Non responded to verification fatal to plaintiff’s case

In New York’s no-fault insurance system, healthcare providers must comply with stringent verification requirements when seeking reimbursement from insurance carriers. These verification requests can include medical records, billing documentation, and other supporting materials that insurers use to evaluate claims. The failure to provide complete responses can have serious consequences for a provider’s ability to recover payment.

A recent Appellate Term decision highlights just how critical it is for healthcare providers to fully comply with these verification demands. The case demonstrates that even when some verification materials are provided, partial compliance may not be sufficient to move forward with litigation.

Jason Tenenbaum’s Analysis:

City Care Acupuncture, P.C. v Allstate Prop. & Cas. Ins. Co., 2017 NY Slip Op 51839(U)(App. Term 2d Dept. 2017)

“In support of plaintiffs’ motion for summary judgment and in opposition to defendant’s cross motion, plaintiffs submitted affirmations from plaintiffs’ counsel and annexed purported verification responses which expressly stated that plaintiffs were not providing responses to some of defendant’s verification requests. As a result, contrary to plaintiffs’ contention, the record demonstrates that defendant had not received all of the requested verification and, thus, that the action is premature”

This is interesting because we are left to reason that certain verification was objected to and certain verification was provided. The Court held that the failure to provide the requested verification (or to indicate where the verification could be obtained) renders the action premature. This Court has often stated that the failure to fully comply with verification renders the matter premature.

Key Takeaway

Healthcare providers cannot pursue litigation against no-fault insurers if they have only partially responded to verification requests. Even when some materials are provided, explicitly stating that certain verification will not be supplied renders the action premature. Complete compliance with all verification demands is essential before litigation can proceed, as courts consistently hold that partial responses are insufficient to establish a valid claim for summary judgment.