No-Fault Verification Requirements: When Partial Compliance Isn’t Enough

Saying that requested records were supplied “to the extent” they were proper and in the provider’s possession left a critical gap in New York Manual v Nationwide Affinity. The owner did not demonstrate complete production or give a sufficient explanation for what was missing. The Appellate Term affirmed dismissal. This 2023 note explains that proof problem; it does not announce a new regulatory deadline or make a patient automatically responsible for an unpaid provider bill.

Historical note — Last reviewed: September 2026. New York Manual, 2023 NY Slip Op 50281(U), applied the production-or-reasonable-justification requirement in 11 NYCRR 65-3.8(b)(3). The provision originated in the 2013 Regulation 68-C amendment, not this 2023 decision. Chapa (2026) later rejected a mandatory 150-day denial deadline without deciding the sufficiency of this affidavit.

The qualification that mattered

New York Manual sought payment of assigned no-fault benefits. The Civil Court granted Nationwide Affinity’s motion for summary judgment and denied the provider’s cross-motion. On February 24, 2023, the Appellate Term, Second Department, affirmed.

The insurer demonstrated timely mailing of its initial and follow-up verification requests and nonreceipt of all requested verification. The owner’s response was qualified: he said he mailed the requested material only to the extent he considered the response proper and the material was in his possession.

The court found that this did not raise a triable issue. The provider had neither demonstrated production of the requested verification nor set out a reasonable justification for the failure to comply. That is the reported reason for affirmance. The opinion does not reproduce the demands, identify every withheld item, or provide a list of explanations that would have succeeded.

The qualification matters because it leaves two questions unanswered: what was not supplied, and why? A statement about sending selected records is not the same factual assertion as a statement that all requested records were supplied. The court needed evidence connecting the response to the request, not merely the provider’s conclusion that it had done enough.

Jason’s original June 2023 observation

Jason focused on the difference between an assertion of complete mailing and an assertion that admits some material was withheld. His original note reads:

Whereas the usual affidavit of mailing will state that all requested verification was mailed, the change now introduces an issue to what was withheld. As for that, an offer of proof as to the reasonableness for not turning over the verification is required.

This decision makes sense.

How the regulation treats missing verification

Sections 65-3.5(o) and 65-3.8(b)(3) of Regulation 68 work together. For requests within their scope, the applicant must supply verification under its control or possession, or written proof giving reasonable justification for failure to comply, within 120 calendar days from the initial request’s date.

The insurer must include the required warning in its request. The denial provision permits a denial after more than 120 calendar days when the stated production-or-justification condition remains unsatisfied. That is not an automatic denial on day 120, and it is not a universal permission to wait until then before communicating.

The provisions exclude prescribed NF-forms, medical examination requests, and examinations under oath. Their effective-date language applies to medical treatment or services rendered on or after April 1, 2013, and to accidents on or after that date for lost earnings and reasonable and necessary expenses. A reader should identify the request type and relevant dates before applying the rule.

An earlier version of this page said verification responses were typically due within 30 days. That conflated the follow-up process with the qualified 120-day provision. Under section 65-3.6(b), the insurer follows up within 10 calendar days when verification remains unsupplied 30 calendar days after the original request. These clocks serve different purposes.

What a useful explanation would address

The decision does not supply an approved form of justification. It does show why a general qualification is a weak way to explain a missing response. A useful factual account identifies the requested item, what was produced, what remains unavailable, and the reason. It also identifies the witness’s knowledge and any records supporting that account.

For example, saying “not in our possession” leaves open whether the provider controls the material, knows its custodian, requested a copy, or objects to producing it. Those are questions for the actual file; they are not facts about the New York Manual record. The case does not establish that every document outside a provider’s office is excused or that every objection is unreasonable.

Likewise, calling a demand improper is a conclusion, not a description of the problem. Is the requested item unrelated to the claim, already supplied, or unavailable for a documented reason? Counsel can assess those distinctions without assuming the objection proves itself. Any explanation should be tied to the real request and response, not supplied from a generic list of supposed excuses.

Preserving the correspondence matters as much as describing it. The demand, the response, its attachments, and evidence of dispatch allow the parties to identify the actual gap. If different people prepared and mailed the response, their roles should be clear. This is a practical way to review the evidence, not a claim that the court mandated a particular packet or checklist.

Why earlier affidavit decisions reached different results

The 2015 trilogy concerned unresolved issues over whether or how providers responded. Those decisions left neither party entitled to judgment on the response disputes described in their records. They did not decide that any form affidavit establishes complete verification.

In Great Health Care v Hereford (2016), an owner’s affidavit raised a presumption that the requested verification was mailed and received, leaving a factual issue about prematurity. The short opinion did not reproduce the affidavit. It would be speculation to assume it used the same qualification that failed in New York Manual.

Global Liberty v Jonathan Lewin (2017), addressed missing MRI films, requests to a third-party imaging provider, and submissions associated with a different provider. The court also recorded an unopposed cross-motion. Its treatment of an authorization did not create a rule that all third-party-records explanations fail.

The comparisons make the archive useful: one record presents a disputed mailing, another admits qualified production, and another concerns films sought from their custodian. A legal argument should identify which situation it addresses. Combining them into “providers always win with an affidavit” or “partial compliance always loses” discards the facts that explain the decisions.

