Key Takeaway
Allstate's unsuccessful appeal in Longevity Med. Supply highlights the importance of properly responding to no-fault verification demands and the futility of meritless appeals.
Understanding No-Fault Verification Requirements: When Appeals Miss the Mark
No-fault insurance disputes often center on verification procedures — the process by which insurers can request additional documentation to support medical claims. When medical providers respond appropriately to these verification demands, insurers must either pay the claim, deny it, or seek additional verification within regulatory timeframes. Failure to follow these procedures can result in unfavorable arbitration decisions.
The Allstate v. Longevity Medical Supply case demonstrates what happens when an insurer challenges a well-supported arbitration award without substantial legal grounds. This case involves the fundamental principles of no-fault verification procedures and highlights the consequences of pursuing appeals that lack merit.
Jason Tenenbaum’s Analysis:
Allstate Ins. Co. v Longevity Med. Supply, Inc., 2018 NY Slip Op 50238(U)(App. Term 1st Dept. 2018)
“There was a rational basis, based on the no-fault regulations, for the master arbitrator’s finding that respondent-medical provider’s proof was sufficient to establish that (1) it responded to the verification demands sent by petitioner, and (2) that petitioner was therefore required, but failed, to rebut the presumption of receipt of the verification, or show that it timely acted upon receipt by paying or denying the claim, or seeking further verification. The master arbitrator’s legal analysis of the arbitrator’s determination was well within the scope of her authority to review and correct an error of law made by the arbitrator”
I do not what the purpose of this appeal was except to maximize on hourly billing. Perhaps i am missing something and need enlightenment.
Key Takeaway
This case reinforces that insurers cannot simply ignore proper responses to verification demands. When medical providers adequately respond to verification requests, the burden shifts to the insurer to act promptly — either by paying, denying, or seeking additional verification. Appeals without substantial legal merit, like those seen in non-compulsory arbitration cases, often serve no practical purpose other than delaying resolution.
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