Verification issues

Introduction: The Critical Intersection of Verification Timing and Tolling Rights

New York’s no-fault insurance system operates on a foundation of strict procedural requirements designed to facilitate rapid claim processing while protecting insurers from fraud. Among the most technically complex areas of no-fault litigation involves the interplay between verification requests, tolling provisions, and the 30-day payment deadline established by statute. When insurers seek additional documentation to substantiate a claim, they trigger a series of regulatory timeframes that can dramatically affect their obligation to pay or deny benefits.

The verification process is governed by 11 NYCRR 65-3.6, which establishes a careful balance between the insurer’s right to investigate claims and the provider’s expectation of prompt payment. Under this regulatory framework, insurers may request verification materials within 15 business days of receiving a claim form, and the provider must respond within 15 business days of receiving the verification request. If the response is incomplete, insurers have an additional 10 business days to issue a follow-up verification request specifying what additional materials are needed.

This seemingly straightforward procedural sequence becomes significantly more complex when examining what happens if an insurer fails to comply with the precise timing requirements for follow-up verification requests. Does a delay of even two days in issuing the follow-up request negate the tolling effect entirely, or do insurers retain some protection despite technical non-compliance? The Atlantic Radiology case examined below highlights a critical divergence in how New York’s appellate courts approach this question, with potentially significant consequences for both insurers and providers navigating the verification process.

Case Background: Atlantic Radiology v. Travelers

Atlantic Radiology Imaging, P.C. v Travelers Prop. Cas. Co. of Am., 2018 NY Slip Op 50053(U)(App. Term 1st Dept. 2018)

In this case, Atlantic Radiology Imaging sought reimbursement from Travelers for diagnostic imaging services provided to an insured patient following a motor vehicle accident. Travelers issued an initial verification request seeking additional documentation to support the claim. When the provider’s response was deemed incomplete, Travelers issued a follow-up verification request. The medical provider alleged that this follow-up request was issued two days beyond the 10-business-day period prescribed by regulation, arguing that this timing defect should vitiate the insurer’s tolling rights. Travelers moved for summary judgment dismissing the claims as premature based on the provider’s failure to fully respond to verification requests. The trial court granted the motion, and the provider appealed to the Appellate Term, First Department.

Jason Tenenbaum’s Analysis

“It being undisputed on this record that plaintiff failed to fully respond to the defendant-insurer’s verification requests, defendant established its prima facie entitlement to summary judgment dismissing the underlying first-party no-fault claims as premature (see St. Vincent Med. Care, P.C. v. Country Wide Ins. Co., 80 AD3d 599, 600 ). Even accepting plaintiff’s speculative assertion that defendant’s followup verification request was issued two days beyond the 10-day period prescribed by the regulation (see 11 NYCRR 65-3.6), this does not, under the circumstances here presented, deprive defendant of the benefit of the tolling of the 30-day period during which an insurer must pay or deny the claim (see Infinity Health Prods., Ltd. v Eveready Ins. Co., 67 AD3d 862 ; Triangle R Inc. v Praetorian Ins. Co., 30 Misc 3d 129, 2010 NY Slip Op 52294 ).”

Two points to be fleshed out here. First, all verification was not received. Problem. Second, the follow-up can be late without consequence. I sense divergence from the Second Department (AT).

Initially, a late follow-up according to the AT second department eliminated the toll. The AT First says otherwise.

Second, how do you harmonize the line of AT 2nd cases saying that the affidavit of compliance with verification is sufficient whereas this case which seems to look for record support regarding received verification?

Legal Significance: Departmental Divergence on Tolling Rights

The Atlantic Radiology decision represents a significant departure from the strict compliance approach traditionally adopted by the Appellate Term, Second Department. The First Department’s willingness to overlook a two-day delay in issuing follow-up verification requests reflects a more substance-over-form analysis that prioritizes the provider’s actual failure to fully respond over the insurer’s technical procedural misstep.

This holding has substantial implications for verification litigation throughout New York. In the Second Department’s jurisdiction, courts have historically held that an untimely follow-up verification request eliminates the tolling benefit entirely, restoring the insurer’s obligation to pay or deny within the original 30-day timeframe. The First Department’s contrary approach suggests that minor timing defects will not automatically defeat an insurer’s tolling rights if the provider has genuinely failed to supply requested verification materials.

The decision also raises important questions about evidentiary standards in verification cases. While some Second Department decisions have held that an affidavit of compliance with verification procedures is sufficient to establish the insurer’s prima facie case, Atlantic Radiology appears to require actual record support demonstrating what verification materials were received and what remained outstanding. This heightened evidentiary requirement could make it more difficult for insurers to prevail on summary judgment in verification-based prematurity cases, as they must now produce documentary evidence of incomplete responses rather than relying solely on testimonial affidavits.

Practical Implications for Insurers and Providers

For insurance carriers operating in the First Department’s jurisdiction, Atlantic Radiology offers some relief from the rigid timing requirements that have complicated verification practice. However, insurers should not interpret this decision as license for sloppy compliance with regulatory deadlines. The court’s decision turned on the provider’s undisputed failure to fully respond to verification requests, not on any general relaxation of timing requirements. Prudent carriers will continue to prioritize strict compliance with the 10-business-day follow-up deadline while recognizing that minor delays may not prove fatal if the provider’s non-compliance is well-documented.

Medical providers facing verification-based prematurity claims must carefully analyze whether they have fully responded to all verification requests. Even in jurisdictions that take a more lenient view of insurers’ timing compliance, a provider’s failure to supply requested materials remains a complete bar to recovery. Providers should also consider whether the insurer has produced sufficient record evidence of incomplete verification responses, as Atlantic Radiology suggests that testimonial affidavits alone may not satisfy the insurer’s prima facie burden in the First Department.

Related Articles

• Understanding verification requests and mailing requirements
• The 120-day verification rule and timeline requirements
• When technical verification requirements override common sense
• The first case interpreting Infinity v. Eveready
• New York No-Fault Insurance Law

Legal Update (February 2026): Since this 2018 post, the verification request procedures under 11 NYCRR 65-3.6 may have been subject to regulatory amendments or interpretive guidance that could affect timing requirements and tolling provisions. The divergent approaches between judicial departments regarding late follow-up verification requests noted in this analysis may have been clarified through subsequent case law or regulatory updates. Practitioners should verify current provisions of 11 NYCRR 65-3.6 and recent appellate decisions when advising on verification compliance issues.