Did unanswered verification requests make the provider’s claim premature, or justify denying it for nonresponse?

Deciding this question means ruling on the insurer's outstanding-verification defense: whether the insurer timely requested additional verification (and followed up), whether the requested verification (or a written reasonable justification) was provided, and the consequence. Under the tolling rule the insurer's 30 days to pay or deny do not begin to run while properly requested verification is outstanding, so the provider's action is premature (usually dismissed without prejudice); for claims under the 2013 amendment (services after April 1, 2013) the insurer may instead deny the claim when verification is not provided within 120 days of the initial request (11 NYCRR 65-3.5 [o], 65-3.8 [b] [3]). A decision decides the question when it holds the action premature, upholds or rejects a denial for nonresponse, finds a triable issue on any element of the defense, or rejects the defense because the requests were defective or the provider complied.

Settled statewide by the Court of Appeals. The rule itself is not disputed anywhere: the Court of Appeals has stated that a timely verification request tolls the 30-day period until the information is received (Hospital for Joint Diseases v Travelers, 9 NY3d 312, 317 [2007], post 9310) and that an insurer must pay or deny only a verified claim (Nyack Hosp. v General Motors Acceptance Corp., 8 NY3d 294 [2007], not in the database), and the Appellate Division draws the consequence that a provider's action on an unverified claim is premature. The Court of Appeals has not itself dismissed an action as premature, so 'settled_department' is the cautious alternative. Disputes have been about application: the Appellate Term's strict reading of the 30-day follow-up timing (rejected by the Second Department in Infinity Health, 2009, and St. Vincent Med. Care, 2011) and the Appellate Term's 2019 '150-day' deadline for a 120-day nonresponse denial (Chapa, 66 Misc 3d 16), rejected by the Second Department in Chapa Prods., Corp. v MVAIC (2026). Decisions applying the 150-day rule between 2019 and January 2026 are no longer good law in the Second Department.

Leading authorities · Authority map · Decisions by court · Plain-text version (Markdown)

