No-Fault Insurance Additional Verification: Complete Guide for New York Providers

A partial response did not complete verification in New Horizon Surgical. The insurer proved that relevant information remained outstanding, and the Appellate Term dismissed the provider’s action as premature. The ruling does not mean every imperfect answer justifies indefinite delay.

Historical note: New Horizon Surgical v Travelers, 65 Misc 3d 139(A) (2019), decided a supported outstanding-verification motion. The verification hub and 2026 Chapa update distinguish that result from a 120-day noncompliance denial and its conditions.

Last reviewed: September 2026.

What New Horizon proved and did not prove

New Horizon Surgical Center, LLC v Travelers Insurance Co., decided October 18, 2019, arose from assigned first-party no-fault claims. The Richmond County Civil Court had denied the insurer’s motion for summary judgment. The Appellate Term reversed and granted dismissal.

The insurer established the mailing of verification requests and that it had not received all the requested verification. The provider’s partial response did not start the insurer’s time to pay or deny. On that record, the suit was premature.

The short opinion does not list every document requested or explain which particular item remained missing. It should not be cited as though the court had ruled on a specific medical chart, invoice, coding record or privacy objection that the opinion never identifies.

Match each answer to the request

A response can be substantial in length while leaving an important question unanswered. Conversely, a brief response may answer everything properly sought. Counting pages does not establish completeness.

For review, pair each requested item with the material said to answer it. Identify whether it was enclosed, provided earlier, unavailable, or disputed. Preserve the actual attachments. A cover letter stating “all verification enclosed” is easier to assess when the enclosure set is also available.

This is a practical comparison, not a court-mandated spreadsheet format. The point is to avoid arguing about “compliance” in the abstract when the parties may mean different documents.

The hospital NF-5 case supplies a useful contrast. There, the hospital furnished the version of the form the insurer specifically requested. The insurer’s later objection that it was outdated did not establish the claimed deficiency.

A written explanation is different from ignoring the request

Regulation 68, § 65-3.5(o), addresses qualifying verification within the applicant’s possession or control. It provides a 120-calendar-day period and the alternative of written proof giving reasonable justification for failure to comply. The insurer’s request must contain the required warning.

The provision excludes prescribed NF forms, IMEs and EUOs and has its own applicability dates. A request governed by another provision cannot be assigned that response period merely because someone calls it verification.

In Elite Medical Supply, a timely objection to pricing requests led to a dispute about master-arbitration review. That opinion requires attention to the objection actually made. It does not guarantee that a stock assertion of burden or confidentiality will succeed.

Prove transmission as well as contents

A party claiming to have responded should be able to identify the response and explain its mailing or other transmission. If the insurer disputes receipt, evidence of an actual mailing or an adequately supported office practice may become important.

The New Way decision denied the insurer judgment on four claims because receipt was genuinely disputed. That did not establish that the provider won the claims. The Right Aid trial instead ended with credited insurer testimony about nonreceipt.

Those outcomes caution against treating an affidavit’s label as a substitute for its contents. A witness should state what the witness knows, how the relevant records were handled, and what the evidence actually shows.

Identify the missing item before arguing prematurity

The published New Horizon opinion does not tell a later reader whether the missing item was an entire record, one part of a response, or something that had been supplied in another communication. Those details have to come from the current file. Do not insert an assumed missing invoice or chart into the description of the case.

A completeness dispute also differs from a dispute about what the documents prove. The insurer may have received a requested report yet disagree with its conclusion. That is not the same factual assertion as never receiving it. Keep the response’s contents available so the parties can identify which disagreement they actually have.

Before deciding a suit is ready

Separate the original claim submission from additional verification. Then examine the requests, follow-ups, answers and any denial in date order. Determine whether the dispute is about a missing item, a rejected explanation, or a response the parties disagree was received.

The 2026 Chapa ruling rejected an added 150-day denial cutoff. It did not eliminate the need to evaluate the request and response evidence. A current dispute needs that evidence even when one side relies on an older, correctly decided case.

Frequently Asked Questions

What happens if I provide a partial response to additional verification?

A relevant missing item can leave verification incomplete, as in New Horizon. The contents and propriety of the request, what was supplied and any supported justification for nonproduction need examination; a percentage of pages produced is not the test.

Can I object to unreasonable verification requests?

A timely, specific written objection may require consideration, as Elite illustrates. Explain the actual issue and retain the response and transmission evidence. An objection does not automatically excuse all production or guarantee a favorable ruling.

What if the requested information doesn’t exist?

Identify what does not exist and explain the basis for that statement. Where the 120-day provision applies, written proof giving reasonable justification is an express alternative. A bare assertion of nonexistence is not automatically sufficient.

How long can insurance companies delay payment through additional verification?

The answer depends on the applicable request and response rules. Properly outstanding verification can postpone payment becoming overdue or make suit premature. New Horizon does not authorize delay based on unspecified or unsupported demands.

Should I use a general compliance affidavit like a Rybak affidavit?

An affidavit should describe the actual file and the witness’s knowledge. A name attached to a template does not establish completeness, mailing or receipt. Avoid assertions that the witness cannot support.

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.
• Hospital NF-5: the insurer received the version it requested.
• 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.