The two decisions New York Manual relied on

Burke Physical Therapy v State Farm, 2022 NY Slip Op 50623(U), used the same qualified-production language before New York Manual. The claims specialist said none of the requested documents had been received. The owner said he mailed verification to the extent the response was proper and the material was in his possession. The court found no triable issue because the provider had not demonstrated production or reasonable justification.

Burke also had a distinct motion history. The provider sought discovery and dismissal of affirmative defenses; the insurer cross-moved for summary judgment. The court affirmed dismissal and the denial of the provider’s motion as academic. That procedural history does not support a blanket proposition that discovery is unavailable in every verification case. It tells the reader what the particular appeal resolved.

CPM Medical Supply v State Farm, 2019 NY Slip Op 50576(U), provides more detail about the missing records. One claim received no response. For another, the provider answered in writing but did not supply the requested invoices or say they were outside its possession or control. Instead, it asserted that the invoices were unnecessary based on its own view of reimbursement calculations.

The court held that this was neither a sufficient response nor reasonable justification. It also noted that the services postdated April 1, 2013 and that the insurer had properly denied the claims for failure to provide verification within 120 days. Although it explained that the insurer was entitled to dismissal with prejudice, it affirmed the existing order because the insurer had not cross-appealed.

That last point prevents a misleading summary. The appellate explanation and the relief actually granted are not always identical. CPM’s discussion of a stronger available disposition does not authorize a writer to report a modification the court expressly declined to make.

Together, the cases trace a specific evidentiary problem from an objection to producing invoices, through a qualified owner’s affidavit, to the similar qualification in New York Manual. The sequence is narrower and more useful than saying that a brand-new compliance standard appeared in 2023.

It also distinguishes possession from disagreement. CPM did not involve a documented statement that the invoices could not be obtained; the provider said they were unnecessary. Burke and New York Manual likewise did not supply a successful written explanation for omitted material. These decisions do not resolve every genuine inability to produce records held elsewhere.

For a present claim, compare the language and supporting proof in the actual response with these examples. Do not replace an unexplained omission with an invented justification after the fact, and do not assume that a written objection proves the insurer’s demand improper merely because the objection was sent.

The separate denial-timing question after Chapa

Chapa’s January 2026 opinion interpreted section 65-3.8(b)(3) and found no mandatory requirement to issue a denial within 150 days of the initial verification request. The regulation’s permission to deny after the qualified 120-day period did not itself impose that additional deadline.

That ruling does not answer what records were supplied in New York Manual or whether a justification was adequate. It also involved a denial and should not be described as a holding that an insurer never needs one. Response sufficiency and denial timing belong in separate parts of a claim analysis.

What this means for a patient or provider reading the bill

This case was an assigned-benefits dispute between a provider and an insurer. It did not decide a patient’s separate contractual obligation to pay the provider. A verification denial alone is not a sufficient basis for this article to declare the patient personally liable.

A patient receiving a request or collection notice should identify the claimant, the disputed service, and the reason stated in the correspondence. Questions about continued treatment belong with the treating clinician; questions about the bill, assignment, or denial require review of those documents. Avoid sending medical records or identifying information through an unverified channel simply because a letter mentions “verification.”

For providers and insurers, the immediate value of the case is evidentiary. It directs attention to the exact limitation in an affidavit, and to whether the papers actually explain what was withheld. That is more useful than repeating a broad claim about a newly tightened no-fault system.

Frequently Asked Questions

What happens if a medical provider doesn’t comply with verification requests?

Depending on the request and record, an unresolved verification issue can support a prematurity defense or a denial under the qualified 120-day provision. New York Manual upheld dismissal on its evidence. It did not determine that the patient automatically owed the provider’s bill.

Can insurance companies make unlimited verification requests?

Section 65-3.2(c) directs insurers not to demand verification of facts without good reasons and to obtain necessary verification promptly. New York Manual does not decide a numerical limit or validate every demand. The actual request and its relationship to the claim still matter.

What should I do if my medical provider stops treatment due to verification disputes?

Discuss treatment needs with the treating clinician and obtain the correspondence explaining the payment dispute. A review of the request, response, assignment, and any denial can clarify the legal issue. This opinion does not decide treatment arrangements or a patient’s financial responsibility.

How long do providers have to respond to verification requests?

For requests within sections 65-3.5(o) and 65-3.8(b)(3), the rule calls for production or written proof of reasonable justification within 120 calendar days from the initial request. It has notice requirements and express exceptions. The insurer’s 30-day and 10-calendar-day follow-up sequence is a different rule.

Can patients help resolve verification disputes?

A patient can help identify correspondence or records requested from them, using an appropriate verified channel. The provider and insurer should still identify exactly what is missing. Do not assume that sharing unrelated medical information will resolve the dispute or replace the required response.

Connect to the Encyclopedia

Start with the verification rules and historical case library for the current framework and the cases behind it.

• The 2015 verification-affidavit trilogy and disputed responses
• Great Health Care: the owner’s affidavit that prevented summary judgment
• Lewin: third-party MRI films and an objection letter
• The 2013 Regulation 68-C amendment and its limits

For review of a particular verification dispute, see our New York no-fault defense practice or contact the firm about the request, response, and claim record. Please do not send medical records or sensitive identifiers through an unverified channel.