The feigned verification response does not slice it – a break from the law as certain arbitrators construe it

Historical note: St. Barnabas was a February 1, 2017 Supreme Court, Nassau County decision, not an appellate ruling. GEICO did send a June 20 follow-up after the hospital’s response. The original commentary below overlooks that letter and reverses the point about ripeness; this action was dismissed as premature.

Last reviewed: September 2026.

A hospital’s general statement that its care was necessary emergency treatment did not answer the particular verification request in St. Barnabas Hospital v GEICO. Justice Randy Sue Marber of Supreme Court, Nassau County, dismissed the action as premature on February 1, 2017. The decision turned on the requested breakdown of services and an unanswered follow-up, not a rule that every objection can be ignored.

The request asked which services fell within the emergency exception

The disputed hospital services were provided April 10–13, 2016. GEICO received the NF-5 and UB-04 on April 25 and requested additional verification on May 16. The request sought information allowing it to distinguish necessary emergency services, including treatment through stabilization, from the remaining billed services.

The hospital responded by letter dated May 20, received May 23, asserting that the services were necessary emergency treatment. The court found that response insufficient to answer the particular inquiry. GEICO then sent a June 20 follow-up, which the hospital did not answer.

The follow-up is important. The original commentary says GEICO failed to communicate after the objection. The published opinion records the June 20 letter. The updated account corrects that omission rather than building a rule on the assumption that the carrier said nothing further.

What the court decided about the objection

The court rejected the hospital’s objection on this record, denied its summary-judgment motion, and granted the insurer’s cross-motion dismissing the claim as premature.

That does not mean any unresponsive letter makes a claim ripe for litigation. It means the necessary verification remained outstanding here. The sentence in Jason’s original comment suggesting the opposite is preserved as historical commentary, with the correction made explicit above and here.

The opinion also should not be described as an appellate reversal of All Health Medical Care or a statewide ruling eliminating an insurer’s duties after every objection. This was a trial-level decision applying the verification rules to the hospital’s response and the further request in this file.

The emergency-services rule needs its statutory context

Insurance Law § 5103(b)(2) contains an exception for necessary emergency health services in a general hospital, including ambulance services and related medical screening, in the intoxication or impairment exclusion context.

The insurance regulator’s 2011 Circular Letter No. 4 explains that framework, including the relationship between emergency treatment and stabilization. It also discusses the requirement that intoxication or impairment contribute to the accident before the applicable exclusion can be invoked.

The point is not that every hospital day is automatically covered, or that all benefits automatically end at stabilization for every patient. The policy, statutory exception, evidence of the relevant condition and contribution, and nature of the services matter. The requested service breakdown was intended to address the distinction relevant to this claim.

What a responsive record would clarify

A useful verification response would identify the requested information actually being supplied and explain any item not available. In a hospital-services dispute, that may require more than restating the legal label “emergency treatment.” The reason the court found this letter insufficient should not be converted into a requirement that every provider generate documents it does not possess.

Village Medical Supply addresses why the insurer needs a good reason for its demand. Lenox Hill Radiology distinguishes actual production from a demand for reproduction payment. Those cases ask different questions: was there a reason for the demand, and did the provider actually supply the requested information?

Keep the procedural outcome distinct from coverage

A premature-action dismissal is not itself a final finding that every disputed service was excluded. The court resolved the pending-verification issue before it. The old AIG hospital decision involved different correspondence and a recalled opinion, so its untimely-denial result cannot be substituted for the analysis here.

Compare the claim dates and correspondence before relying on either hospital decision. Without them, two hospital cases can look similar while turning on different reasons for allowing or rejecting the verification defense.

Jason’s original commentary

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

The context of the within matter involves the when the insurance carrier is liable to a hospital for no-fault coverage following a patient’s “stabilization”.  What is noteworthy here is that in response to verifications, the hospital objected and GEICO failed to communicate with the hospital.  Most arbitrator’s apply a 13 year old Civil Court case, stating that an insurance carrier must respond to an objection at its own peril.  All Health Med. Care, P.C. v. Gov’t Employees Ins. Co., 2 Misc. 3d 907, 911, (Civ. Ct. Queens Co. 2004).  This case is contra.  And, it makes sense.  If the provider sends documentation that is unresponsive to the verification, then why does the insurance carrier have to play “ping pong”.  Upon objecting to a verification or providing unresponsive information. the claim is ripe for arbitration or litigation.

In this case, the Court held that objection lacked merit, did not require the insurance carrier to do anything further, and dismissed the claim.  In my mind, that is the right call.

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:

• Radiology Today: the requested MRI films were missing.
• Lenox Hill Radiology: MRI reproduction costs and the verification toll.
• Mount Sinai v Dust Transit: the NF-5 and the missing follow-up.
• Village Medical Supply: a good reason to request manufacturer invoices.
• The recalled AIG opinion and its November replacement.
• SS Medical Care: letter copies and an unopposed cross-motion.

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.