The 120-Day Verification Rule in New York No-Fault: Chapa v MVAIC and How the Rule Developed

Why this page exists

This page is the hub for no-fault verification in the Legal Encyclopedia. The firm’s notes on the verification decisions of the Appellate Term and the Appellate Division from 2008 to 2023 are collected in the directory at the end of this page. The February 2026 version of this page read the 2026 Chapa opinion as dispensing with the denial. It does not, and the note above says so. The rule statements below were rewritten from the text of 11 NYCRR 65-3.5(o) and 65-3.8(b)(3) and from the opinions listed under Sources, each read for this revision.

Use the directory this way. The entries are grouped by the question each decision answers, newest first within each group, each with the month it was published and the note’s own one-line summary. An entry is marked as reversed only where an opinion read for this revision says so; there is one, the November 2019 Chapa note.

The current rule

Section 65-3.5(o) of the regulation puts the obligation on the applicant: “An applicant from whom verification is requested shall, within 120 calendar days from the date of the initial request for verification, submit all such verification under the applicant’s control or possession or written proof providing reasonable justification for the failure to comply.” The same subdivision requires the request to advise the applicant that the insurer may deny the claim if neither arrives within the 120 days.

Section 65-3.8(b)(3) supplies the consequence. Its first sentence is the older rule: an insurer “shall not issue a denial of claim form (NYS form NF-10) prior to its receipt of verification of all of the relevant information requested.” Its second sentence is the 2013 addition: “However, an insurer may issue a denial if, more than 120 calendar days after the initial request for verification, the applicant has not submitted all such verification under the applicant’s control or possession or written proof providing reasonable justification for the failure to comply, provided that the verification request so advised the applicant as required in section 65-3.5(o) of this Subpart.”

Both subdivisions exclude a prescribed NF form, a medical examination request and an examination under oath request, and both apply to medical services rendered on or after April 1, 2013 (for lost earnings and other expenses, to accidents on or after that date). A request outside those lines is governed by the first sentence alone and by the toll in section 65-3.8(a)(1): benefits are not overdue until 30 calendar days after the insurer receives proof of claim, “which shall include verification of all of the relevant information requested.”

The appellate position is Chapa. The Second Department read the second sentence of section 65-3.8(b)(3) as one that “unambiguously states” that the insurer “may issue a denial” after the 120 days, and found that “[t]he regulations do not specify a time frame under which the insurer must issue a denial following the 120-day period.” Consequently, a denial on the 120-day ground is not untimely because of the number of days between the initial request and the denial. That is the whole of the holding. The court did not decide what “reasonable justification” means, did not decide whether a partial response ever satisfies the subdivision, and did not say that an insurer may treat a claim as closed without issuing a denial.

An insurer that never denies is where it has always been: the claim is not overdue until the verification arrives (11 NYCRR 65-3.8(a)(1)), and an action on it is premature. The 2019 Chapa decision, 66 Misc 3d 16 (App Term, 2d Dept, November 1, 2019), said as much (“merely provides that an insurer ‘may’ issue a denial”), and the 2026 reversal did not touch that passage.

The clocks that surround the rule, in order:

How the rule developed in New York

The rule has three ages: eleven years in which an unanswered request simply kept a claim open, the amendment that let the insurer close it, and thirteen years of decisions about what closing it requires. The timeline lists each step with its date, court and holding. The prose after it says what each step did not decide.

2002 to 2012: a toll with no end date

Revised Regulation 68 has been in effect since April 4, 2002. The Court of Appeals upheld it in Matter of Medical Socy. of State of N.Y. v Serio, 100 NY2d 854 (October 21, 2003), which concerned the shortened notice and proof-of-claim periods and says nothing about an applicant’s time to answer a verification request, because the revised regulation set none. Section 65-3.8(b)(3) then consisted of what is now its first sentence: no denial “prior to its receipt of verification of all of the relevant information requested.”

The Court of Appeals described the structure twice in 2007. Nyack Hosp. v General Motors Acceptance Corp., 8 NY3d 294 (March 22, 2007): an insurer “must pay or deny only a verified claim … within 30 calendar days of receipt; and, conversely, is not obligated to pay any claim until it has been so verified.” Hospital for Joint Diseases v Travelers Prop. Cas. Ins. Co., 9 NY3d 312 (November 20, 2007): the 30-day window “is tolled until it receives the relevant information requested,” and a carrier that fails to deny within the 30 days “is generally precluded from asserting a defense against payment of the claim,” citing Presbyterian Hosp. in City of N.Y. v Maryland Cas. Co., 90 NY2d 274 (1997).