Leading authorities

Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co. (2005 NYSlipOp 09484) Appellate Division, Second Department, 2005Second Department: unanswered verification request makes the action prematureThe hospital admitted receiving the insurer's initial verification request but did not show any response, so the insurer was entitled to summary judgment dismissing its claim: an insurer need not pay or deny until it receives all requested verification. A second hospital that supplied the verification later, after which the claim was paid, could not recover interest or attorney's fees.
the plaintiff Central Suffolk Hospital, as assignee of Renard Legette, admitted receiving the defendant’s initial request for verification of the claim, yet failed to state what response, if any, was made. Pursuant to 11 NYCRR 65-3.8 (a) (1) and (b) (3), on the undisputed facts presented, the defendant was entitled to summary judgment dismissing the plaintiffs’ first cause of action
Later history: lv denied 7 NY3d 704 (2006), as cited in Lincoln Gen. Ins. Co. v Alev Med. Supply (post 8354)
New York & Presbyt. Hosp. v Progressive Cas. Ins. Co. (2004 NY Slip Op 01750) Appellate Division, Second Department, 2004Source of the rule: no response means 30 days never runRestates the verification timetable (request within 10 days, follow-up within 10 days after 30 days without response) and holds that a claim need not be paid or denied until all demanded verification is provided; when the hospital fails to respond, its claim is premature. Applied claim by claim (some claims granted because the insurer's verification proof was conclusory or related to another claim).
When a hospital fails to respond to a verification request, the 30-day period in which to pay or deny the claim does not begin to run, and any claim for payment by the hospital is premature
Sound Shore Med. Ctr. v New York Cent. Mut. Fire Ins. Co. (2013 NY Slip Op 02390) Appellate Division, Second Department, 2013Toll needs two timely post-claim requests; without follow-up, not prematureA request sent before the insurer received the N-F 5 (only a UB-04 had been received) did not toll; the only effective request was the one after the N-F 5, and because the insurer sent no follow-up, the toll expired, the action was not premature and the hospital won summary judgment. Nothing requires a third request.
any claim for payment by the medical service provider after two timely requests for verification have been sent by the insurer subsequent to its receipt of an N-F 5 form from the medical service provider is premature, if the provider has not responded to the requests
Later history: Reversed the Appellate Term order in Sound Shore Med. Ctr. v New York Cent. Mut. Fire Ins. Co., 2011 NY Slip Op 50033(U) (post 7480)
Chapa Prods., Corp. v MVAIC (2026 NY Slip Op 00342) Appellate Division, Second Department, 2026120-day nonresponse denial has no 150-day deadline11 NYCRR 65-3.8 (b) (3) sets no deadline for issuing a denial after the 120-day period; the Appellate Term erred in requiring the denial within 150 days of the initial request, and dismissal of the complaint on the 120-day ground was reinstated.
Had the New York State Department of Financial Services intended to impose a mandatory 150-day time limit to issue a denial for failure to provide the requested verification, it would have included such language in the regulations
Later history: Reversed the Appellate Term order in Chapa Prods. Corp. v MVAIC, 66 Misc 3d 16 (2019 NY Slip Op 29341, post 17551)
Hospital for Joint Diseases v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 05413) Appellate Division, Second Department, 2004Undisputed failure to respond to records requests: claim prematureDismissal of the fifth cause of action was affirmed because it was undisputed that the hospital never responded to the insurer's requests for medical records, so the insurer's time to respond never began to run and the claim was premature; requests made by letter rather than prescribed form were effective. (The first cause of action was decided on policy exhaustion, which is why many later citations are unrelated.)
It is undisputed that the NYHMCQ failed to respond to the defendant’s verification requests for medical records. Accordingly, the period within which the defendant was required to respond to this claim did not begin to run, and any claim for payment was premature
Nyack Hosp. v General Motors Acceptance Corp. 8 NY3d 294An insurer must pay or deny only a verified claim (quoted in Freligh, post 3834); basis for treating an unverified claim as not overdue. Cited by 64 posts.Not in our database.
Westchester County Med. Ctr. v New York Cent. Mut. Fire Ins. Co. 262 AD2d 553A claim need not be paid or denied until all demanded verification is provided; confusion about a request must be addressed by communication, not inaction. Cited by 67 posts.Not in our database.
St. Vincent's Hosp. of Richmond v American Tr. Ins. Co. 299 AD2d 338Insurer not obligated to pay or deny until all requested verification is received; partial responses do not trigger the 30 days; letter requests are effective. Cited by both anchors.Not in our database.
New York & Presbyt. Hosp. v American Tr. Ins. Co. 287 AD2d 699Timely verification request tolls the 30-day period (cited in Sound Shore and Infinity Health).Not in our database.
11 NYCRR 65-3.5 (o) and 65-3.8 (b) (3) (2013 amendment, effective April 1, 2013) 11 NYCRR 65-3.5 (o); 65-3.8 (b) (3)120-day period to provide verification or written reasonable justification; insurer may deny after it. Basis of the nonresponse_denial_upheld category.Not in our database.

Authority map

Each circle is a decision on this question, placed by court and date; its colour is the position it took. Lines are citations between them. Select a circle (or find a decision by name) to see its links and summary. The same decisions are listed by court below the map.

Timely requests went unanswered; the claim is not overdue and the action is prematureInsurer properly denied the claim because verification was not provided (120-day rule)Fact issues remain on whether the verification defense appliesDefense rejected because the insurer's requests or proof were deficientDefense rejected because the provider supplied the verification or justified noncomplianceRing: rules on the question, but another ground decided the caseContrasted, distinguished or limitedDeclined to follow, questioned, overruled or reversedCited Show ordinary citations

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How the rule was applied, by court

Court	Premature: verification outstanding	Nonresponse denial upheld	Triable issue	Insurer's showing fails	Provider complied	Total
Appellate Division, First Department	0	1	0	1	0	2
Appellate Division, Second Department	12	2	8	5	3	30
Appellate Division, Third Department	0	0	1	0	0	1
Appellate Term, First Department	21	1	3	4	1	30
Appellate Term, Second Department	118	9	94	46	2	269
Trial courts in the First Department	3	0	1	2	0	6
Trial courts in the Second Department	21	7	10	26	4	68

Decisions (406)

Every decision in our database that rules on this question: highest court first, then by department, newest first. 371 turn on it; the others rule on it alongside a different main ground (marked "also decides"). The one-sentence summaries describe what each court said on this question.

