120-day rule crumbles

The 120-day verification rule did not disappear in Elite Medical Supply. The Fourth Department upheld a master arbitrator’s authority to correct the legal treatment of a timely objection to pricing requests. The case is about how that objection was handled, not a right to ignore verification.

Historical note: Progressive v Elite Medical Supply, 162 AD3d 1471 (2018), concerned master-arbitration review. The headline and original reaction record Jason’s view at the time. For the response provision and the separate 2026 denial-timing decision, use the current verification hub.

Last reviewed: September 2026.

What Elite challenged

In Matter of Progressive Casualty Insurance Co. (Elite Medical Supply of N.Y., LLC), decided June 8, 2018, a supplier disputed requests concerning the cost and pricing of durable medical equipment kits. It responded with objections, including an assertion that requested information was proprietary.

Arbitrators denied the claims in 14 awards. A master arbitrator vacated the awards and remitted the matters for further proceedings. The insurer sought to overturn that action through an article 75 proceeding. The Fourth Department affirmed the denial of the insurer’s petition.

The appellate court treated the master arbitrator’s ruling as permissible correction of an error of law, rather than impermissible reweighing of factual evidence. That review question was central to the result.

The objection needed a decision

The master arbitrator reasoned that the supplier’s timely written objection had to be addressed. If the objection was overruled, the supplier should have an opportunity to produce the information before its claims were denied for nonproduction. The Fourth Department upheld the master’s authority to take that approach.

The ruling did not establish that every pricing request is improper. It did not adjudicate every claimed trade secret or approve permanent withholding whenever a supplier uses that label. It required a legally proper treatment of the response made in these proceedings.

A provider reading the case should distinguish “I object, for these stated reasons” from leaving the request unanswered. An insurer should distinguish an absent response from one that supplies a reason for not producing an item. Both sides still need to address what was actually requested and what the written answer actually said.

Why the original prediction needs a limit

Jason’s original paragraph below emphasizes the importance of responding and objecting. It then predicts a broad effect on the 120-day rule and possible EUO dismissals. The prediction is historical commentary, not the appellate holding.

In particular, the opinion does not support an assurance that the worst possible outcome of every objection is a dismissal without prejudice. The type of proceeding, the objection’s substance and the governing rule matter. Nor did this appeal decide that missing an EUO after objecting necessarily produces that result.

The GLM EUO notice case concerns proof of notices and nonappearance. Its different subject is a reminder to avoid moving a document-production result directly into an examination dispute.

The regulation’s two response alternatives

Section 65-3.5(o) of Regulation 68 requires qualifying applicants within 120 calendar days to provide requested verification in their possession or control, or written proof giving reasonable justification for failure to comply. The request must advise the applicant of those alternatives and the possibility of denial.

The subdivision excludes prescribed NF forms, medical examinations and examinations under oath. It also has applicability dates: for medical-service claims, the treatment or service must be on or after April 1, 2013.

A statement that a document does not exist or is held by someone else therefore needs an explanation tied to the request. It is not safe to replace that factual work with a standard objection sent in every file. Elite did not decide whether a different explanation, submitted at a different time, would suffice.

Partial production is another issue

In New Horizon Surgical, the court found the provider’s response incomplete and dismissed the action as premature. The brief opinion does not describe the timely pricing objection or master-arbitration question presented in Elite.

Read the cases together by identifying the missing item, the response and the procedural posture. A partial response may leave relevant verification outstanding. A reasoned objection requires examination of its merits. Neither description tells a court everything it needs to know.

For a practical review, put the response beside the original request and mark which items were supplied, which were disputed, and which remain unanswered. Keep the supporting attachments and evidence of transmission with that comparison.

The later denial-timing question

Chapa Products v MVAIC, 245 AD3d 880 (2026), rejected a judicially added 150-day deadline for issuing the denial in that case. It did not abolish the applicant’s response alternatives, and it did not decide the objection procedure in Elite.

The archive’s 2017 TAM note records an earlier question about denial timing. Following that discussion through Chapa shows why a date-specific update is needed alongside older commentary. The rules changed in identifiable ways; “the whole 120-day rule crumbled” would lose that distinction.

Jason’s original commentary

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

This case highlights how important it is to respond and object to verification demands. The worst thing that can happen, should an objection be lodged, is that the denial of the claim is without prejudice. I would sense in certain circumstances an objection to an attendance at an EUO landing in a denial could also be a dismissal without prejudice. The 120-day rule has been neutered and it may have ramifications far beyond 65-3.5 and 65-3.6.

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:

• Triangle R: an unanswered request and a five-day-late follow-up.
• New Horizon: partial production and premature dismissal.
• GLM: EUO notices, nonappearance proof and the ADA-comment limit.
• NF-3 and Right Aid: the official provider form and receipt evidence.
• TAM Medical: disputed receipt before the later Chapa ruling.
• Parisien: written verification received after an EUO nonappearance.

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.