Infinity Health Prods., Ltd. v Eveready Ins. Co., 67 AD3d 862 (2d Dept, November 17, 2009), shows the toll at its limit. The provider ignored the initial request and the follow-up. The Second Department held that the 30-day period “did not commence to run,” that the action was premature, and that the complaint should be dismissed “without prejudice to commencement of a new action”; a follow-up mailed three days early did not forfeit the toll. The archive’s notes from August 2009, November 2009 and January 2010 follow that appeal.

The problem the toll left was this. An unanswered request kept the claim open indefinitely. The insurer could not deny, because the first sentence of section 65-3.8(b)(3) forbade it; the provider could not win, because the claim was never overdue; and the provider could sue again the day after answering. That is the gap the 2013 amendment closed.

April 1, 2013: the amendment

The amendment added subdivision (o) to section 65-3.5 and the second sentence to section 65-3.8(b)(3), both quoted above, and added subdivision (p), under which an insurer’s technical defect or missed time frame “shall not negate an applicant’s obligation to comply with the request or notice.” Each applies to medical services rendered on or after April 1, 2013. The archive’s February 2013 note reproduces the adopted text and the reaction at the time; subdivision (p) has its own thread, beginning with the August 2019 note on Lida’s Medical Supply, a decision not re-read for this revision.

The drafting choice that mattered was the verb. The applicant “shall” respond within 120 days. The insurer “may” deny afterward. The regulation says when the applicant’s obligation ends and nothing about when the insurer’s permission ends. Every decision from 2017 to 2026 turns on one of those two words.

2017 to 2019: the Appellate Terms apply the rule

TAM Med. Supply Corp. v Tri State Consumers Ins. Co., 57 Misc 3d 133(A) (App Term, 2d Dept, September 22, 2017), was the first appellate application of subdivision (o): the insurer showed prima facie non-receipt, the provider’s affidavit raised “a presumption that the requested verification had been mailed to, and received by, defendant,” and the result was a trial. The Civil Court’s premise that the denial had been “timely and properly” issued was recited, not reviewed; the archive’s October 2017 note asked when a 120-day denial is timely. Solution Bridge, Inc. v State Farm Mut. Auto. Ins. Co., 61 Misc 3d 143(A) (App Term, 2d Dept, November 16, 2018), reached the same result and again recited a “timely” denial without defining it (November 2018 note).

The Fourth Department took the response side in Matter of Progressive Cas. Ins. Co. (Elite Med. Supply of N.Y., LLC), 162 AD3d 1471 (June 8, 2018). A supplier had refused pricing information within the 120 days as a trade secret, and the master arbitrator vacated fourteen awards on the reasoning that “a claimant who responds within the requisite 120-day period with a ‘reasonable justification’ is permitted to have that objection decided by the arbitrator and, if overruled by the arbitrator, is to be afforded the opportunity to produce the requested information.” The Fourth Department held that this corrected an alleged error of law, within the master arbitrator’s power; whether the objection was itself a reasonable justification was not decided. The June 2018 note carried a headline that overstated the decision and now says so.

The First Department’s Appellate Term decided Village Med. Supply, Inc. v Travelers Prop. Cas. Ins. Co., 61 Misc 3d 126(A) (September 17, 2018), on the older ground: the provider “failed to respond to timely requests for verification,” the claims were premature, and a “no good reason” objection under section 65-3.2(c) raised no issue. Subdivision (o) is not cited (September 2018 note).

CPM Med Supply, Inc. v State Farm Fire & Cas. Ins. Co., 63 Misc 3d 140(A) (App Term, 2d Dept, April 12, 2019), drew the line between the two ages. The provider “was required to respond.” A written answer that the requested invoices were “not needed” “is not a ‘reasonable justification for the failure to comply’ with a verification request (11 NYCRR 65-3.8 [b] [3]), or a sufficient response.” The court went further: the services were rendered after April 1, 2013 and the insurer “properly denied the claims at issue on the ground that plaintiff had failed to provide the requested verification within 120 days”; therefore, the insurer “was entitled to dismissal of plaintiff’s complaint with prejudice,” and the dismissal stood as one without prejudice only because the insurer had not cross-appealed. Before 2013, silence produced a premature action. After 2013, on a warned request and a denial, silence produces a dismissal with prejudice.