Appellate Division, First Department (2 decisions)

Health E. Ambulatory Surgical Ctr. v Country-Wide Ins. Co. (2025 NY Slip Op 06648) Appellate Division, First Department, December 2, 2025Defense rejected because the insurer's requests or proof were deficientRejected the verification defense because proving that verification requests were sent was the insurer's trial burden, and it offered no admissible proof of them, its motion-paper statements not being admissible evidence in chief.
Hereford Ins. Co. v 21 Century Chiropractic Care (2025 NY Slip Op 06022) Appellate Division, First Department, October 30, 2025Insurer properly denied the claim because verification was not provided (120-day rule)Upheld summary judgment for the insurer because it timely demanded subscription of the EUO transcripts within 15 business days and the claimants did not return them for years, well beyond the 120-day period allowing denial.

Appellate Division, Second Department (30 decisions)

Chapa Prods., Corp. v MVAIC (2026 NY Slip Op 00342) Leading case Appellate Division, Second Department, January 28, 2026Insurer properly denied the claim because verification was not provided (120-day rule)Held the insurer's denial for failure to provide requested verification within 120 days valid because 11 NYCRR 65-3.8 (b) (3) sets no deadline for issuing it, reinstating summary judgment dismissing the complaint.
Mount Sinai Hosp. v Auto One Ins. Co. (2014 NYSlipOp 06954) Appellate Division, Second Department, October 15, 2014Fact issues remain on whether the verification defense appliesHeld the insurer failed to show the action premature because the hospital answered as to records it held, and triable issues remained on the propriety of requests for items possibly not in its possession.
New York Hosp. Med. Ctr. of Queens v QBE Ins. Corp. (2014 NY Slip Op 00639) Appellate Division, Second Department, February 5, 2014Timely requests went unanswered; the claim is not overdue and the action is prematureHeld one claim not overdue because the insurer timely and properly requested and followed up on verification that went unanswered, while on another claim the insurer failed to show it properly requested verification.
Westchester Med. Ctr. v Allstate Ins. Co. (2013 NY Slip Op 08616) Appellate Division, Second Department, December 26, 2013Defense rejected because the insurer's requests or proof were deficientHeld the 30-day period was not extended because the insurer submitted no evidence that it mailed the required follow-up verification request after the hospital failed to answer the initial one.
Sound Shore Med. Ctr. v New York Cent. Mut. Fire Ins. Co. (2013 NY Slip Op 02390) Leading case Appellate Division, Second Department, April 10, 2013Defense rejected because the insurer's requests or proof were deficientHeld a request sent after a UB-04 but before the N-F 5 did not toll, and the insurer sent no follow-up to its only effective request, so the toll expired and the action was not premature.
Westchester Med. Ctr. v Progressive Cas. Ins. Co. (2011 NY Slip Op 08747) Appellate Division, Second Department, November 29, 2011Timely requests went unanswered; the claim is not overdue and the action is premature (also decides)Held, on one claim, that the insurer timely requested verification and paid within 30 days of receiving it, so payment was not overdue and the hospital's motion was denied.
Westchester Med. Ctr. v Country Wide Ins. Co. (2011 NY Slip Op 03838) Appellate Division, Second Department, May 3, 2011Fact issues remain on whether the verification defense appliesHeld the insurer raised a triable issue whether the hospital fully complied with its verification demand, since the insurer need not pay or deny until all demanded verification is provided, so summary judgment was denied.
New York Hosp. Med. Ctr. of Queens v Country Wide Ins. Co. (2011 NY Slip Op 01628) Appellate Division, Second Department, March 1, 2011Defense rejected because the provider supplied the verification or justified noncomplianceHeld the hospital complied with the verification requests by supplying exactly the forms requested, so the insurer could not object that they were outdated and raised no triable issue.

