Verification – MRI

Lenox Hill Radiology & MIA, P.C. v Hereford Ins. Co., 2021 NY Slip Op 21157 (Civ. Ct. NY Co. 2021)

“Although plaintiff submitted decisions from no-fault arbitrations where the arbitrators ruled that the provider’s responses to demand payment of reproduction costs complied with the insurer’s verification requests (see plaintiff’s supplemental affirmation in opposition, arbitration awards), this court declines to follow those arbitration decisions. Those decisions rest on the premise that the toll triggered by the insurer’s verification request ended when the provider demanded payment of the reproduction costs. However, as discussed above, in this court’s view, the insurer’s right to demand and receive verification is not contingent upon the insurer’s payment of the reproduction costs. Thus, the provider is not excused from complying with any verification requests to provide the MRI films until it was reimbursed the reproduction costs. Consequently, the toll did not end either when plaintiff responded that defendant must pay the reproduction costs before receiving the MRI films, or when defendant had promised but failed to pay the reproduction costs. The toll should not end because plaintiff had not objected to providing the MRI films, and the verification sought was never provided”

Often when I subpoena records, the entity if they charge a copying or professional cost and will provide the records with a bill. I would assume the provider could later sue for the $5.00, yet without threat of an attorney fee (the 20% rule makes these lawsuits untenable), where does this really lead us?

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