Why Trust This Analysis
This article is part of our ongoing no-fault coverage, with 271 published articles analyzing no-fault 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 NF-10 Denial Forms in No-Fault Insurance Cases
The Appellate Term’s decision in Sheepshead Bay Med. Supply, Inc. v Erie Ins. Co. of N.Y. provides important guidance on two critical issues in New York no-fault insurance law: the sufficiency of NF-10 denial forms and the burden of proof for proper mailing. This case illustrates the ongoing challenges healthcare providers face when insurance companies deny claims and the strict evidentiary standards courts apply.
NF-10 forms are standardized denial notices that insurance companies must use when rejecting no-fault claims. The regulatory requirements for these forms are designed to ensure that claimants receive adequate notice of the reasons for denial. However, as this case demonstrates, courts will accept forms that contain “substantially the same, pertinent information” as the prescribed form, even if they’re not the most current version.
The decision also reinforces the fundamental principle that attorneys cannot simply submit affirmations without personal knowledge to create factual disputes in summary judgment motions.
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Sheepshead Bay Med. Supply, Inc. v Erie Ins. Co. of N.Y., 2021 NY Slip Op 50491(U)(App. Term 2d Dept. 2021)
“Contrary to plaintiff’s assertion, defendant established that it had mailed the NF-10 denial of claim forms at issue in duplicate. The affirmation of plaintiff’s counsel in opposition to defendant’s motion for summary judgment was insufficient to raise a triable issue of fact, as counsel did not demonstrate that he had personal knowledge of the facts (see Zuckerman v City of New York, 49 NY2d 557 ). To the extent that plaintiff contends that it was prejudiced by defendant’s improper use of “outdated” denial of claim forms, the denial forms at issue are not fatally defective, as they contain substantially the same, pertinent information as the prescribed form (see 11 NYCRR 65-3.8 ; NYU-Hospital for Joint Diseases v Allstate Ins. Co., 123 AD3d 781 ; see also 11 NYCRR 65-3.8 ). Plaintiff’s remaining contention was improperly raised for the first time on appeal and, in any event, lacks merit.”
Key Takeaway
Insurance companies can successfully defend no-fault cases by proving proper mailing of NF-10 forms and demonstrating that even “outdated” forms meet regulatory requirements if they contain substantially similar information. Healthcare providers must present evidence with personal knowledge to create genuine factual disputes in litigation.
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Legal Context
Why This Matters for Your Case
New York's no-fault insurance system, established under Insurance Law Article 51, is one of the most complex insurance frameworks in the country. Every motorist must carry Personal Injury Protection coverage that pays medical expenses and lost wages regardless of fault, up to $50,000 per person.
But insurers routinely deny valid claims using peer reviews, EUO scheduling tactics, fee schedule reductions, and coverage defenses. The Law Office of Jason Tenenbaum has handled over 100,000 no-fault cases since 2002 — from initial claim submissions through arbitration before the American Arbitration Association, trials in Civil Court and Supreme Court, and appeals to the Appellate Term and Appellate Division. Jason Tenenbaum is one of the few attorneys in the state who both writes his own appellate briefs and tries his own cases.
His 2,353+ published legal articles on no-fault practice are cited by attorneys throughout New York. Whether you are dealing with a medical necessity denial, an EUO no-show defense, a fee schedule dispute, or a coverage question, this article provides the kind of detailed case-law analysis that helps practitioners and claimants understand exactly where the law stands.
About This Topic
New York No-Fault Insurance Law
New York's no-fault insurance system requires every driver to carry Personal Injury Protection (PIP) coverage that pays medical expenses and lost wages regardless of who caused the accident. But insurers routinely deny, delay, and underpay valid claims — using peer reviews, IME no-shows, and fee schedule defenses to avoid paying providers and injured claimants. Attorney Jason Tenenbaum has litigated thousands of no-fault arbitrations and court cases since 2002.
271 published articles in No-Fault
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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.
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