Show all 30 decisions

St. Vincent Med. Care, P.C. v Country Wide Ins. Co. (2011 NY Slip Op 00214) Appellate Division, Second Department, January 11, 2011Timely requests went unanswered; the claim is not overdue and the action is prematureHeld a follow-up request sent on the 30th day after the initial request was effective and, because the provider did not fully comply, the 30-day period never began, so the action was premature and dismissed without prejudice.
Delta Diagnostic Radiology, P.C. v Country Wide Ins. Co. (2011 NY Slip Op 00174) Appellate Division, Second Department, January 11, 2011Timely requests went unanswered; the claim is not overdue and the action is prematureHeld follow-up verification requests sent on the 30th day after the initial requests were not premature or without effect, so the insurer was entitled to dismissal of the complaint without prejudice.
Infinity Health Prods., Ltd. v Eveready Ins. Co. (2009 NY Slip Op 08585) Appellate Division, Second Department, November 17, 2009Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the provider ignored both verification requests, and estopped it from attacking the follow-up that went out three days before the 30-day mark, so the time to pay or deny never began.
St. Barnabas Hosp. v American Tr. Ins. Co. (2008 NY Slip Op 09585) Appellate Division, Second Department, December 2, 2008Fact issues remain on whether the verification defense appliesHeld the insurer raised a triable issue as to whether the hospital timely complied with the verification demand, since the insurer need not pay or deny until all verification is provided, so the hospital's summary judgment was denied.
Westchester Med. Ctr. v Allstate Ins. Co. (2008 NY Slip Op 06146) Appellate Division, Second Department, July 1, 2008Fact issues remain on whether the verification defense appliesHeld the insurer raised a triable issue whether the hospital complied with its timely, properly sent verification requests for the assignor's toxicology report, defeating summary judgment.
Westchester Med. Ctr. v Countrywide Ins. Co. (2007 NY Slip Op 09024) Appellate Division, Second Department, November 13, 2007Defense rejected because the insurer's requests or proof were deficientRejected the prematurity defense because the insurer failed to prove its verification and follow-up requests were mailed to and received by the proper party.
Hospital for Joint Diseases v New York Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 08038) Appellate Division, Second Department, October 23, 2007Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the cause of action premature because the insurer proved timely initial and follow-up verification requests and offered unrebutted proof that the hospital ignored them; the objection that the requests were improper was raised too late.
New York & Presbyt. Hosp. v Countrywide Ins. Co. (2007 NY Slip Op 07675) Appellate Division, Second Department, October 9, 2007Fact issues remain on whether the verification defense appliesHeld triable issues existed on whether verification requests were pending on one claim, which tolled the insurer's time, while on another claim the hospital's proven mailing of the requested records defeated the defense.
Westchester Med. Ctr. v Progressive Cas. Ins. Co. (2007 NY Slip Op 06865) Appellate Division, Second Department, September 18, 2007Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the hospital's claim premature because the insurer timely requested intoxication information and never received it, leaving no triable issue whether the hospital supplied the required information.
Mount Sinai Hosp. v Chubb Group of Ins. Cos. (2007 NY Slip Op 06650) Appellate Division, Second Department, September 11, 2007Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the insurer timely requested verification and, even assuming the material was mailed, it was received after suit was filed, so the 30-day period had not expired when the action began.
Westchester Med. Ctr. v Liberty Mut. Ins. Co. (2007 NY Slip Op 04483) Appellate Division, Second Department, May 22, 2007Defense rejected because the provider supplied the verification or justified noncomplianceHeld the hospital proved it mailed the requested medical records, so the insurer's claim of unanswered verification was rebutted and payment became overdue 30 days after receipt.
