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

Last reviewed: September 2026.

Legal Update (September 2026): Chapa Prods., Corp. v MVAIC, 245 AD3d 880 (2d Dept 2026) rejected a mandatory 150-day deadline for a denial based on missing verification. It did not hold that a claim automatically disappears after 120 days.

The original headline is too broad. The decision concerns the timing of a denial that the insurer had issued; it should not be read as dispensing with every denial or every requirement for the defense.

What changed between the two Chapa decisions

Chapa sought payment of assigned no-fault benefits. The Civil Court granted MVAIC’s cross-motion for summary judgment in March 2017. The Appellate Term’s November 2019 decision then imposed a deadline: deny within 30 days after the applicant’s 120-day response period expires. MVAIC’s denials had been mailed 208 days after the initial requests.

That court treated the denials as ineffective for the complete defense, but still dismissed the action without prejudice as premature because verification remained outstanding. Those are different outcomes. Failure to establish a complete defense did not establish that the bills were payable.

On January 28, 2026, the Second Department reversed the order insofar as appealed from and restored the Civil Court’s grant of MVAIC’s cross-motion. The regulation permitted denial after more than 120 days under its stated conditions but did not add a mandatory 150-day cutoff. The court declined to insert one.

The archive’s 2019 Chapa note records the earlier position. Its 150-day analysis must be read with this reversal, not applied as the current holding.

What the 120-day rule actually requires

The DFS text of Regulation 68, §§ 65-3.5(o) and 65-3.8(b)(3) supplies the conditions that the earlier version of this article omitted.

An applicant must provide the requested verification within its control or possession, or written proof giving reasonable justification for noncompliance, within 120 calendar days of the initial request. The insurer’s request must advise the applicant of those alternatives and the possibility of denial.

After more than 120 calendar days, the regulation permits a denial when neither qualifying submission has been made. Its wording is not an automatic-withdrawal provision.

These subdivisions expressly exclude prescribed NF forms, medical-examination requests and examination-under-oath requests. For medical-service claims, they apply to treatment or services rendered on or after April 1, 2013; the accident date controls applicability for the specified lost-earnings and expense claims. An older note may therefore concern a different regulatory setting.

That matters when a file contains both document requests and EUO notices. Identify which request supports the defense. A rule about missing documents cannot simply be carried over to a missed examination.

Initial requests and follow-up remain separate steps

Under § 65-3.5(b), additional verification is requested within 15 business days after receipt of the completed prescribed verification forms. This is not a single deadline for every notice an insurer sends.

Section 65-3.6(b) addresses follow-up. If verification remains missing 30 calendar days after the original request, the insurer must follow up within ten calendar days, by mail or a properly documented telephone call. The provision also requires written identification of the missing verification and its requested source to the applicant and attorney.

Chapa decided the added denial deadline. It did not excuse missing request evidence, resolve every mailing dispute or remove the response and notice conditions in the regulation.

A response is not the same thing as silence

In Matter of Progressive Cas. Ins. Co. (Elite Med. Supply of N.Y., LLC), 162 AD3d 1471 (4th Dept 2018), the court upheld master-arbitration review addressing a timely reasonable-justification response. The master arbitrator treated the objection as requiring a decision and, if rejected, an opportunity to supply the information.

That procedural holding does not make every objection sufficient or every denial without prejudice. Read the original 2018 commentary with that limitation.

TAM Med. Supply Corp. v Tri State Consumers Ins. Co., 57 Misc 3d 133(A) (App Term 2017) illustrates a different issue: competing proof about whether verification was mailed created a factual dispute. Its use of timeliness language did not calculate a universal post-120-day deadline. The 2017 note preserves the question practitioners were asking before Chapa.

For a particular claim, read the request and its warning alongside the response evidence. Then identify the relief sought: dismissal on a complete defense, dismissal because the action is premature, or payment of an overdue bill. A date calculation alone does not answer all three.

Latest developments

The 2026 Chapa reversal above supplies the current denial-timing development for this topic. The directory below preserves the earlier debates about requests, proof and responses. Historical headlines describe their own posts, not a certification that every proposition remains current.

Cases in this topic

This directory contains 83 legacy posts from 2008–2023, grouped by the issue they discuss and ordered newest first within each group. Start with the request type and the proof in dispute. Some notes predate the 2013 amendment; the 2019 Chapa timing rule was reversed in 2026.