November 1, 2019: Chapa at the Appellate Term

MVAIC had mailed its denials 208 days after its initial verification requests. The provider raised the timing argument for the first time on appeal; the majority (Pesce, P.J., and Siegal, J.) reviewed it because it “has thus far evaded review.” The majority held that “the deadline to issue a denial based upon the ground that an applicant failed to provide complete verification … is 150 days after the initial request for verification,” that is, “30 days after the insurer is permitted to conclude that there was a failure to fully comply,” by analogy to the Second Department’s EUO and medical-examination no-show rule (Westchester Med. Ctr. v Lincoln Gen. Ins. Co., 60 AD3d 1045 [2009]). A denial after the 150th day “is a nullity with respect to that defense.”

The provider still lost. The documents it had sent were “not in compliance with the request,” so the pre-2013 rule applied: “the action should be dismissed as premature, i.e., without prejudice, which is the same position the parties would have been in before 11 NYCRR 65-3.8 (b) (3) was amended.” The difference between with and without prejudice was the whole appeal.

Justice Weston dissented in part: “by providing that an insurer ‘may’ issue a denial in these circumstances, the regulation clearly intends for the denial to be permissive, not mandatory,” and, in the sentence the Appellate Division would echo six years later, “Had the Department of Financial Services intended to impose a 150-day time limit on when an insurer must deny a claim for failure to provide the requested verification, it would have included such language in the regulations” (citing Patrolmen’s Benevolent Assn. of City of N.Y. v City of New York, 41 NY2d 205 [1976]). Leave to appeal was granted May 1, 2020. The archive’s November 2019 note was written on the majority’s rule and now carries the reversal.

2019 to 2023: the response cases while the appeal was pending

The 150-day rule did not slow the with-prejudice cases. Six weeks later, in Crystal Acupuncture, P.C. v Travelers Ins., 66 Misc 3d 130(A) (App Term, 2d Dept, December 13, 2019), the same court dismissed claims denied on the 120-day ground because the insurer’s prima facie proof of non-receipt “of all of the requested verification” went unrebutted (February 2020 note).

Two decisions then fixed what a provider’s affidavit must say. In Burke Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co., 75 Misc 3d 143(A) (App Term, 2d Dept, July 1, 2022), a panel led by Justice Weston held that an owner who “merely stated that he had mailed the requested verification ‘to the extent such response was proper and in [his] possession’” had “failed to demonstrate that it had provided the requested verification or had set forth a reasonable justification for the failure to comply.” New York Manual, P.T., P.C. v Nationwide Affinity Ins. Co. of Am., 78 Misc 3d 128(A) (App Term, 2d Dept, February 24, 2023), applied the same sentence to the same language (July 2022 and June 2023 notes).

January 28, 2026: the Second Department

The Appellate Division reversed the 2019 order “insofar as appealed from, on the law,” and affirmed the Civil Court’s grant of MVAIC’s cross motion, in one paragraph. Section 65-3.8(b)(3) “unambiguously states” that an insurer “may issue a denial” after 120 days; “[t]he regulations do not specify a time frame under which the insurer must issue a denial following the 120-day period”; had the Department of Financial Services intended a 150-day limit “it would have included such language in the regulations,” citing the same Patrolmen’s Benevolent Association decision the dissent had cited; therefore, “the Appellate Term improperly determined that the defendant’s denial of the plaintiff’s claim was untimely.”

The court did not reach the preservation point, so an insurer defending a late denial should not assume the argument will be treated as unpreserved; and the court did not say what a provider must show to defeat the defense, so CPM, Burke and New York Manual remain the answer: production, or a written reason given within the 120 days.

Where the courts stand

In the Second Department, the Appellate Division has spoken: a 120-day denial has no outer time limit, and the Appellate Term’s own decisions from CPM through New York Manual govern what a response must contain. In the First Department, the Appellate Term has treated an unanswered request as a prematurity problem (Village Med. Supply, 2018); no First Department decision on the timing of a 120-day denial is in the firm’s archive or was found for this revision. The Fourth Department’s only word is Elite: in arbitration, a timely written objection must be decided before the claim is denied for non-production, reviewed under CPLR article 75. No Third Department decision on subdivision (o) is in the archive. The Court of Appeals has not construed subdivision (o) or the second sentence of section 65-3.8(b)(3) in any decision read for this revision.

Three questions remain open: what written proof amounts to “reasonable justification” (the decided cases are negative examples, “not needed” in CPM and the qualified affidavit in Burke and New York Manual, plus the arbitration procedure in Elite); what happens when the applicant gives a timely written reason and the insurer denies anyway (no Second Department court decision read for this revision has faced that record); and whether the First Department’s Appellate Term will apply Chapa when a denial-timing argument reaches it.

