Key Takeaway
New York no-fault case shows partial response to verification requests is insufficient - providers must fully comply or risk premature dismissal of benefits claims.
Understanding verification requirements in New York no-fault insurance cases is crucial for medical providers seeking reimbursement. When insurance carriers request additional verification to support claims, healthcare providers must respond completely and thoroughly. The recent Appellate Term decision in Doctor Goldshteyn Chiropractic, P.C. v Travelers demonstrates how a partial response can doom an otherwise valid claim.
This case highlights a persistent challenge in New York No-Fault Insurance Law - the “partial response paradigm” that courts have consistently found problematic for medical providers. The decision reinforces established precedent regarding verification compliance and provides important guidance for practitioners navigating these complex procedural requirements.
The ruling builds on earlier decisions addressing similar verification non-receipt issues and underscores the importance of complete documentation when responding to carrier requests.
Jason Tenenbaum’s Analysis:
Doctor Goldshteyn Chiropractic, P.C. v Travelers Indem. Co., 2017 NY Slip Op 51816(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.
Contrary to plaintiff’s contention, the record demonstrates that defendant did not receive requested verification and, thus, that the action is premature (see Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492 ). Indeed, on appeal, plaintiff notes that it had partially responded to defendant’s verification request”
Again, the “partial response paradigm” appears to be fatal to the medical provider. I suppose the correct record has to be established to see if an objection to verification will destroy an insurance carrier’s summary judgment motion?
Key Takeaway
The Goldshteyn decision reinforces that partial compliance with verification requests is legally insufficient in New York no-fault cases. Medical providers must fully satisfy all verification requirements before pursuing litigation, as incomplete responses will result in premature dismissal. This ruling emphasizes the critical importance of thorough documentation and complete response protocols when dealing with insurance carrier verification demands.
