Key Takeaway
Expert guide to NY no-fault insurance additional verification requirements. Learn compliance strategies and legal protections. Call 516-750-0595.
This article is part of our ongoing additional verification coverage, with 92 published articles analyzing additional verification issues across New York State. Attorney Jason Tenenbaum brings 24+ years of hands-on experience to this analysis, drawing from his work on more than 1,000 appeals, over 100,000 no-fault cases, and recovery of over $100 million for clients throughout Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx. For personalized legal advice about how these principles apply to your specific situation, contact our Long Island office at (516) 750-0595 for a free consultation.
Understanding Additional Verification Requirements in New York No-Fault Insurance
Additional verification requests represent one of the most complex areas of New York no-fault insurance law. They often create confusion for healthcare providers and patients alike.
Recent court decisions, including the significant ruling in New Horizon Surgical Ctr., LLC v Travelers Ins. Co., have clarified important aspects of these requests. Specifically, they address how insurance companies can delay claim payments through verification demands.
As experienced New York personal injury attorneys who regularly handle no-fault insurance disputes, we understand the frustration providers experience when dealing with additional verification requirements that seem designed to delay rightful payments.
The New Horizon Decision: A Landmark Ruling
In New Horizon Surgical Ctr., LLC v Travelers Ins. Co., 2019 NY Slip Op 51690(U)(App. Term 2d Dept. 2019), the court issued a definitive ruling about partial responses to verification requests:
“Contrary to plaintiff’s contention, defendant was not required to pay or deny plaintiff’s claims upon receipt of a ‘partial response’ to defendant’s verification requests (see 11 NYCRR [*2]65-3.8 ; ; New York & Presbyt. Hosp. v Progressive Cas. Ins. Co., 5 AD3d 568, 570 [‘A claim need not be paid or denied until all demanded verification is provided’]).”
This ruling has significant implications for healthcare providers and their approach to responding to verification demands.
Legal Framework: 11 NYCRR 65-3.8 Requirements
The 30-Day Rule and Verification Demands
Under New York’s no-fault insurance regulations, specifically 11 NYCRR 65-3.8, insurance companies have specific obligations regarding claim processing:
- 30-day payment requirement: Claims must generally be paid or denied within 30 days of submission
- Verification exception: This timeline can be extended through proper additional verification requests
- Complete response requirement: As New Horizon clarifies, partial responses don’t trigger the obligation to pay or deny
What Constitutes Proper Additional Verification?
The regulations and case law establish several requirements for valid additional verification requests:
- Must be reasonable and related to the claim
- Should be specific and clearly defined
- Cannot be duplicative of information already provided
- Must be legally permissible under HIPAA and state privacy laws
Strategic Implications of the New Horizon Ruling
The Complete Response Standard
The New Horizon decision establishes a clear standard. Insurance companies can continue to delay payment as long as any portion of their verification request remains unanswered.
This creates both challenges and opportunities for providers.
Challenges for providers:
- Must provide complete, comprehensive responses to all verification requests
- Cannot rely on partial compliance to trigger payment obligations
- Face continued delays if any element is missing or incomplete
Best Practices for Responding to Additional Verification
Comprehensive Documentation Strategy
Based on the New Horizon ruling and established no-fault practice, providers should adopt a comprehensive approach:
- Review each request carefully: Analyze every element of the verification demand
- Provide complete responses: Address every aspect of the request, not just portions
- Document unavailable information: Clearly state when requested information doesn’t exist
- Challenge improper requests: Object to verification demands that are unreasonable or legally improper
- Maintain detailed records: Keep comprehensive records of all verification correspondence
Working with Legal Counsel
Given the complexity of additional verification requirements and the potential for significant payment delays, healthcare providers should consider working with experienced no-fault insurance attorneys who can:
- Evaluate the reasonableness of verification requests
- Craft appropriate responses that satisfy legal requirements
- Challenge improper or excessive demands
- Develop long-term compliance strategies
- Represent providers in disputes and litigation
Frequently Asked Questions About Additional Verification
What happens if I provide a partial response to additional verification?
According to the New Horizon decision, insurance companies are not required to pay or deny claims upon receipt of a “partial response.” You must provide a complete response to all aspects of the verification request to trigger the insurer’s obligation to pay or deny the claim.
Can I object to unreasonable verification requests?
Yes, you can and should object to verification requests that are “palpably improper” or clearly unreasonable. However, you should work with experienced counsel to ensure your objections are properly documented and legally sound.
What if the requested information doesn’t exist?
A complete response stating that certain requested information doesn’t exist or isn’t available can satisfy the verification requirement, provided the response is truthful and comprehensive.
How long can insurance companies delay payment through additional verification?
There’s no specific time limit for additional verification under current regulations. Insurance companies can continue to request additional verification as long as their requests are reasonable and properly made.
Should I use a general compliance affidavit like a Rybak affidavit?
The use of general compliance affidavits in light of the New Horizon decision requires careful consideration. While these affidavits may address some verification requests, they may not constitute a “complete response” to specific, detailed verification demands.
Expert Legal Assistance for No-Fault Verification Disputes
Navigating the complex landscape of additional verification requirements requires sophisticated understanding of both no-fault insurance law and practical compliance strategies. At the Law Office of Jason Tenenbaum, we have extensive experience helping healthcare providers, patients, and other stakeholders address verification-related challenges.