What this means in practice

For the provider or the billing office

Calendar day 120 runs from the date on the initial request, not from the day it arrived and not from the follow-up. Answer every item. For each item you will not or cannot supply, write down why, in the response, within the 120 days. “Not needed” is not a reason (CPM). In my experience the response that survives a motion lists each requested item and states, item by item, produced, not in our possession, or objected to for a stated reason.

Keep the mailing record that describes the office practice; that is what raised the presumption in TAM and Solution Bridge. An affidavit written after suit that hedges (“to the extent such response was proper and in [his] possession”) lost in Burke and New York Manual. Do not treat a denial as void because it came late; after Chapa, the date of a 120-day denial is not a defense. If the request itself is the problem, object within the 120 days and say why; in arbitration, Elite means the objection is decided before the claim is denied for non-production, and in court a bare “no good reason” objection lost in Village Med. Supply.

For the injured person

For lost earnings and other expenses, subdivision (o) applies to accidents on or after April 1, 2013, and the request must warn you that the claim may be denied. Answer in writing and keep a copy. If an employer or another third party holds the information, say so in the response and say what you did to get it. Section 65-3.5(m) bars a denial “based upon late submission of proof of claim” where a third party withheld wage information; it does not address the 120-day response.

For the insurer or the claims office

The second sentence of section 65-3.8(b)(3) applies only “provided that the verification request so advised the applicant as required in section 65-3.5(o).” A request without the warning leaves the first sentence and the toll. Follow up within 10 calendar days after the 30th day (11 NYCRR 65-3.6(b)); Infinity forgave a three-days-early follow-up on its facts, and the archive’s January 2018 note records a late one that was not forgiven. Be able to prove the mailing of the request; in Healing Health Prods., Inc. v New York Cent. Mut. Fire Ins. Co., 44 Misc 3d 59 (App Term, 2d Dept, May 22, 2014), the question was “not whether the requests were received by plaintiff, but whether defendant mailed them.” Chapa removes the 150-day cutoff. It does not remove the need for a denial that states the ground, or for proof of non-receipt of “all of the requested verification” (Crystal, New York Manual).

The three responses a court sees most often, and what each has produced:

Bring these to the first call, whichever side of the file you are on: the initial request with its warning paragraph; each follow-up, with its date; the response, its attachments and the mailing record; the denial of claim form (NF-10), with its date and stated ground; and the dates of service, because a service before April 1, 2013 is outside subdivision (o).

Decisions in the archive, newest first

Each entry below is one of the firm’s notes on a verification decision, grouped by the question the decision answers and listed newest first within each group. The one-line description is the note’s own summary. Only the decisions listed under Sources were re-read for this revision; the notes name the rest as the archive names them. One entry is marked as reversed, on the strength of the 2026 Chapa opinion.

120-day responses, denial timing and regulatory changes

• No-Fault Verification Requirements: When Partial Compliance Isn’t Enough (June 2023): New York Manual’s 2023 partial-verification ruling: what the affidavit failed to explain, the reasonable-justification rule, and related historical decisions.
• Justification for a lt (July 2022): Burke Physical Therapy v State Farm: why a qualified mailing statement failed to prove verification compliance or a reasonable justification.
• 120-day rule and Fee Schedule (February 2020): Crystal Acupuncture v Travelers: claims denied for failure to provide verification within 120 days were dismissed on unrebutted proof of non-receipt, and the fee schedule branches were upheld.
• The 120-day rule (November 2019): The 2019 Chapa 150-day verification deadline was reversed in 2026. Compare the two decisions, the 120-day response rule and premature no-fault suits. (Reversed insofar as appealed from by Chapa Prods., Corp. v MVAIC, 245 AD3d 880, January 28, 2026.)
• The first citing of 65-3.5(p): somewhat ominous (August 2019): Lida’s Medical Supply and 11 NYCRR 65-3.5(p): an unpreserved timing argument, denied cross-motions, and the distinction between compliance and proof.
• Understanding Verification Requirements in No-Fault Insurance Claims: When the Denial Can Wait (July 2019): Parisien held an EUO denial timely after written verification was received. Read the event sequence and why the case does not permit indefinite delay.
• 120-day rule rebutted (November 2018): Solution Bridge v State Farm left a factual dispute over mailed verification. It did not abolish the 120-day rule or require postal receipts in every case.
• 120-day rule crumbles (June 2018): Elite Medical Supply addressed timely objections to verification in master arbitration. The 120-day rule survived; read the holding and its EUO limits.
• First sighting of 120-day rule (October 2017): TAM Medical raised a receipt dispute, not a new universal denial deadline. Follow the 2017 note through the 2026 Chapa rejection of a 150-day cutoff.
• The amendments to the regulations and what they mean to you. (February 2013): The 2013 Regulation 68-C amendment, its effective-date limits, verification and denial provisions, and what Chapa clarified about the 120-day rule in 2026.