New York & Presbyterian Hospital v Allstate Insurance Company (2006 NY Slip Op 04815) Appellate Division, Second Department, June 13, 2006Timely requests went unanswered; the claim is not overdue and the action is prematureAffirmed dismissal of one cause of action because the insurer's claims representative showed it requested medical verification within 30 days and never received it, and the provider raised no issue.
Mount Sinai Hosp. v Allstate Ins. Co. (2006 NY Slip Op 00490) Appellate Division, Second Department, January 24, 2006Fact issues remain on whether the verification defense appliesHeld that the insurer's evidence raised a triable issue as to whether the hospital complied with a verification demand, so the hospital's summary judgment was denied because the claim was premature until the 30-day start date was established.
Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co. (2005 NYSlipOp 09484) Leading case Appellate Division, Second Department, December 12, 2005Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the insurer entitled to dismissal because the hospital admitted receiving the initial verification request but showed no response, and denied interest and fees on a second claim paid after verification was later supplied.
Nyack Hosp. v State Farm Mut. Auto. Ins. Co. (2005 NY Slip Op 05278) Appellate Division, Second Department, June 20, 2005Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the complaint properly dismissed because the assignor and another hospital undisputedly never answered the insurer's requests for the blood alcohol record, so the time to pay or deny never began and the claim was premature.
New York & Presbyt. Hosp. v Eagle Ins. Co. (2005 NY Slip Op 03210) Appellate Division, Second Department, April 25, 2005Defense rejected because the provider supplied the verification or justified noncomplianceHeld that once the insurer received the requested verification, albeit more than a year late, it had to pay or deny, and having done neither it was precluded from relying on the hospital's untimely response.
New York & Presbyt. Hosp. v Government Empls. Ins. Co. (2005 NY Slip Op 02813) Appellate Division, Second Department, April 11, 2005Fact issues remain on whether the verification defense applies (also decides)Held a triable issue existed whether the insurer's first verification request preceded its receipt of the hospital's claim, which would make the request a nullity, so the insurer's summary judgment was denied.
Hospital for Joint Diseases v ELRAC, Inc. (2004 NY Slip Op 07140) Appellate Division, Second Department, October 4, 2004Insurer properly denied the claim because verification was not provided (120-day rule)Held the claim properly denied and dismissed because the insurer timely requested verification, its follow-ups were ignored, and it denied the claim more than 180 days after notice without receiving the verification.
Montefiore Med. Ctr. v New York Cent. Mut. Fire Ins. Co. (2004 NY Slip Op 05783) Appellate Division, Second Department, July 6, 2004Fact issues remain on whether the verification defense appliesHeld that the insurer raised a triable issue of fact whether it timely sought verification of one hospital's incomplete claim, so the hospital's summary judgment should have been denied.
New York Hosp. Med. Ctr. of Queens v New York Cent. Mut. Fire Ins. Co. (2004 NY Slip Op 05626) Appellate Division, Second Department, June 28, 2004Defense rejected because the insurer's requests or proof were deficientRejected the insurer's verification-based objection to the assignments because it did not prove the verification requests were mailed, so the claims were overdue and the hospitals won summary judgment.
Hospital for Joint Diseases v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 05413) Leading case Appellate Division, Second Department, June 21, 2004Timely requests went unanswered; the claim is not overdue and the action is premature (also decides)Held one hospital's claim premature because it undisputedly never responded to the insurer's requests for medical records, so the insurer's time to pay or deny never began, and letter requests rather than prescribed forms were effective.
New York & Presbyt. Hosp. v Progressive Cas. Ins. Co. (2004 NY Slip Op 01750) Leading case Appellate Division, Second Department, March 15, 2004Defense rejected because the insurer's requests or proof were deficientHeld the hospitals entitled to judgment on two claims because the insurer offered only conclusory hearsay of telephone verification requests or requests relating to a different claim, while a triable issue existed whether requests related to a third claim.

