
• Burke: post-EUO documents and later appellate decisions
• Orthoplus: incomplete production and authorized counsel
• New Horizon: the missing informed-consent form
• Pomona: inadequate proof that a verification response was mailed
• Compas v Praetorian: an owner’s affidavit and a split result

For review of a particular claim or verification dispute, contact the firm. Please use the initial message to describe the issue without sending medical records or other sensitive documents.