Mailing, follow-up requests and claim-processing time

• Untimely Follow-Up EUO Letters: The 10-Day Rule in New York No-Fault Cases (February 2020): Restoration Chiropractic v 21st Century: a follow-up EUO scheduling letter mailed more than 10 days after a no-show is untimely under New York’s no-fault rules.
• Understanding Verification Requests in New York No-Fault Insurance Claims (December 2018): Lenox Hill Radiology’s 2018 mailing ruling: initial and follow-up requests, proof of nonresponse, and comparisons with other verification cases.
• There is no safety valve for a late follow-up (January 2018): Acupuncture Healthcare Plaza v Allstate: the late EUO follow-up ruling, section 65-3.8(l), and why other timing decisions need careful comparison.
• Verification issues (January 2018): Atlantic Radiology’s 2018 late-follow-up ruling, the correct calendar-day requirements, and the difference between an alleged delay and incomplete verification.
• The verifications were not mailed (October 2016): Daily Medical v Auto One: the insurer failed to prove mailing of verification requests. NF-10s are denial forms, not requests for additional verification.
• Do you really believe that the verification was mailed? I don’t (November 2015): New Way v State Farm: a provider’s mailing affidavit created a receipt dispute, while a separate illegibility defense failed. Two claims, two results.
• Time frame to deny following EUO (August 2015): South Nassau Orthopedic v Farm Family: how bill receipt and the completed EUO set the denial deadline when no other verification was outstanding.
• The Verification Process in No-Fault Insurance: When Technical Requirements Override Common Sense (March 2011): The official Exoto opinion was withdrawn from online publication. Preserve the 2011 commentary, then check NF-3 signatures and forms against DFS sources.
• Understanding New York No-Fault Insurance Verification Timing: When 30 + 10 + 5 = Timely (January 2011): Triangle R upheld tolling despite a follow-up five days late on its facts. See the dates, the 30-plus-10-day rule and the limits of the 2010 decision.
• Verification Timing in No-Fault Claims: When Bills Are Properly Delayed (January 2011): Sound Shore v NYCM: why an earlier UB-04 supported verification timing, how NF-5 differs from NF-2, and what the contrasting GMAC record showed.

