Key Takeaway
Learn about NY no-fault insurance: claim filing steps, verification process, and recent case law affecting insurance carriers' verification rights.
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.
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The Basics of No-Fault Insurance Under New York’s no-fault insurance system, every registered vehicle owner must carry a minimum of $50,000 in personal injury protection (PIP) coverage. This coverage is designed to pay for the policyholder’s medical expenses, lost wages, and other
reasonable and necessary expenses related to the accident, regardless of who was at fault. The primary goal of the no-fault system is to reduce the number of lawsuits arising from motor vehicle accidents and to ensure that injured parties receive prompt compensation for their losses.
By eliminating the need to determine fault in most cases, the system allows for a more efficient
claims process and reduces the burden on the court system.
Filing a No-Fault Claim in New York State, the injured party must follow several key steps:
- Notify the insurance company: The policyholder must notify their insurance company of
the accident as soon as possible, typically within 30 days of the incident. - Complete the application for benefits: The injured party must fill out an Application for
Motor Vehicle No-Fault Benefits (Form NF-2) and submit it to the insurance company
within 30 days of the accident. - Provide supporting documentation: Along with the application, the claimant must submit
any relevant medical bills, proof of lost wages, and other documentation supporting their
claim.
Attend medical examinations: The insurance company may require the claimant to
undergo an Independent Medical Examination (IME) to assess the extent of their injuries
and the necessity of the treatment they are receiving.
5. Submit ongoing documentation: As treatment continues, the claimant must submit
additional medical bills and proof of lost wages to the insurance company for
reimbursement.
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No-Fault Claims Insurance companies have the right to Verification
Verification can be done to ensure a claims accuracy and prevent fraudulent claims. This
verification process may involve:
- Medical records review: The insurance company may request and review the claimant’s
medical records to confirm the extent of their injuries and the necessity of the treatment
they are receiving. - Independent Medical Examinations (IMEs): As mentioned earlier, the insurance company
may require the claimant to attend an IME with a healthcare provider of their choice to
assess the extent of the injuries and the appropriateness of the treatment.
Wage verification: If the claimant is seeking reimbursement for lost wages, the insurance
company may request documentation from their employer to verify their income and the
time missed from work due to the accident.
4. Examinations Under Oath (EUOs): In some cases, the insurance company may require
the claimant to submit to an EUO, during which they will be asked questions about the
accident and their injuries under oath.
Recent Case Law exemplifying the Potential Pitfalls Attorney’s and Consumers need to navigate
An insurance carrier has the right to bootstrap verification or to seek additional verification after receiving other verification. In a parallel universe, this would be a supplemental discovery and inspection following a deposition, medical examination or some other information. The regulations are being construed asymmetrically in different courts. The consumer and practitioner needs to tread carefully when verifying a claim.
In a recent case, the Appellate Term of the Supreme Court of the State of New York, Second
Department was clear that an insurance carrier did not have the right to engage in supplemental
verification following the conducting of the EUO (Examination under Oath). “We agree that defendant’s time to pay or deny the claims was tolled by the EUO scheduling letter, which letter was “timely” issued
pursuant to 11 NYCRR 65-3.5 (b) and 65-3.8 (l), but, contrary to defendant’s apparent position,
that toll expired on September 14, 2018 when the EUO was conducted and proof of claim
became complete.” Burke Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co., 2024 NY
Slip Op 24111 (App. Term 2d Dept. 2024)
Other cases have rejected this absolutist result. See e.g. Keith v Liberty Mut. Fire Ins. Co., 118
AD2d 151, 154 (2d Dept 1986)(allowing a subsequent verification request following the receipt
of information); Quality Psychological Servs., P.C. v Utica Mut. Ins. Co., 2013 NY Slip Op
50148(U)(App Term 1st Dept. 2013) (finding demand for provider EUO untimely because it was
not demanded within 15 business days of the Assignor EUO).
It seems that the Appellate Term over the last five (5) years has returned to its post 2000 roots of
reading the regulations narrowly and eschewing delay. See Quality Health Supply Corp. , 69 Misc 3d 133(A)(App Term 2d Dept. 2020) (holding that EUO demands that
are not strictly scheduled in accordance with the regulations are invalid), rev’d by Quality Health
Supply Corp. , 216 AD3d 1013, 1014 (2d Dept. 2023) (holding that follow-up
demands for EUOs can spring from mutually re-scheduled EUOs); **Alleviation Med. C.
v Allstate Ins. , 55 Misc 3d 44 (App Term 2d Dept.
2017), affd 191 AD3d 934 (2d Dept.
2021)** (holding that the priority of payment regulation must be strictly construed to exercise
policy exhaustion defense); **Neptune Med. C. , 2015 NY
Slip Op 51220(U), *1 (App Term, 2d Dept.
In Conclusion it is imperative the Attorney understands the shifting landscape of Verification in various Courts and Jurisdictions. Failure to do so can result in failure to collect the highest verdict possible on an injury or loss. It also could open the practitioner to potential Malpractice. For more information contact the Law Office of Jason Tenenbaum, P.C. today, we can help maximize the return on your Bodily Injury, Employment, or Wage and Hour Case.
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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.
If you need legal help with a no-fault matter, contact our office at (516) 750-0595 for a free consultation. We serve clients throughout Long Island (Huntington, Babylon, Islip, Brookhaven, Smithtown, Riverhead, Southampton, East Hampton), Nassau County (Hempstead, Garden City, Mineola, Great Neck, Manhasset, Freeport, Long Beach, Rockville Centre, Valley Stream, Westbury, Hicksville, Massapequa), Suffolk County (Hauppauge, Deer Park, Bay Shore, Central Islip, Patchogue, Brentwood), Queens, Brooklyn, Manhattan, the Bronx, Staten Island, and Westchester County. Prior results do not guarantee a similar outcome.