120-day responses, denial timing and regulatory changes

• No-Fault Verification Requirements: When Partial Compliance Isn’t Enough (2023)
• Justification for a lt (2022)
• 120-day rule and Fee Schedule (2020)
• The 120-day rule (2019)
• The first citing of 65-3.5(p) – somewhat ominous (2019)
• Understanding Verification Requirements in No-Fault Insurance Claims: When the Denial Can Wait (2019)
• 120-day rule crumbles (2018)
• 120-day rule rebutted (2018)
• First sighting of 120-day rule (2017)
• The amendments to the regulations and what they mean to you. (2013)

Mailing, follow-up requests and claim-processing time

• Untimely Follow-Up EUO Letters: The 10-Day Rule in New York No-Fault Cases (2020)
• Understanding Verification Requests in New York No-Fault Insurance Claims (2018)
• There is no safety valve for a late follow-up (2018)
• Verification issues (2018)
• The verifications were not mailed (2016)
• Do you really believe that the verification was mailed? I don’t (2015)
• Time frame to deny following EUO (2015)
• Understanding New York No-Fault Insurance Verification Timing: When 30 + 10 + 5 = Timely (2011)
• The Verification Process in No-Fault Insurance: When Technical Requirements Override Common Sense (2011)
• Verification Timing in No-Fault Claims: When Bills Are Properly Delayed (2011)

Proof of compliance, non-receipt and partial responses

• Who Bears the Burden of Proving Verification Compliance at a No-Fault Trial? (2019)
• Verification, again (2019)
• Additional Verification non-receipt (2017)
• Additional Verification in No-Fault: What Counts as a Proper Response (Excel Surgery v Fiduciary) (2017)
• Partial response to verification insufficient (2017)
• The feigned verification response does not slice it – a break from the law as certain arbitrators construe it (2017)
• Enough with the Rybak verification affidavit (2016)
• The verification affidavits again (2016)
• Verification non-receipt – Partial response insufficient (2016)
• Additional verification not produced is probative of nothing (2015)
• A verification non receipt decision that does not make sense. (2015)
• Another less than valid verification compliance affidavit suffices (2015)
• Boilerplate affidavit mandates triable issue of fact on verification issue (2015)
• EUO no-show and verification non-receipt (2015)
• Non receipt and verification (2015)
• Verification Affidavits and the Mailing Presumption: Compas Med. v Praetorian (2015)
• A triable issue of fact (2014)
• Non receipt of verification not proven (2014)
• Verification (2014)
• Verification defense upheld (2014)
• Another verification again (2013)
• Additional Verification (2013)
• Additional Verification non-receipt and lack of medical necessity. (2013)
• Amended motion/Admissible Reply papers/Defects in affidavits/delay letter vs. verification requests (2013)
• Evidence insufficient to prove that provider complied with verification request (2013)
• Additional verification non receipt + unrebutted IME (2011)
• Defense of unbundling requires coding expert affidavit (2010)
• Spell it out in the affidavit (2010)

Forms, requested materials and medical-billing issues

• Verification – MRI (2021)
• Verification and Fee Schedule Defenses in No-Fault Litigation: Blackman v Nationwide (2020)
• Verification Forms in New York No-Fault Insurance: Understanding NF-3 Requirements (2019)
• No-Fault Insurance Additional Verification: Complete Guide for New York Providers (2019)
• The By-Report (2017)
• Follow the NF-5 (2014)
• Navigating New York No-Fault Additional Verification Challenges: Long Island Healthcare Providers (2013)
• Additional verification not received – MRI films from an MRI facility (2012)
• How did you know that you never received the requested verification? (2010)
• The failure to respond to ALL of the requested verification renders lawsuit premature (2010)
• I was beaten by a fellow blogger on the verification issue… (2008)

Objections, EUO requests and procedural context

• Post-EUO Verification Demands and the 120-Day Rule: State Farm v Burke Physical Therapy (2022)
• Remote Legal Practice During COVID-19: How New York No-Fault Litigation Adapted (2020)
• Another Verification (2019)
• Outstanding Verification Trials: New York No-Fault Insurance Defense Guide (2019)
• A 65-3.2 sighting (2018)
• No need to send letter to attorney (2018)
• Non responded to verification fatal to plaintiff’s case (2017)
• Trial de-novo win where carrier did not respond to verification objection letter and wins. (2017)
• Allowing non-sense to continue (2015)
• Delay letters v. verification requests (2015)
• They did not act in good faith (2015)
• Additional verification issue (2014)
• New York Central Mutual has got tied up in Sound Shore (again?) (2014)
• EUO letter did not toll time to pay or deny (2013)
• Conclusory statement that the bill was not received is insufficient to stave off summary judgment (2011)
• EUO letter need not be in large font – ADA litigation here we come (2011)
• Insurance Verification Requests: Be Careful What You Ask For | Long Island No-Fault Attorney (2011)
• My AIG bail out money at work (2011)
• An unobjected to EUO notice precludes a later challenge to the propriety of the notice (2010)
• Procedural Fairness in No-Fault Insurance Litigation: Is It Fair? | Long Island & NYC Legal Analysis (2010)
• The EIP does NOT need to be notified when the carrier is seeking verification from a provider of medical services (2010)
• The first case interpreting Infinity v. Eveready (2010)
• Appellate Division to Rule on Timeliness of Follow-Up Additional Verification Requests (2009)
• Equitable considerations now invade no-fault law (2009)

Connect to the Encyclopedia

Return to the Legal Encyclopedia’s no-fault topics for the surrounding subject areas. For the historical sequence, use:

• Chapa in 2019: the 150-day rule later reversed.
• The 2013 verification amendments: the regulatory starting point.
• TAM in 2017: a dispute over whether verification was supplied.
• Progressive in 2018: reasonable justification in master-arbitration review.

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