Proof of compliance, non-receipt and partial responses

• Who Bears the Burden of Proving Verification Compliance at a No-Fault Trial? (September 2019): Right Aid v State Farm reversed a verification-trial dismissal and ordered a new trial. Read the correct burden ruling and the companion Island Life decision.
• Verification, again (March 2019): New Horizon v Travelers: a requested informed-consent form was missing from the verification record, defeating the provider’s assertion of full compliance.
• Partial response to verification insufficient (December 2017): Doctor Goldshteyn v Travelers: partial verification left the suit premature. Read the limited holding, objection distinction and later Chapa timing update.
• Additional Verification non-receipt (July 2017): Daily Medical v Interboro: missing verification made the suit premature. Compare receipt evidence, mailing presumptions and Jason’s delivery-receipt question.
• Additional Verification in No-Fault: What Counts as a Proper Response (Excel Surgery v Fiduciary) (April 2017): Excel Surgery v Fiduciary: why a general records disclaimer failed, and how Mount Sinai v Auto One differs without guaranteeing payment.
• The feigned verification response does not slice it: a break from the law as certain arbitrators construe it (March 2017): St. Barnabas v GEICO: why a general emergency-treatment response left verification outstanding, the follow-up the insurer sent, and the limits of the ruling.
• Verification non-receipt: partial response insufficient (October 2016): Compas v Travelers: partial verification responses, timely objections, and the proof supporting dismissal of a no-fault action as premature.
• Enough with the Rybak verification affidavit (June 2016): Great Health Care’s 2016 affidavit ruling, Jason’s original criticism, and the evidence needed to distinguish a disputed response from partial compliance.
• The verification affidavits again (June 2016): Great Health Care Chiropractic v Hereford: an owner’s affidavit raised a verification-receipt issue, but the decision did not approve bare mailing assertions.
• Verification Affidavits and the Mailing Presumption: Compas Med. v Praetorian (December 2015): Compas v Praetorian: an owner’s affidavit kept one verification claim alive, while separate IME dismissals stood. The opinion does not reproduce the affidavit.
• A verification non receipt decision that does not make sense. (November 2015): New Way’s 2015 appeal left four verification claims disputed but affirmed the fifth claim’s dismissal. Compare the ruling with Jason’s original file critique.
• Another less than valid verification compliance affidavit suffices (November 2015): Compas v Praetorian: a mailing affidavit created a dispute on one verification claim, while five IME/EUO dismissals remained in place.
• Additional verification not produced is probative of nothing (October 2015): Compas v Praetorian separated outstanding document verification from missed IMEs and EUOs. Read the claim-by-claim proof and Jason’s original case note.
• EUO no-show and verification non-receipt (October 2015): The insurer’s proof of timely mailed verification requests and EUO scheduling letters, set against the provider’s claim of non-receipt and the assignor’s no-shows.
• Boilerplate affidavit mandates triable issue of fact on verification issue (May 2015): Three 2015 verification-affidavit decisions compared: who moved, what remained disputed, and why neither a form affidavit nor nonreceipt decides every case.
• Non receipt and verification (April 2015): Longevity v Praetorian separates nonreceipt of a bill from nonreceipt of verification: one claim won summary judgment and the other remained disputed.
• Verification defense upheld (August 2014): SS Medical Care v Eveready: an unopposed verification cross-motion and why this record did not require extra proof that the letter copies were unaltered.
• A triable issue of fact (June 2014): NYU Hospital-Tisch v GEICO: the final verification response, a denial 29 days later, and why a peer-review dispute did not justify summary judgment.
• Verification (June 2014): Healing Health Products v NYCM: detailed incoming-mail evidence raised a verification dispute, and neither party had the trial-limiting order it assumed.
• Non receipt of verification not proven (April 2014): E4 Services v Lincoln General: why denying receipt did not defeat proof of mailed verification requests, and what the court said about office procedures.
• Evidence insufficient to prove that provider complied with verification request (November 2013): Pomona v Praetorian: why a third-party biller’s affidavit failed to prove a verification response, without requiring an eyewitness to every mailing.
• Amended motion/Admissible Reply papers/Defects in affidavits/delay letter vs. verification requests (August 2013): Colonia Medical: correcting an IME affidavit did not cure inconsistent proof, and an investigation delay letter did not toll the no-fault claim clock.
• Additional Verification (April 2013): Leica Supply explains why a delay notice did not toll no-fault payment deadlines. Read the decision, the limits of its holding and verification comparisons.
• Additional Verification non-receipt and lack of medical necessity. (April 2013): Utica Acupuncture separated missing-verification proof from medical necessity. Read why the insurer won both branches and what the provider’s evidence lacked.
• Another verification again (February 2013): Viviane Etienne’s 2013 appeal separated verification, IME and fee-schedule claims. Read the mixed result without turning Jason’s coding suspicion into law.
• Additional verification non receipt + unrebutted IME (August 2011): Verification non-receipt and an unrebutted IME report in one motion: what each branch required the insurer to prove before litigation.
• Spell it out in the affidavit (December 2010): An attorney’s affirmation without personal knowledge carried no probative weight on whether the verification was supplied.
• Unbundling defense needs a qualified coding affidavit (First Aid) (February 2010): First Aid’s unbundling defense lacked qualified affidavit support, while its verification branches succeeded. Read the split 2010 result and later proof rules.

Forms, requested materials and medical-billing issues

• Verification: MRI (June 2021): Lenox Hill Radiology v Hereford: MRI copying costs did not end the verification toll, but the court left a separate 120-day denial question open.
• Verification and Fee Schedule Defenses in No-Fault Litigation: Blackman v Nationwide (February 2020): Blackman v Nationwide: a generic mailing affidavit raised an issue of fact on verification, and the 2015-service fee schedule defense needed no preservation.
• No-Fault Insurance Additional Verification: Complete Guide for New York Providers (October 2019): New Horizon Surgical explains incomplete no-fault verification responses. Compare the 2019 decision, current response alternatives and proof of compliance.
• Verification Forms in New York No-Fault Insurance: Understanding NF-3 Requirements (August 2019): Find New York’s official NF-3 provider form, distinguish it from additional verification, and read Right Aid’s ruling on proof of nonreceipt.
• The By-Report (February 2017): Bronx Acupuncture v Hereford: By Report codes 97039 and 99199, missing documentation, and why the insurer’s summary judgment motion failed.
• Follow the NF-5 (May 2014): Mount Sinai v Dust Transit: the NF-5 claim date, an effective verification request without follow-up, and why the hospital won summary judgment.
• New York no-fault additional verification challenges for Long Island providers (All Boro v Allstate) (January 2013): All Boro v Allstate: unpaid did not establish overdue, and uncontroverted missing verification supported dismissal on a search of the appellate record.
• Additional verification not received: MRI films from an MRI facility (January 2012): Radiology Today v NYCM: missing MRI films, proof of mailed verification requests, and dismissal as premature rather than a ruling on medical necessity.
• The failure to respond to ALL of the requested verification renders lawsuit premature (October 2010): Eagle Surgical’s October 2010 appeal found an incomplete verification response. Compare its record with the August proof failure and later objection rules.
• How did you know that you never received the requested verification? (August 2010): Eagle Surgical’s August 2010 appeal: timely verification requests did not prove nonreceipt. Read the witness-proof gap and the contrasting October decision.
• I was beaten by a fellow blogger on the verification issue… (December 2008): Infinity v Eveready: the 2008 premature-follow-up ruling, its 2009 reversal, and the distinction between insurer deadlines and provider responses.

