Key Takeaway
Court rules that no-fault insurer's 30-day payment period doesn't start until they actually receive requested verification documents, even if provider claims they were sent.
The burden of proof in no-fault insurance verification disputes can determine whether an insurance company must pay a claim or can legitimately deny it. Under New York No-Fault Insurance Law, insurers have 30 days to pay or deny claims, but this timeline only begins when they receive all requested verification materials. A recent Appellate Term decision highlights the critical importance of proving actual receipt of verification documents, particularly when verification non-receipt issues arise between medical providers and insurance companies.
The case involves a medical equipment distributor seeking payment for supplies provided under no-fault coverage. The insurance company requested verification in the form of an affidavit confirming receipt of supplies from the eligible injured person (EIP). When the provider sued for non-payment, both parties sought summary judgment, but the central question became whether the insurer had actually received the requested verification materials.
Jason Tenenbaum’s Analysis:
Daily Med. Equip. Distrib. Ctr., Inc. v Interboro Ins. Co., 2017 NY Slip Op 50958(U)(App. Term 2d Dept. 2017)
“In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint on the ground that the action was premature because defendant had timely and properly requested verification and the verification had not been provided to defendant. Insofar as is relevant to this appeal, the Civil Court denied defendant’s cross motion and found that the only remaining issue for trial was whether defendant had received the verification it had requested.
As defendant demonstrated that it had not received the requested verification, and plaintiff did not show that the verification had been provided to defendant prior to the commencement of the action, the 30-day period within which defendant was required to pay or deny the claims did not begin to run (see 11 NYCRR 65-3.5 ; 65-3.8 )”
The verification to be received was an affidavit of receipt of supplies from the EIP. I am curious if the outcome would have changed had a delivery receipt -should it have existed – was annexed to the answering papers,
Key Takeaway
Actual receipt, not just mailing, triggers the 30-day payment clock. Insurance companies can successfully defend against premature lawsuits by demonstrating they never received requested verification materials. Medical providers must prove delivery, not merely that documents were sent, to start the insurer’s payment timeline under the 120-day rule and fee schedule requirements.
Legal Update (February 2026): Since this post’s publication in 2017, New York’s no-fault verification procedures under 11 NYCRR 65-3 may have been subject to regulatory amendments, particularly regarding timeframes for verification requests, electronic submission protocols, and burden of proof standards for receipt confirmation. Additionally, fee schedules referenced in verification disputes have likely been updated through subsequent regulatory revisions. Practitioners should verify current provisions of sections 65-3.5 and 65-3.8 and consult the most recent fee schedule publications when handling verification non-receipt cases.