Appellate Division, Third Department (1 decision)

Freligh v Government Empls. Ins. Co. (2018 NY Slip Op 00584) Appellate Division, Third Department, February 1, 2018Fact issues remain on whether the verification defense applies (also decides)Held triable issues existed on whether the lost-wage claim was properly verified, because the missing employer wage form may never have reached the employer and the insurer had other documents and an employer interview supplying the information.

Appellate Term, First Department (30 decisions)

Health E. Ambulatory Surgical Ctr. v Country-Wide Ins. Co. (2024 NY Slip Op 51346(U)) Appellate Term, First Department, September 30, 2024Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the claim was not overdue, and dismissed the complaint, because the provider's own evidence showed the insurer timely requested verification that was not provided.
Orthoplus Prods., Inc. v Global Liberty Ins. Co. of N.Y. (2019 NY Slip Op 51003(U)) Appellate Term, First Department, June 19, 2019Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the provider did not fully respond to verification requests properly mailed to its attorney, so the 30-day period never began to run and the claims were not overdue.
Village Med. Supply, Inc. v Travelers Prop. Cas. Ins. Co. (2018 NY Slip Op 51311(U)) Appellate Term, First Department, September 17, 2018Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the claims premature because the record conclusively showed the provider never responded to timely verification requests, and its argument that the insurer lacked good reason to request the manufacturer's invoice raised no triable issue.
Karina K. Acupuncture, P.C. v Phoenix Ins. Co. (2018 NY Slip Op 50913(U)) Appellate Term, First Department, June 18, 2018Timely requests went unanswered; the claim is not overdue and the action is premature (also decides)Held the remaining claims premature because it was undisputed that the provider did not fully respond to the insurer's verification request, so the 30-day period to pay or deny never began to run.
Atlantic Radiology Imaging, P.C. v Travelers Prop. Cas. Co. of Am. (2018 NY Slip Op 50053(U)) Appellate Term, First Department, January 18, 2018Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the claims premature because the provider undisputedly failed to fully respond to the verification requests, and a follow-up allegedly sent two days late did not defeat the toll.
Acupuncture Approach, P.C. v Tri State Consumer Ins. Co. (2017 NY Slip Op 51170(U)) Appellate Term, First Department, September 19, 2017Timely requests went unanswered; the claim is not overdue and the action is prematureAffirmed dismissal of the remaining claims as premature because it was undisputed the provider failed to respond to duly issued verification requests.
PR Med., P.C. v Praetorian Ins. Co. (2016 NY Slip Op 50338(U)) Appellate Term, First Department, March 21, 2016Defense rejected because the insurer's requests or proof were deficient (also decides)Held the 30-day period was not tolled because the insurer's letter only announced payment was delayed pending IMEs and its verification requests preceded receipt of the claims.
EMA Acupuncture v Statewide Ins. Co. (2015 NY Slip Op 51622(U)) Appellate Term, First Department, November 12, 2015Defense rejected because the insurer's requests or proof were deficientRejected the prematurity defense because the insurer offered no adequate proof that its verification requests were mailed, so it raised no issue of fact.

