No Denial Required When Provider Fails to Respond to Verification Within 120 Days

A Significant Shift in Verification Defense Practice

The Appellate Division has issued a ruling that will reshape how insurers handle verification non-response in no-fault claims. In Chapa Prods., Corp. v MVAIC, the court held that there is no need to issue a denial when the basis to deny a claim is that the medical provider or injured person failed to respond to verification demands within 120 days of the first verification request.

Chapa Prods., Corp. v MVAIC

Chapa Prods., Corp. v MVAIC, AD3d, 2026 NY Slip Op 00342, 1 (2026)

The holding is direct: when a carrier sends verification demands and the provider or claimant fails to respond within 120 days of the first request, the claim is deemed withdrawn by operation of the regulation. No separate denial is required.

This is a significant clarification because the interplay between verification timelines and the duty to issue timely denials has been a persistent source of litigation in no-fault practice. Providers have routinely argued that the insurer’s failure to issue a formal denial — even after the 120-day verification window expired — either waived the defense or precluded the carrier from later relying on the verification non-response.

Chapa Prods. eliminates that argument.

The 120-Day Verification Framework

Under 11 NYCRR 65-3.5, insurers may request verification of a no-fault claim within specific timeframes. Once the initial verification request is sent, the provider or claimant has an obligation to respond. The regulatory framework provides:

1. Initial verification request — Must be made within 15 business days of receipt of the claim.
2. Follow-up requests — The insurer may send follow-up verification demands if the initial response is incomplete.
3. 120-day window — If the requested verification is not received within 120 days of the initial request, the claim may be deemed withdrawn.

The Pre-Chapa Dispute

Before this decision, the question was whether the 120-day non-response automatically deemed the claim withdrawn, or whether the insurer still needed to issue a denial citing the verification non-response as the basis. Practitioners on both sides had reasonable arguments:

The insurer’s position: The regulation itself deems the claim withdrawn after 120 days. A denial is a response to a pending claim, but if the claim is no longer pending (because it has been deemed withdrawn), there is nothing to deny.

The provider’s position: The 30-day pay-or-deny rule requires insurers to either pay or deny every claim. Failing to issue a denial means the insurer has not preserved its defense and is precluded from raising it later.

Chapa Prods. adopts the insurer’s position: the claim is deemed withdrawn by operation of regulation, and no separate denial is required.

How This Changes the Landscape

For Insurers and Defense Counsel

This decision provides significant defensive protection:

• No denial necessary — When verification goes unanswered for 120 days, the claim is deemed withdrawn without any affirmative action by the insurer.
• No preclusion risk — The insurer’s failure to issue a denial within 30 days does not preclude the verification non-response defense, because there was no claim pending to deny.
• Simplified practice — Defense counsel can rely on the 120-day timeline without worrying about concurrent denial obligations.

However, documentation remains critical. Insurers must still be able to prove:

1. Timely mailing of the initial verification request
2. Proper follow-up if applicable
3. That no responsive verification was received within 120 days

The proof-of-mailing standards that apply to other no-fault defenses apply with equal force here.

For Providers and Plaintiff Counsel

This decision makes verification compliance more important than ever. The consequences of failing to respond to verification requests are now stark:

• No safety net — Providers can no longer argue that the insurer’s failure to issue a denial preserved the claim despite verification non-response.
• 120 days is a hard deadline — Once 120 days pass from the first verification request without a response, the claim is gone.
• Objections must be timely — If a verification request is objectionable, the objection must be raised within the 120-day window. Silence is fatal.

The Broader Verification Timeline

The Chapa Prods. decision is the latest in a long line of cases addressing verification requirements:

• 2010 — Failure to respond to all verification renders lawsuit premature — early establishment that partial compliance is insufficient.

• 2014 — Non-receipt of verification not proven — insurer bears burden of proving verification was properly mailed.

• 2015 — “Do you really believe the verification was mailed?” — courts scrutinize proof of mailing with increasing rigor.

• 2017 — Non-responded-to verification fatal to plaintiff’s case — partial verification response held insufficient; action is premature.

• 2018 — Verification issues continue — ongoing pattern of disputes over compliance.

• 2026 — Chapa Prods. — no denial required when verification goes unanswered for 120 days.

The trajectory shows courts progressively strengthening the verification requirement while simultaneously clarifying the procedural framework. Chapa Prods. represents the logical endpoint: if the regulation deems a claim withdrawn for non-response, then the insurer has no obligation to act on a claim that no longer exists.

Practical Recommendations

For Providers

1. Treat every verification request as urgent. The 120-day clock starts running immediately.
2. Calendar the deadline. Track the 120-day window from the date of the initial request.
3. Respond in full. Partial responses are insufficient and may be treated as non-responses.
4. Object in writing if the request is improper. Silence will be treated as non-response.
5. Confirm receipt. Use certified mail or other trackable methods to confirm that verification responses were received.

For Insurers

1. Document everything. Proof of mailing of verification requests is essential.
2. Track the 120-day window. Maintain systems that flag claims where verification has not been received within 120 days.
3. While no denial is required, consider issuing one anyway as a belt-and-suspenders approach, particularly for high-value claims where the defense may be challenged.

The Intersection with Other No-Fault Defenses

The Chapa Prods. holding does not exist in isolation. Verification non-response often intersects with other defenses:

• EUO no-show — If verification includes an EUO demand, non-appearance at the EUO is a separate defense with its own requirements.
• Priority of payment — The recent holdings on priority of payment in arbitration may affect how exhaustion defenses interact with verification timelines.
• Medical necessity — A peer review denial is a separate defense that requires its own timely denial, distinct from verification non-response.

Understanding how these defenses interact is essential for effective no-fault practice.

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For questions about verification requirements, 120-day timelines, or any no-fault insurance matter, contact the Law Office of Jason Tenenbaum at 516-750-0595 for a free consultation.