A 65-3.2 sighting

Historical note: Village Medical Supply applied the good-reason requirement in 11 NYCRR 65-3.2(c) to manufacturer invoices requested for the billed supplies. The insurer won on that record. The decision does not establish that every verification request is reasonable or document a general trend in later cases.

Last reviewed: September 2026.

An insurer needs a reason for verification, but a provider’s general assertion that no good reason exists does not necessarily create a factual dispute. In Village Medical Supply v Travelers Property Casualty Co., decided September 17, 2018, the Appellate Term, First Department, granted the insurer summary judgment dismissing the provider’s action as premature.

The requested documents were manufacturer invoices

The verification requests sought the manufacturer’s invoices showing the cost of the supplies for which reimbursement was claimed. The insurer established timely mailing of its initial and follow-up requests and the absence of a response.

The provider argued that the insurer lacked a good reason to demand the material. The appellate court rejected that argument on the record before it. The invoices had a concrete connection to evaluating the charges; the provider’s opposition did not raise a factual issue sufficient to defeat the motion.

The holding concerns those manufacturer invoices and that opposition. The court did not authorize unrestricted access to a provider’s business records, make all invoice requests automatically proper, or decide a fee amount in this opinion.

Section 65-3.2(c) is a real limitation

The claim-practice principles in section 65-3.2 require prompt and fair handling. Subsection (c) limits demands to verification for which there is a good reason and calls for necessary verification to be obtained expeditiously.

It is therefore wrong to read this carrier victory as eliminating the reasonableness requirement. It is equally wrong to treat citing the subsection as a complete answer to a request. The disputed documents and their relationship to the claim must still be explained.

For example, a record can show that a request concerns the actual supplies being billed, or instead reveal uncertainty about which items are sought. Those are questions for the correspondence and supporting evidence. This decision did not supply a universal objection form that makes the insurer’s payment deadline run again.

Jason’s observation was about the citation

Jason noted the court’s use of subsection (c) and described seeing more attention to it. His original observation is preserved below. It records what caught his attention in 2018; it is not a measured claim about citation frequency through 2026.

The distinction matters because the provider actually lost this appeal. The significance is that the court considered the good-reason argument, not that it accepted the objection or created a new defense that automatically defeats verification.

Separate the invoice objection from the mailing question

First identify what the request seeks and why. Then identify whether it was timely mailed, whether a proper follow-up was sent, and what the provider supplied or explained. A dispute about the reason for a request is different from a dispute about whether it arrived.

The Radiology Today MRI decision involved unanswered requests for actual films. Lenox Hill Radiology involved a demand for reproduction payment before production. Neither should be used to replace the invoice-specific reasoning here.

The Right Aid trial decision addresses another distinct step: who had to introduce proof after an earlier order had already resolved the mailing issue. A case about a trial burden does not establish the substantive validity of every demand sent during claims processing.

The limits of the result

Village Medical Supply ended in a premature-action dismissal, not an adjudication that the provider’s supplies were unnecessary or fraudulently billed. The insurer’s successful procedural motion should not be presented as such a finding.

For a current dispute, the relevant documents include the actual invoices or explanation of their availability, the request and follow-up, and the evidence of mailing and receipt. The governing hub below supplies the later verification framework. This case contributes the narrower example of a supported request that survived a general good-reason objection.

Jason’s original commentary

The original comments below are retained as historical commentary. The case-specific corrections and later developments are explained above.

So while this was a win for the insurance carrier, 3.2(c) now serves as a basis to defeat a verification request. My study of this area of law has shown fleeting citations of 3.2(c), but now it is clearly in vogue.

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:

• Radiology Today: the requested MRI films were missing.
• Lenox Hill Radiology: MRI reproduction costs and the verification toll.
• Mount Sinai v Dust Transit: the NF-5 and the missing follow-up.
• Right Aid: reversal over the verification-trial burden.
• St. Barnabas: an insufficient emergency-treatment response.
• SS Medical Care: letter copies and an unopposed cross-motion.

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.