Objections, EUO requests and procedural context

• Post-EUO Verification Demands and the 120-Day Rule: State Farm v Burke Physical Therapy (March 2022): State Farm v Burke: the 2022 post-EUO ruling, later appellate decisions on document scope and timing, and why reasonable justification remains record-specific.
• Remote Legal Practice During COVID-19: How New York No-Fault Litigation Adapted (March 2020): Jason’s March 2020 remote-practice dispatch, the actual scope of New York’s filing restrictions, and the records that no-fault case review still needs.
• Outstanding Verification Trials: New York No-Fault Insurance Defense Guide (August 2019): Island Life v Travelers: who presents proof first at a limited verification trial, what CPLR 3212(g) establishes, and why a new trial was ordered.
• Another Verification (July 2019): Orthoplus v Global Liberty: incomplete verification, requests authorized through counsel, and why the First Department dismissed the action as premature.
• A 65-3.2 sighting (September 2018): Village Medical Supply v Travelers: the reason for requesting manufacturer invoices under 11 NYCRR 65-3.2(c), and why a general objection failed.
• No need to send letter to attorney (January 2018): Recover Medical Services v Ameriprise: late EUO requests defeated dismissal for some bills, while the attorney-notice objection failed for three others.
• Non responded to verification fatal to plaintiff’s case (December 2017): City Care Acupuncture v Allstate: the providers’ own responses left verification unanswered, supporting dismissal as premature on that 2017 record.
• Trial de-novo win where carrier did not respond to verification objection letter and wins. (July 2017): The 2017 Lewin verification dispute: missing MRI films, third-party requests, the unopposed cross-motion, and the limits of a provider’s objection letter.
• Delay letters v. verification requests (November 2015): A generic delay letter does not toll the time to pay or deny; only a request for verification extends it.
• Allowing non-sense to continue (August 2015): Compas v American Transit left separate disputes over bill receipt and verification responses for trial; the opinion does not reproduce a “bare” affidavit.
• They did not act in good faith (February 2015): Allstate v Westchester Medical Group upheld a no-fault arbitration award under limited judicial review; the good-faith observation came from the arbitrator.
• New York Central Mutual has got tied up in Sound Shore (again?) (August 2014): Mount Sinai v New York Central Mutual: why the NF-5 started the claim clock after a defective UB-04 submission, and why the earlier denial failed.
• Additional verification issue (April 2014): Elmont Open MRI v New York Central: a verification dispute prevented summary judgment for both sides. Read the Nassau appeal’s limited result.
• EUO letter did not toll time to pay or deny (October 2013): An EUO scheduling letter that did not identify the person to be examined lost the toll, as the 2013 note reads the decision.
• Conclusory statement that the bill was not received is insufficient to stave off summary judgment (September 2011): Darlington v Praetorian: a conclusory denial of receiving verification, the insurer’s initial mailing proof, and the difference between requests and bills.
• My AIG bail out money at work (May 2011): The AIG hospital decision was recalled and replaced in November 2011. Read the corrected opinion on investigation letters, verification and untimely denial.
• Insurance Verification Requests: Be Careful What You Ask For | Long Island No-Fault Attorney (March 2011): A hospital supplied the January 2004 NF-5 version the insurer requested. Read the 2011 ruling, the official hospital form and limits on technical objections.
• EUO letter need not be in large font: ADA litigation here we come (February 2011): GLM rejected a bold-or-large-font rule for EUO notices on its record. Read the ruling, nonappearance proof and limits of the ADA remark.
• The EIP does NOT need to be notified when the carrier is seeking verification from a provider of medical services (December 2010): Triangle R v Clarendon: misaddressed copies to the injured person did not invalidate verification requests properly directed to the medical provider.
• An unobjected to EUO notice precludes a later challenge to the propriety of the notice (May 2010): A provider that did not object to an EUO notice when it arrived could not later challenge the notice’s propriety, as the 2010 note reads the decision.
• Procedural Fairness in No-Fault Insurance Litigation: Is It Fair? | Long Island & NYC Legal Analysis (March 2010): Ambrister upheld a documented second-notice practice. Separate that narrow holding from Jason’s broader questions about no-fault summary-judgment evidence.
• The first case interpreting Infinity v. Eveready (January 2010): Velen Medical Supply, the first Appellate Term decision the archive found applying Infinity v Eveready to verification request timing.
• Equitable considerations now invade no-fault law (November 2009): Infinity Health Products: the 2009 early follow-up ruling, the insurer’s actual win, and how later verification cases fit the historical decision.
• Appellate Division to Rule on Timeliness of Follow-Up Additional Verification Requests (August 2009): The Infinity v Eveready appeal was decided in November 2009. Read the outcome, the early follow-up timeline and the limits of its equitable holding.

