Verification lack of response affirmed/Judge Ciaffa’s opinion prevails

Advantage Radiology, P.C. v Nationwide Mut. Ins. Co.. 2017 NY Slip Op 27061 (App. Term 2d Dept. 2017)

“Plaintiff’s contention that, pursuant to 11 NYCRR 65-3.6 (b), upon sending the follow-up verification request to plaintiff, defendant was required to send plaintiff’s attorney a delay letter lacks merit, as there is no such requirement, where, as here, the party from whom the verification is sought is the plaintiff, rather than another person or entity (see GNK Med. Supply, Inc. v Tri-State Consumer Ins. Co., 37 Misc 3d 138[A], 2012 NY Slip Op 52195[U] [App Term, 1st Dept 2012]; Doshi Diagnostic Imaging Servs. v State Farm Ins. Co., 16 Misc 3d 42, 44 [App Term, 2d Dept, 2d & 11th Jud Dists 2007]).

To the extent plaintiff contends that, in accordance with the letter received from plaintiff’s counsel, defendant was obligated to send the initial and follow-up verification requests to plaintiff’s counsel, we disagree. Insurers are obligated to comply with the no-fault regulations, which require that both the initial and follow-up verification requests be sent to the party from whom the verification is sought (see 11 NYCRR 65-3.5 [b]; 65-3.6 [b]) and, thus, defendant cannot be penalized for sending the verification requests to plaintiff notwithstanding the request from plaintiff’s counsel”

The opinion here follows the opinion of Former Judge Ciaffa in  Advanced Neurological Care, P.C. v. State Farm Mut. Auto. Ins. Co., 38 Misc. 3d 750, 754-55 (Dist. Ct. Nassau 2012).

The rub for the providers is that when their collection attorney/biller sends a letter of rep, the failure to mail the verification letters to the attorney is not necessary.  Of course, this could also mean that IME and EUO letters (verification requests)  do not need to be sent to counsel for the EIP/provider to be deemed valid.  The above-notwithstanding, the better practice is to mail the letters to the EIP/provider and any counsel representing them.