Key Takeaway
Judge Ciaffa's verification requirements affirmed: NY court rules insurers must send verification requests to claimants, not attorneys, under no-fault regulations.
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, 2012 NY Slip Op 52195 ; Doshi Diagnostic Imaging Servs. v State Farm Ins. Co., 16 Misc 3d 42, 44 ).
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 ; 65-3.6 ) 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.
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): Since this 2017 decision, the verification procedures under 11 NYCRR 65-3.5 and 65-3.6 may have been subject to regulatory amendments or clarifications regarding notice requirements and attorney representation protocols. The specific requirements for delay letters and verification request routing procedures discussed in this case should be verified against current regulatory provisions, as no-fault regulations have undergone periodic updates since 2017.