Sources

Regulations, from the Legal Information Institute’s current text of 11 NYCRR part 65:

• 11 NYCRR 65-3.5, Claim procedure (subdivisions (b), (m), (o) and (p))
• 11 NYCRR 65-3.6, Follow-up requirements (subdivision (b))
• 11 NYCRR 65-3.8, Payment or denial of claim (30-day rule) (subdivisions (a)(1), (b)(3), (c) and (l))

Opinions, from the New York State Law Reporting Bureau unless noted:

• Chapa Prods., Corp. v MVAIC, 245 AD3d 880, 2026 NY Slip Op 00342 (2d Dept, January 28, 2026)
• Chapa Prods. Corp. v MVAIC, 66 Misc 3d 16, 2019 NY Slip Op 29341 (App Term, 2d Dept, 2d, 11th and 13th Jud Dists, November 1, 2019)
• New York Manual, P.T., P.C. v Nationwide Affinity Ins. Co. of Am., 78 Misc 3d 128(A), 2023 NY Slip Op 50281(U) (App Term, 2d Dept, February 24, 2023)
• Burke Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co., 75 Misc 3d 143(A), 2022 NY Slip Op 50623(U) (App Term, 2d Dept, July 1, 2022)
• Crystal Acupuncture, P.C. v Travelers Ins., 66 Misc 3d 130(A), 2019 NY Slip Op 52055(U) (App Term, 2d Dept, December 13, 2019)
• CPM Med Supply, Inc. v State Farm Fire & Cas. Ins. Co., 63 Misc 3d 140(A), 2019 NY Slip Op 50576(U) (App Term, 2d Dept, April 12, 2019)
• Solution Bridge, Inc. v State Farm Mut. Auto. Ins. Co., 61 Misc 3d 143(A), 2018 NY Slip Op 51648(U) (App Term, 2d Dept, November 16, 2018)
• Village Med. Supply, Inc. v Travelers Prop. Cas. Ins. Co., 61 Misc 3d 126(A), 2018 NY Slip Op 51311(U) (App Term, 1st Dept, September 17, 2018)
• Matter of Progressive Cas. Ins. Co. (Elite Med. Supply of N.Y., LLC), 162 AD3d 1471, 2018 NY Slip Op 04122 (4th Dept, June 8, 2018)
• TAM Med. Supply Corp. v Tri State Consumers Ins. Co., 57 Misc 3d 133(A), 2017 NY Slip Op 51247(U) (App Term, 2d Dept, September 22, 2017)
• Healing Health Prods., Inc. v New York Cent. Mut. Fire Ins. Co., 44 Misc 3d 59, 2014 NY Slip Op 24145 (App Term, 2d Dept, May 22, 2014)
• Infinity Health Prods., Ltd. v Eveready Ins. Co., 67 AD3d 862, 2009 NY Slip Op 08585 (2d Dept, November 17, 2009)
• Hospital for Joint Diseases v Travelers Prop. Cas. Ins. Co., 9 NY3d 312 (November 20, 2007) (Caselaw Access Project scan of the official reporter)
• Nyack Hosp. v General Motors Acceptance Corp., 8 NY3d 294 (March 22, 2007) (Caselaw Access Project scan of the official reporter)
• Matter of Medical Socy. of State of N.Y. v Serio, 100 NY2d 854 (October 21, 2003) (Caselaw Access Project scan of the official reporter)

If a verification file of yours is in dispute, whether you issued the denial or received it, request a case review or call (516) 750-0595. Bring the initial request, the response and the denial; the dates on those three documents decide most of these cases.

Attorney Jason Tenenbaum has recovered more than $100 million for clients across personal injury, employment, and no-fault matters since 2002. We work on contingency: no fee unless we win.