Verification – MRI

Legal Update: Lenox Hill Radiology dismissed the suit without prejudice as premature. It did not eliminate reproduction reimbursement or decide whether unpaid fees could support reasonable justification against a 120-day denial; footnote 4 leaves that question open. See the 2026 verification guide for the later Chapa ruling.

Last reviewed: September 2026.

A demand for MRI copying costs did not end the verification toll in Lenox Hill Radiology & MIA v Hereford Insurance Co., decided June 1, 2021. The Civil Court, New York County, dismissed the provider’s action without prejudice because the requested films remained outstanding. That result did not mean that reproduction services were free or that every dispute over advance payment had been resolved.

The dispute was about payment before production

The parties did not dispute that Hereford had timely requested the MRI films. The provider demanded payment of reproduction charges before supplying them. The insurer promised payment but did not pay, and the images were never furnished.

Some arbitration decisions submitted by the provider treated its payment demand as a sufficient response to verification. Judge Richard Tsai declined to follow that approach. In his view, a demand for copying costs was not the requested verification, and the unfulfilled promise to pay did not end the toll.

That is narrower than saying an insurer’s verification rights defeat every possible objection. The court addressed a production condition based on payment. It did not dispense with timely requests, proper follow-up or the need for the requested material to relate to the claim.

Reimbursement and advance payment are different questions

The decision recognized the provider’s entitlement to reproduction charges while holding that advance payment was not a condition of the carrier’s verification right. Its discussion drew on the insurance regulator’s April 4, 2008 opinion on MRI films.

That agency opinion addressed the reproduction provision then in effect and the handling of original films. It explained that, if the provider requested their return, original films were to be returned within 20 days after receipt. This is historical guidance cited by the court, not a certification of today’s reimbursement rate for every imaging format.

Whether the copying charge is recoverable is one question. Whether withholding the images makes the treatment bill overdue is another. Lenox Hill decided the latter against this provider. It did not award the copying charge, determine a separate collection action or establish that carriers can keep supplied materials without regard to applicable obligations.

Jason’s original comment asks whether small reproduction charges are worth pursuing. That remains his practical question, preserved below. The figures and fee reference in that quotation are not a new statement of current rates, a universal attorney-fee rule or a prediction that collection litigation will succeed.

Footnote 4 is an important limit

The court expressly left another issue undecided: whether, in a case involving a denial after 120 days, the insurer’s failure to pay reproduction charges could supply written reasonable justification for the provider’s failure to produce the films.

This action involved a continuing verification toll and a premature lawsuit, not a merits determination sustaining that kind of denial. It therefore cannot be used to say that nonpayment is never relevant to reasonable justification.

The current provisions in 11 NYCRR 65-3.5(o) and 65-3.8(b)(3) require attention to the warning, the material under the applicant’s control or possession, and any written explanation. The later Chapa decision discussed in the hub below addresses an asserted mandatory denial cutoff; it does not answer the reproduction-fee question reserved here.

What records would let counsel distinguish the issues?

For a dispute like this, the useful file contains the actual verification demand, follow-up, request for reproduction costs, response or promise of payment, and evidence of whether the films were ultimately supplied. A bill for copying is not evidence that the images themselves were sent.

The dates should also identify whether counsel is addressing a premature-action defense or an issued denial. Blending those positions can make the same correspondence appear to decide an issue it never reached. South Nassau Orthopedic illustrates a different timing problem: the clock after a completed EUO when no other verification remained outstanding.

How the older MRI note fits

In Radiology Today, the provider failed to address the particular MRI films that the insurer showed were missing. Lenox Hill adds the advance-payment dispute but does not erase the basic distinction between the report, the images and proof of their delivery.

These are claim-file decisions, not guidance to ignore requests or provide unlimited material without question. A written, item-specific response preserves a clearer record than silence, while the validity and effect of the request still depend on the applicable law and facts.

Jason’s original commentary

The original comments below are retained as historical commentary. The case-specific corrections and later developments are explained above.

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?

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:

• Radiology Today: the requested MRI films were missing.
• South Nassau Orthopedic: the clock after a completed EUO.
• Village Medical Supply: a good reason to request manufacturer invoices.
• Right Aid: reversal over the verification-trial burden.
• St. Barnabas: an insufficient emergency-treatment response.

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.