Don’t let complex verification requirements delay your rightful compensation. Contact our experienced team to protect your rights and ensure proper compliance with New York’s evolving no-fault insurance requirements.
Call 516-750-0595 for a free consultation with our experienced New York no-fault insurance attorneys.
Legal Update (February 2026): Since this post’s publication in 2019, the Additional Verification regulations under 11 NYCRR 65-3.8 may have been subject to amendments or clarifying guidance from the New York Department of Financial Services. Additionally, subsequent court decisions may have further refined the interpretation of verification requirements established in the New Horizon case. Practitioners should verify current regulatory provisions and recent case law developments when advising on additional verification procedures and payment obligations.
Related Articles
Legal Context
Why This Matters for Your Case
New York law is among the most complex and nuanced in the country, with distinct procedural rules, substantive doctrines, and court systems that differ significantly from other jurisdictions. The Civil Practice Law and Rules (CPLR) governs every stage of civil litigation, from service of process through trial and appeal. The Appellate Division, Appellate Term, and Court of Appeals create a rich and ever-evolving body of case law that practitioners must follow.
Attorney Jason Tenenbaum has practiced across these areas for over 24 years, writing more than 1,000 appellate briefs and publishing over 2,353 legal articles that attorneys and clients rely on for guidance. The analysis in this article reflects real courtroom experience — from motion practice in Civil Court and Supreme Court to oral arguments before the Appellate Division — and a deep understanding of how New York courts actually apply the law in practice.
About This Topic
Additional Verification in No-Fault Claims
Under New York's no-fault regulations, insurers may request additional verification of a claim within specified time limits. The timeliness, scope, and reasonableness of verification requests — and the consequences of a claimant's failure to respond — are among the most litigated issues in no-fault practice. These articles examine the regulatory framework for verification requests, court decisions on compliance, and the interplay between verification delays and claim determination deadlines.
92 published articles in Additional Verification
Keep Reading
More Additional Verification Analysis
No Denial Required When Provider Fails to Respond to Verification Within 120 Days
Appellate Division holds insurers need not issue a denial when a medical provider or injured person fails to respond to verification demands within 120 days. Analysis of Chapa...
Feb 25, 2026
120-day rule and Fee Schedule
New York court ruling demonstrates how healthcare providers can lose no-fault claims due to verification failures and fee schedule violations in insurance disputes.
Feb 1, 2020
Verification, again
New Horizon Surgical case analysis: Court dismisses no-fault claim when plaintiff's affidavit failed to include requested informed consent form despite claiming full compliance.
Mar 20, 2019
Enough with the Rybak verification affidavit
Long Island no-fault attorney criticizes Appellate Term's handling of Rybak verification affidavit cases, calling for proper proof standards in summary judgment motions.
Jun 10, 2016
IME no-show denial timely where verification requested after no-show
Court ruling clarifies timing requirements for IME no-show denials when verification is requested after the missed appointment in New York no-fault insurance cases.
Apr 19, 2014
Verification Timing in No-Fault Claims: When Bills Are Properly Delayed
Learn how verification timing affects no-fault insurance payment deadlines. Long Island attorneys explain UB-04, NF-2, and NF-5 form requirements.
Jan 20, 2011Was this article helpful?
About the Author
Jason Tenenbaum, Esq.
Jason Tenenbaum is the founding attorney of the Law Office of Jason Tenenbaum, P.C., headquartered at 326 Walt Whitman Road, Suite C, Huntington Station, New York 11746. With over 24 years of experience since founding the firm in 2002, Jason has written more than 1,000 appeals, handled over 100,000 no-fault insurance cases, and recovered over $100 million for clients across Long Island, Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, the Bronx, and Staten Island. He is one of the few attorneys in the state who both writes his own appellate briefs and tries his own cases.
Jason is admitted to practice in New York, New Jersey, Florida, Texas, Georgia, and Michigan state courts, as well as multiple federal courts. His 2,353+ published legal articles analyzing New York case law, procedural developments, and litigation strategy make him one of the most prolific legal commentators in the state. He earned his Juris Doctor from Syracuse University College of Law.
Disclaimer: This article is published by the Law Office of Jason Tenenbaum, P.C. for informational and educational purposes only. It does not constitute legal advice, and no attorney-client relationship is formed by reading this content. The legal principles discussed may not apply to your specific situation, and the law may have changed since this article was last updated.
New York law varies by jurisdiction — court decisions in one Appellate Division department may not be followed in another, and local court rules in Nassau County Supreme Court differ from those in Suffolk County Supreme Court, Kings County Civil Court, or Queens County Supreme Court. The Appellate Division, Second Department (which covers Long Island, Brooklyn, Queens, and Staten Island) and the Appellate Term (which hears appeals from lower courts) each have distinct procedural requirements and precedents that affect litigation strategy.
If you need legal help with a additional verification matter, contact our office at (516) 750-0595 for a free consultation. We serve clients throughout Long Island (Huntington, Babylon, Islip, Brookhaven, Smithtown, Riverhead, Southampton, East Hampton), Nassau County (Hempstead, Garden City, Mineola, Great Neck, Manhasset, Freeport, Long Beach, Rockville Centre, Valley Stream, Westbury, Hicksville, Massapequa), Suffolk County (Hauppauge, Deer Park, Bay Shore, Central Islip, Patchogue, Brentwood), Queens, Brooklyn, Manhattan, the Bronx, Staten Island, and Westchester County. Prior results do not guarantee a similar outcome.
