Key Takeaway
TAM Med. Supply Corp. case introduces new questions about timing requirements for 120-day denials in New York no-fault insurance disputes.
Understanding the 120-Day Rule in No-Fault Insurance Claims
New York’s no-fault insurance system includes specific timeframes that both providers and insurers must follow when processing claims. One critical aspect involves the 120-day rule for additional verification requests, which allows insurers to deny claims when healthcare providers fail to submit requested documentation within 120 days.
The TAM Med. Supply Corp. case represents the first judicial examination of an important but previously unexplored question: what constitutes a “timely” 120-day denial? While the regulation (11 NYCRR 65-3.5) establishes the 120-day timeframe for provider responses, it doesn’t explicitly address when insurers must issue their denials based on this rule.
This case highlights the ongoing complexity in New York no-fault insurance law, where seemingly straightforward regulations can reveal gaps that require judicial interpretation.
Jason Tenenbaum’s Analysis:
TAM Med. Supply Corp. v Tri State Consumers Ins. Co., 2017 NY Slip Op 51247(U)(App. Term 2d Dept. 2017)
“In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court which granted defendant’s motion for summary judgment dismissing the complaint on the ground that defendant had timely and properly denied the claim at issue based upon plaintiff’s failure to provide requested verification within 120 days of the initial verification request (see 11 NYCRR 65-3.5 ). ”
The case was followed the usual rubric where the Court found a non-specific affidavit sufficient to raise an issue of fact. What is more interesting, however, is the Court held that the a 120-day denial had to be timely issued. This begs the question: When is a 120-day denial “timely” denied? Good question.
Key Takeaway
This case establishes that 120-day denials must be “timely” issued by insurers, but leaves the critical question unanswered: what constitutes timely? This gap in the regulation creates potential procedural challenges for both insurers and providers in verification non-receipt disputes.
Legal Update (February 2026): Since this 2017 analysis of 11 NYCRR 65-3.5 and the 120-day rule for additional verification requests, New York’s no-fault regulations have undergone multiple amendments and procedural updates. The regulatory framework governing timing requirements for insurer denials and provider documentation submissions may have been modified through subsequent regulatory changes or judicial decisions. Practitioners should verify current provisions of 11 NYCRR 65-3 and review recent case law interpreting timing requirements for no-fault claim denials.