Show all 30 decisions

Pomona Med. Diagnostic P.C. v Praetorian Ins. Co. (2013 NY Slip Op 51798(U)) Appellate Term, First Department, October 28, 2013Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the insurer showed its verification letters were timely mailed and the provider raised no triable issue that it responded.
Okslen Acupuncture, P.C. v Lancer Ins. Co. (2013 NY Slip Op 50821(U)) Appellate Term, First Department, May 21, 2013Fact issues remain on whether the verification defense appliesHeld the insurer failed to show its EUO verification requests tolled its time to pay or deny, since the earlier letters preceded receipt of the claim, and triable issues existed whether it made the required follow-up to the later request.
Utica Acupuncture, P.C. v Interboro Ins. Co. (2013 NY Slip Op 50643(U)) Appellate Term, First Department, April 18, 2013Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the insurer showed its verification requests were sent and unanswered, and the provider's general description of its logging procedure without a search result and bare denial of receipt raised no triable issue.
GNK Med. Supply, Inc. v Tri-State Consumer Ins. Co. (2012 NY Slip Op 52195(U)) Appellate Term, First Department, November 30, 2012Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature and dismissed it because the provider undisputedly never answered the timely mailed verification requests, and no separate delay letter to counsel was required.
Danielson v Country-Wide Ins. Co. (2012 NY Slip Op 52189(U)) Appellate Term, First Department, November 28, 2012Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the claims premature because the provider undisputedly failed to respond to the verification requests; a request made after 15 days but within the 30-day window only shortened the time to pay or deny.
Muhammad Tahir, M.D., P.C. v Travelers Prop. Cas. Ins. Co. (2012 NY Slip Op 51802(U)) Appellate Term, First Department, September 19, 2012Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the insurer's time to pay or deny was tolled because it proved at trial timely initial and follow-up verification requests to the provider's attorney and the provider's failure to respond, so the complaint was dismissed.
Darlington Med. Diagnostic, P.C. v Praetorian Ins. Co. (2012 NY Slip Op 51757(U)) Appellate Term, First Department, September 11, 2012Timely requests went unanswered; the claim is not overdue and the action is prematureDismissed the complaint because the insurer timely and properly mailed initial and follow-up verification demands, the provider did not meaningfully deny receipt, and the demands went unanswered, so the claim was not overdue.
Darlington Med. Diagnostic, P.C. v Praetorian Ins. Co. (2012 NY Slip Op 51756(U)) Appellate Term, First Department, September 11, 2012Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the insurer entitled to dismissal because the provider's biller acknowledged receiving the follow-up demand and the provider never responded in any way to the properly issued verification demands.
Comprehensive Neurological Servs., PA v Tri-State Consumer Ins. Co. (2012 NY Slip Op 50950(U)) Appellate Term, First Department, May 29, 2012Timely requests went unanswered; the claim is not overdue and the action is prematureDismissed the complaint because the provider failed to rebut the presumption that it received the insurer's verification letters, leaving the insurer's prima facie verification defense unrebutted.
Heights Med. Care, P.C. v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 52326(U)) Appellate Term, First Department, December 23, 2011Timely requests went unanswered; the claim is not overdue and the action is prematureHeld one claim dismissed because it was undisputed the provider never responded to the insurer's timely and proper verification request, while triable issues on the verification and fraud defenses precluded summary disposition of the remaining claims.
Darlington Med. Diagnostics, P.C. v Praetorian Ins. Co. (2011 NY Slip Op 51634(U)) Appellate Term, First Department, August 31, 2011Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature and dismissed it because the provider undisputedly failed to respond to the timely mailed verification requests.
Omega Diagnostic Imaging, P.C. v MVAIC (2011 NY Slip Op 51259(U)) Appellate Term, First Department, July 6, 2011Defense rejected because the provider supplied the verification or justified noncompliance (also decides)Held that MVAIC's timely verification request tolled its time to pay or deny until it received the provider's response, despite no follow-up, so the claim accrued only when MVAIC denied it after receiving that response.
Omega Diagnostic Imaging, P.C. v MVAIC (2011 NY Slip Op 50432(U)) Appellate Term, First Department, March 24, 2011Defense rejected because the insurer's requests or proof were deficient (also decides)Rejected, by reference to the companion decision, MVAIC's argument raised first on appeal that the action was premature because verification requests were outstanding.
Lenox Hill Radiology, P.C. v Tri-State Consumer Ins. Co. (2010 NY Slip Op 20530) Appellate Term, First Department, December 30, 2010Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the claims premature and dismissed the action because the insurer proved timely mailing of its initial and follow-up verification requests and the provider never claimed or showed any response.
Triangle R Inc. v Praetorian Ins. Co. (2010 NY Slip Op 52294(U)) Appellate Term, First Department, December 3, 2010Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the provider never responded, and a follow-up sent 15 days late, or an earlier improper follow-up, did not cost the insurer the toll under the circumstances.
Triangle R Inc. v Praetorian Ins. Co. (2010 NY Slip Op 52041(U)) Appellate Term, First Department, November 26, 2010Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the claim premature because the insurer undisputedly never received a response to its medical-records verification requests, and an ineffective blanket IME denial did not bar the insurer from relying on noncompliance with verification.
Omega Diagnostic Imaging, P.C. v MVAIC (2010 NY Slip Op 51779(U)) Appellate Term, First Department, October 15, 2010Defense rejected because the insurer's requests or proof were deficientHeld the action not premature because MVAIC's requests that the provider and assignor obtain an affidavit of no insurance from the nonparty out-of-state driver were improper, there being no good reason for them.
Beta Supply, Inc. v Government Employees Insurance Co. (2008 NY Slip Op 51406(U)) Appellate Term, First Department, July 16, 2008Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the claim premature and dismissed the action because the provider undisputedly never answered the insurer's timely verification requests, so payment was not yet due.
IK Med., P.C. v Travelers Prop. Cas. Ins. Co. (2006 NY Slip Op 51719(U)) Appellate Term, First Department, September 13, 2006Insurer properly denied the claim because verification was not provided (120-day rule)Upheld timely denials based on the assignors' uncontroverted failure to respond to repeated requests for statements about the accident and treatment, granting dismissal of those claims.
Bronx Expert Radiology, P.C. v Travelers Ins. Co. (2006 NY Slip Op 51227(U)) Appellate Term, First Department, June 29, 2006Fact issues remain on whether the verification defense appliesDenied the provider summary judgment because it failed to show it answered the insurer's verification request, leaving the outstanding-verification defense unresolved and remanding for further proceedings.
Elite Chiropractic Servs., PC v Travelers Ins. Co. (2005 NY Slip Op 51735(U)) Appellate Term, First Department, October 26, 2005Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the complaint should be dismissed because the provider and its assignor failed to respond to the insurer's timely additional verification requests, so the time to pay or deny never began and the claim was premature.
Edison Med. Servs., P.C. v Lumbermans Mut. Cas. Co. (2005 NY Slip Op 50134(U)) Appellate Term, First Department, February 7, 2005Fact issues remain on whether the verification defense appliesDenied the provider summary judgment because the record raised triable issues whether the insurer's initial and follow-up verification requests were timely and properly made under the regulatory timetable.

