Key Takeaway
Judge Ciaffa's verification requirements affirmed: NY court rules insurers must send verification requests to claimants, not attorneys, under no-fault regulations.
This article is part of our ongoing additional verification coverage, with 92 published articles analyzing additional verification issues across New York State. Attorney Jason Tenenbaum brings 24+ years of hands-on experience to this analysis, drawing from his work on more than 1,000 appeals, over 100,000 no-fault cases, and recovery of over $100 million for clients throughout Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx. For personalized legal advice about how these principles apply to your specific situation, contact our Long Island office at (516) 750-0595 for a free consultation.
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).
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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.
Legal Context
Why This Matters for Your Case
New York law is among the most complex and nuanced in the country, with distinct procedural rules, substantive doctrines, and court systems that differ significantly from other jurisdictions. The Civil Practice Law and Rules (CPLR) governs every stage of civil litigation, from service of process through trial and appeal. The Appellate Division, Appellate Term, and Court of Appeals create a rich and ever-evolving body of case law that practitioners must follow.
Attorney Jason Tenenbaum has practiced across these areas for over 24 years, writing more than 1,000 appellate briefs and publishing over 2,353 legal articles that attorneys and clients rely on for guidance. The analysis in this article reflects real courtroom experience — from motion practice in Civil Court and Supreme Court to oral arguments before the Appellate Division — and a deep understanding of how New York courts actually apply the law in practice.
About This Topic
Additional Verification in No-Fault Claims
Under New York's no-fault regulations, insurers may request additional verification of a claim within specified time limits. The timeliness, scope, and reasonableness of verification requests — and the consequences of a claimant's failure to respond — are among the most litigated issues in no-fault practice. These articles examine the regulatory framework for verification requests, court decisions on compliance, and the interplay between verification delays and claim determination deadlines.
92 published articles in Additional Verification
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More Additional Verification Analysis
No Denial Required When Provider Fails to Respond to Verification Within 120 Days
Chapa v MVAIC rejected a 150-day denial deadline, not the need to prove a verification defense. Read the 2026 decision and the historical case directory.
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120-day rule and Fee Schedule
New York court ruling demonstrates how healthcare providers can lose no-fault claims due to verification failures and fee schedule violations in insurance disputes.
Feb 1, 2020
Additional verification not received – MRI films from an MRI facility
Radiology Today v NYCM: missing MRI films, proof of mailed verification requests, and dismissal as premature rather than a ruling on medical necessity.
Jan 11, 2012
Appellate Division to Rule on Timeliness of Follow-Up Additional Verification Requests
The Infinity v Eveready appeal was decided in November 2009. Read the outcome, the early follow-up timeline and the limits of its equitable holding.
Aug 19, 2009
Trial de-novo win where carrier did not respond to verification objection letter and wins.
The 2017 Lewin verification dispute: missing MRI films, third-party requests, the unopposed cross-motion, and the limits of a provider's objection letter.
Jul 17, 2017
Non receipt and verification
Longevity v Praetorian separates nonreceipt of a bill from nonreceipt of verification: one claim won summary judgment and the other remained disputed.
Apr 7, 2015Was this article helpful?
Disclaimer: This article is published by the Law Office of Jason Tenenbaum, P.C. for informational and educational purposes only. It does not constitute legal advice, and no attorney-client relationship is formed by reading this content. The legal principles discussed may not apply to your specific situation, and the law may have changed since this article was last updated.
New York law varies by jurisdiction — court decisions in one Appellate Division department may not be followed in another, and local court rules in Nassau County Supreme Court differ from those in Suffolk County Supreme Court, Kings County Civil Court, or Queens County Supreme Court. The Appellate Division, Second Department (which covers Long Island, Brooklyn, Queens, and Staten Island) and the Appellate Term (which hears appeals from lower courts) each have distinct procedural requirements and precedents that affect litigation strategy.
If you need legal help with a additional verification matter, contact our office at (516) 750-0595 for a free consultation. We serve clients throughout Long Island (Huntington, Babylon, Islip, Brookhaven, Smithtown, Riverhead, Southampton, East Hampton), Nassau County (Hempstead, Garden City, Mineola, Great Neck, Manhasset, Freeport, Long Beach, Rockville Centre, Valley Stream, Westbury, Hicksville, Massapequa), Suffolk County (Hauppauge, Deer Park, Bay Shore, Central Islip, Patchogue, Brentwood), Queens, Brooklyn, Manhattan, the Bronx, Staten Island, and Westchester County. Prior results do not guarantee a similar outcome.
