First sighting of 120-day rule

TAM Medical Supply denied the insurer summary judgment because the provider’s mailing evidence raised a factual issue about receipt of verification. It did not award the provider payment or announce a new universal deadline for a 120-day denial.

Legal Update (September 2026): The timing question in this 2017 commentary now has a later reference: Chapa Products v MVAIC, 245 AD3d 880 (2026), rejected an added 150-day denial cutoff. The verification hub explains that holding and its limits; TAM itself decided a disputed-response motion.

Last reviewed: September 2026.

What happened in TAM Medical Supply

TAM Medical Supply Corp. v Tri State Consumers Insurance Co., 57 Misc 3d 133(A), decided September 22, 2017, involved a provider’s assigned no-fault claims. The Civil Court granted the insurer summary judgment on a 120-day verification-noncompliance defense.

The Appellate Term reversed and denied the motion. The insurer made its initial showing that the requested verification had not been received. The provider then supplied an affidavit describing a mailing practice adequate to raise a presumption of receipt. That left a triable issue.

The provider therefore defeated the insurer’s request for judgment. It did not establish an unconditional right to payment. The case remained disputed.

The opening description is not a new holding

The opinion’s introductory reference to a timely and proper denial describes the basis on which the lower court granted the insurer’s motion. The appellate analysis resolved the motion through the competing evidence about receipt.

Jason’s original paragraph below asks when a 120-day denial must be issued. That was an observation about the language appearing in this early case, not proof that TAM prescribed a new calculation. The historical title records the author’s first sighting; it is not a verified claim that this was the first decision anywhere to apply the regulation.

Keeping that distinction avoids treating a procedural recital as a holding on a question the court did not separately decide.

What the 120-day provisions actually require

Sections 65-3.5(o) and 65-3.8(b)(3) address qualifying document-verification requests. They provide a 120-calendar-day response period for verification within the applicant’s possession or control, or written proof giving reasonable justification for noncompliance. The request must advise the applicant of those alternatives and the possible denial.

The provisions exclude prescribed NF forms, medical examinations and EUOs. For medical-service claims they apply to treatment or services on or after April 1, 2013. A current file needs those applicability questions answered before the days are counted.

A dispute about whether the response arrived can affect the premise that the applicant failed to comply. That is why TAM’s mailing evidence mattered even though the parties were litigating a deadline-based defense.

The later answer in Chapa

In January 2026, the Second Department’s Chapa decision reversed the Appellate Term’s added deadline requiring denial within 150 days of the initial verification request. The regulation did not specify that outer denial period.

The decision concerned a denial that had been issued. It did not abolish all insurer deadlines or hold that every claim can be rejected without a denial. Nor did it decide the factual question of receipt in TAM.

For a modern citation, use Chapa for the rejected 150-day cutoff and TAM for the motion evidence about a response. Each authority does useful work without having to be stretched into a rule about every verification dispute.

Evidence still determines whether the defense fits

The New Way appeal similarly found a factual issue when the provider’s mailing proof opposed an insurer’s nonreceipt showing. Neither decision endorses a nonspecific affidavit simply because someone calls it a compliance affidavit.

The witness’s source of knowledge matters. So do the response’s contents and the connection between a mailing practice and the documents allegedly sent. If the response contained only some requested material, receipt would not necessarily resolve completeness; compare New Horizon Surgical.

An objection requires another comparison. In Elite Medical Supply, the master-arbitration issue arose from a timely response explaining why pricing information was withheld. That response was not silence, but the opinion also did not validate every asserted objection.

Read the appellate order before deciding who won

TAM reversed the insurer’s summary-judgment award. That left the insurer unable to end the disputed claims on those papers. It did not amount to a finding that the provider’s account of mailing was true after a trial.

The difference affects what evidence remains worth examining. A presumption sufficient to raise a factual issue can be challenged through testimony and other admissible proof in later proceedings. The short opinion does not tell a future reader how that dispute was ultimately resolved.

The Right Aid trial illustrates the distinction: there, a factfinder had heard and credited the insurer’s evidence of nonreceipt. TAM’s motion-stage result cannot be treated as a contrary finding about the same record; the records and procedural stages were different.

Assemble the chronology that the argument needs

A useful file review begins with the initial request and its warning, the follow-up, the response with attachments, evidence of transmission or receipt, and any denial. Place the treatment dates and the applicable regulatory version alongside those events.

Then identify the actual dispute: a response never sent, one allegedly lost, an incomplete production, or a written justification. A single “120-day” label can conceal all four.

Use TAM to examine the evidence of receipt. Use Chapa to address the later 150-day denial-cutoff argument. A current dispute may require both questions to be answered.

Jason’s original commentary

The contemporaneous comments below are preserved as historical commentary, with the case-specific and current-law qualifications explained above.

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.

Connect to the Encyclopedia

Start with the no-fault verification hub and 2026 Chapa update for the governing framework and case directory. Related case notes:

• New Way: disputed receipt and a split motion result.
• Triangle R: an unanswered request and a five-day-late follow-up.
• Elite Medical: a timely pricing objection in master arbitration.
• New Horizon: partial production and premature dismissal.
• Utica Acupuncture: a missing mail-search result and medical necessity.
• NF-3 and Right Aid: the official provider form and receipt evidence.

For review of a particular no-fault verification dispute, request a Free Case Review. Keep the requests, responses and relevant claim dates available for that review.