The 120-day rule

The 150-day denial deadline discussed in this 2019 no-fault note is no longer the rule announced by Chapa. The Second Department reversed that part of the decision in January 2026. A late denial cannot be rejected simply because it came more than 150 days after the first document request.

Legal Update (September 2026): Chapa Products v MVAIC, 245 AD3d 880 (2d Dept 2026) reversed the 2019 denial-timing ruling. The current verification hub explains the remaining conditions; neither decision makes every unpaid bill payable or automatically extinguishes a claim on day 120.

Last reviewed: September 2026.

What the 2019 decision actually decided

Chapa Products Corp. v MVAIC, 66 Misc 3d 16, decided November 1, 2019, involved assigned medical-benefit claims. The Appellate Term treated a denial issued 208 days after the initial verification requests as too late to establish the complete 120-day noncompliance defense. It imposed a deadline 30 days after the applicant’s 120-day response period.

The court nevertheless found the provider’s response incomplete. It dismissed the action without prejudice as premature, rather than directing payment. The provider’s success on denial timing did not establish compliance with the requests. Justice Weston dissented from the added deadline, reasoning that it did not appear in the regulation.

That distinction explains the historical title and URL. This page preserves the earlier debate so readers can follow what changed, not apply the superseded cutoff to a current claim.

The 2026 reversal

On January 28, 2026, the Second Department held that the regulation did not specify a period within which the insurer had to deny after the 120-day response period. It restored the Civil Court’s grant of MVAIC’s cross-motion for summary judgment.

The court declined to insert a 150-day deadline that DFS had not written. The decision concerned a denial that MVAIC had issued. It did not decide that insurers never need denials, that every verification demand is proper, or that all other no-fault deadlines have disappeared.

A present-day argument based on this appeal should identify the precise holding being invoked. “The old 150-day cutoff was reversed” is supported. “The carrier can ignore every deadline” is not.

Separate the request, response and denial

The DFS regulations, §§ 65-3.5(o) and 65-3.8(b)(3), distinguish three matters. A qualifying request must advise the applicant of the response alternatives and possible denial. The applicant has 120 calendar days to submit verification within its possession or control, or written proof giving reasonable justification for noncompliance. After more than 120 days without either qualifying submission, the insurer may deny under the stated conditions.

These subdivisions exclude prescribed NF forms, medical-examination requests and EUO requests. For medical-service claims, the treatment or service must fall within the provision’s applicability date, April 1, 2013 or later. The date of an older published opinion alone does not establish which regulatory version governed its claims.

The request and its follow-up also need their own evidence. The date on a denial does not establish when a request was sent, what it asked for, or whether a response reached the carrier.

Missing documents are different from an unanswered objection

In Progressive v Elite Medical Supply, 162 AD3d 1471 (4th Dept 2018), the supplier responded with objections concerning pricing information and its asserted proprietary character. The Fourth Department upheld the master arbitrator’s authority to correct the legal treatment of a timely reasonable-justification response.

The ruling concerned master-arbitration review and an opportunity to address the objection, then produce information if it was rejected. It did not approve every refusal to supply records. A written objection has to be assessed on its actual reasons; calling a demand burdensome does not establish that the objection succeeds.

Compare the archive’s 2017 partial-response note. That short decision affirmed premature dismissal on a record showing missing verification. It did not adjudicate the objection procedure considered in Elite.

Build the chronology before choosing the argument

For a disputed file, assemble the bill, each request, the follow-up, the response with its attachments, and any denial. Put the dates beside those documents. Then identify whether the dispute concerns a request that never arrived, documents that were sent but allegedly not received, an incomplete production, or an objection.

The New Way mailing decision illustrates why this matters: employee evidence supporting a presumption of receipt created a factual dispute. In Daily Medical, the provider did not show that verification had been supplied before suit. A shared “verification” label did not produce a shared result.

This chronology is a practical reading method, not a substitute for proof. A claims-system status of “pending” does not explain the request or prove that the payment period was properly extended. Conversely, an unpaid balance alone does not answer a supported outstanding-verification defense.

Frequently Asked Questions

What happens if an insurance company denies a claim after 150 days from the initial verification request?

The 2026 Chapa decision rejected a mandatory 150-day cutoff for this defense. A denial is not ineffective merely because of that calculation. Its grounds, the request warnings, response evidence and applicable regulatory conditions still need examination.

Does the 150-day rule apply to all types of no-fault denials?

No. The cutoff discussed here was a 2019 judicial rule later reversed, not a universal no-fault deadline. Document verification, prescribed forms, EUOs, medical examinations and other denial grounds cannot be treated as interchangeable.

Can healthcare providers sue immediately if verification is requested, or must they wait for a denial?

Neither “sue immediately” nor “always wait for a denial” is a reliable blanket rule. Properly outstanding verification can make an action premature. An insurer’s failure to act on an overdue, sufficiently supported claim is a different situation; a denial is not invariably required before a provider can seek relief.

What constitutes a complete response to a verification request?

Match the materials actually submitted to the relevant items requested. For requests governed by the 120-day provisions, examine the alternative of written proof giving reasonable justification for noncompliance. Preserve evidence identifying the contents and transmission of the response, not only an assertion that something was mailed.

How does the 150-day rule interact with New York’s 30-day pay or deny requirement?

The 2026 reversal did not abolish ordinary claim-processing deadlines. It rejected the extra 150-day cutoff for this particular verification defense. The verification hub separates the payment period, initial and follow-up requests, and the applicant’s response obligations.

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:

• Exoto: the withdrawn online opinion and NF-3 form questions.
• Daily Medical: failure to show verification was supplied before suit.
• New Way: mailing evidence and two different claim results.
• All Boro: unpaid versus overdue on a search of the record.
• Doctor Goldshteyn: partial production and the objection question.

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.