Verification Forms in New York No-Fault Insurance: Understanding NF-3 Requirements

New York’s NF-3 is the Verification of Treatment by Attending Physician or Other Provider of Health Service form. The official DFS NF-3 is available directly from the regulator. It is a prescribed treatment-claim form, not a generic request for additional information.

Historical note: Right Aid v Travelers, 64 Misc 3d 138(A) (2019), decided whether the trial evidence established nonreceipt of requested verification. It did not establish the NF-3 form’s contents. The form and current verification hub supply the separate regulatory context.

Last reviewed: September 2026.

What belongs on the NF-3

The DFS form asks for information identifying the patient, accident, insurer and health-service provider. It includes diagnosis and concurrent conditions, the relationship of symptoms to the accident, treatment information and a report of services rendered. The service report requests dates, charges and identifying information for the services or supplies.

The form also contains distinct authorization-to-pay and assignment provisions. Read the selected provision and its signature requirements rather than treating payment direction as an automatic transfer of all rights. The person completing the form should use the actual treatment and claim information; this case note is not a substitute for that clinical record.

The published form bears a January 2004 revision date. That date on an official form does not itself mean the form is unusable. Obtain it from DFS and check the instructions and policy applicable to the claim, rather than selecting an unofficial version based only on which date looks newest.

Completing the treatment and payment sections

Page one asks when symptoms appeared, when the patient first consulted the provider, and whether the patient had the same or a similar condition before. It separately asks whether the condition resulted solely from the automobile accident and provides space for an explanation when the answer is no. These questions call for the treating record; an accident date alone does not answer the patient’s prior-history questions.

The work-disability entries are also distinct from the diagnosis. The form asks for the period during which the patient could not work and an expected return date if disability continues. Where the form permits an undetermined answer, that should not be turned into an unsupported prediction.

Page two’s service report identifies the service date, place of service, treatment description, fee-schedule treatment code and charge. It permits additional sheets where necessary. If the treating provider differs from the billing provider, a separate section asks for the treating provider’s identity, credentials and business relationship. Another section addresses owners and professional licensing credentials for the specified business forms.

The instructions for an earlier report on the same accident permit the provider to note changes and additional charges. That instruction concerns continuing reports; it does not establish that an incomplete initial claim or a later request for missing relevant information can be ignored.

Items 20 and 21 are alternative payment arrangements. The form expressly warns against choosing both its authorization-to-pay and assignment options. Its assignment instructions require agreement and signatures from both patient and provider and restrict alteration of the prescribed assignment language. A signature elsewhere on the form should not simply be assumed to answer those separate requirements.

For a reader downloading the form, check all three pages rather than stopping after the treatment report. Retain the completed version and any attached service sheets with the claim record. This page explains the official fields; it does not ask you to submit medical information through the website.

NF-3, NF-5 and additional requests

NF-3 is not the hospital facility form. Hospitals have the separate NF-5, addressed in the archive’s hospital verification decision. The regulatory treatment of those prescribed forms should not be confused with a later letter requesting records.

Under Regulation 68, § 65-3.5(b), the insurer must seek additional verification required to establish proof of claim within 15 business days after receiving the completed prescribed forms. Those additional requests need not themselves be made on a prescribed form.

Section 65-3.5(f) generally requires acceptance of a form with substantially the same information, while allowing the insurer to require NF-2, NF-3 and NF-5. That qualification is why “any invoice is enough” would be an unreliable description of the rule.

Do not put every deadline on one clock

The form instructions address submission of proof of claim and refer to the applicable endorsement. The insurer’s time to request additional information and the applicant’s time to respond are different matters.

The 120-day response provision in § 65-3.5(o) expressly excludes prescribed NF forms. It should not be used to tell a provider that every NF-3 can be returned within 120 days. The ordinary medical proof-of-claim deadline is addressed separately in the regulations and policy; the older endorsement alternatives printed on the form also require attention to which policy governs.

For the payment stage, Viviane Etienne Medical Care v Country-Wide, 25 NY3d 498 (2015), explains the provider’s summary-judgment showing: admissible proof of mailing and receipt of the statutory claim forms and that benefits were overdue. Sending a form and establishing a right to judgment are related but separate steps.

What Right Aid actually decided

Right Aid Medical Supply Corp. v Travelers Insurance Co., decided July 19, 2019, followed a nonjury trial. The parties limited the issue to whether the insurer had failed to receive the requested verification.

The insurer’s witness was its only trial witness and described relevant processing practices at its Buffalo and Melville offices. The court credited that testimony, and the Appellate Term affirmed dismissal of the provider’s complaint as premature.

The witness’s 27 years of employment was part of the record, not a minimum qualification for every claims witness. The opinion did not prescribe an automated claims platform, mandate a particular database or announce new NF-3 form requirements.

Keep the response and its transmission together

A response dispute needs evidence identifying what was sent and how. Retain the request, response letter, attachments and available mailing or transmission record together. That makes it possible to distinguish a missing claim form from missing additional verification.

Right Aid’s trial result differs from the New Way motion decision, where provider evidence created a factual dispute. In Utica Acupuncture, a provider described a mail-log practice without stating the result of a search for the disputed requests.

None of these opinions supports inventing a receipt date or assuming an enclosure was sent because it normally would have been. A witness’s explanation should fit the actual records and the proposition being proved.

Frequently Asked Questions

Q: How long do I have to respond to an NF-3 verification request?

Identify whether the document is the prescribed NF-3 claim form or a separate additional-verification request. There is no universal 15-to-30-day applicant response rule supplied by Right Aid. The form instructions, governing endorsement and applicable regulation control; the 120-day provision excludes prescribed NF forms.

Q: What happens if I don’t respond to a verification request?

Properly outstanding verification can affect when payment becomes overdue and whether suit is premature. Qualifying additional-document requests may also support a denial under the 120-day provisions if their conditions are met. The outcome is not determined by calling every request an NF-3.

Q: Can insurance companies request verification multiple times for the same claim?

The regulations contemplate initial and follow-up requests and permit relevant additional verification. A later request still needs examination for its contents, timing and relationship to the claim. Right Aid did not approve unlimited repetitive demands.

Q: What should I do if a verification request seems unreasonable or excessive?

Address the actual demand in writing, explain the reason for the objection and preserve the supporting records and transmission proof. The Elite objection decision discusses a timely pricing objection in arbitration; it does not make all objections successful.

Q: How can I prove I responded to a verification request if the insurance company claims they didn’t receive it?

Identify the response and its enclosures, then examine actual-mailing evidence, an adequately supported office practice, or appropriate transmission records. Certified mail is one possible record, not the exclusive method established by Right Aid. Its trial result turned on the evidence the court heard.

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:

• Leica: a delay notice without a specific verification request.
• New Way: disputed receipt and a split motion result.
• Elite Medical: a timely pricing objection in master arbitration.
• New Horizon: partial production and premature dismissal.
• Hospital NF-5: the insurer received the version it requested.
• Utica Acupuncture: a missing mail-search result and medical necessity.
• Parisien: written verification received after an EUO nonappearance.
• TAM Medical: disputed receipt before the later Chapa ruling.

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.