Appellate Term, Second Department (269 decisions)

Prompt Med. Group, Inc. v Erie Ins. Co. of N.Y. (2026 NY Slip Op 50796(U)) Appellate Term, Second Department, May 15, 2026Defense rejected because the insurer's requests or proof were deficient (also decides)Held the verification requests did not toll the insurer's time because their mailing was not proved, so the nonresponse branch needed no remittal and the denial was untimely.
Burke 2 Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. (2025 NY Slip Op 51152(U)) Appellate Term, Second Department, June 20, 2025Insurer properly denied the claim because verification was not provided (120-day rule)Affirmed summary judgment dismissing the complaint for failure to provide requested verification, rejecting the argument that requests for ownership and financial documents were improper.
Burke Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. (2025 NY Slip Op 50845(U)) Appellate Term, Second Department, May 16, 2025Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the denial issued more than 150 days after the initial verification request a nullity and, searching the record, dismissed the action without prejudice as premature because verification remained outstanding.
Burke 2 Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. (2025 NY Slip Op 50195(U)) Appellate Term, Second Department, February 14, 2025Insurer properly denied the claim because verification was not provided (120-day rule)Affirmed summary judgment dismissing the complaint because the provider, which objected to the requests as nullities, provided neither the requested verification nor written reasonable justification within 120 days of the initial request.
Burke Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. (2025 NY Slip Op 50196(U)) Appellate Term, Second Department, February 14, 2025Insurer properly denied the claim because verification was not provided (120-day rule)Affirmed dismissal because the owner's affidavit that verification was mailed 'to the extent such responses were proper and in his possession' did not show the requested verification or a reasonable justification was provided under the 120-day rule.
Burke Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. (2024 NY Slip Op 50803(U)) Appellate Term, Second Department, June 14, 2024Fact issues remain on whether the verification defense appliesHeld the provider's affidavit raised a presumption that the requested verification was mailed and received, so the insurer's motion to dismiss for failure to respond to verification requests should have been denied.
Burke Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. (2024 NY Slip Op 24111) Appellate Term, Second Department, March 15, 2024Defense rejected because the insurer's requests or proof were deficientHeld the denial for nonresponse untimely because the EUO toll ended when the EUO was held, and a new written verification request made almost 60 days after the claim was received was a nullity that could not extend the insurer's time.
Burke Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. (2023 NY Slip Op 50794(U)) Appellate Term, Second Department, July 21, 2023Insurer properly denied the claim because verification was not provided (120-day rule)Granted the insurer summary judgment because it timely requested verification, never received it and timely denied the claims; the owner's statement that he mailed responses 'to the extent proper' showed neither compliance nor reasonable justification.

Show all 269 decisions

New York Manual, P.T., P.C. v Nationwide Affinity Ins. Co. of Am. (2023 NY Slip Op 50281(U)) Appellate Term, Second Department, February 24, 2023Insurer properly denied the claim because verification was not provided (120-day rule)Upheld dismissal because the insurer timely requested verification and did not receive it, and the provider's statement that it mailed responses 'to the extent proper' was neither compliance nor reasonable justification under the 120-day rule.
Burke Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. (2022 NY Slip Op 51217(U)) Appellate Term, Second Department, December 9, 2022Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the provider's owner's affidavit raised no triable issue that verification was provided, and bringing documents to an EUO without letting the insurer copy them was not providing them, so dismissal was affirmed.
American Kinetics Lab, Inc. v Travelers Ins. Co. (2022 NY Slip Op 51212(U)) Appellate Term, Second Department, December 9, 2022Defense rejected because the insurer's requests or proof were deficientHeld the insurer failed to show the action was premature because its letters sought information only from the prescribing doctor, not the provider, and so were delay letters rather than verification requests requiring a response.
Spring Rehab, P.T., P.C. v Hereford Ins. Co. (2022 NY Slip Op 51270(U)) Appellate Term, Second Department, December 2, 2022Defense rejected because the insurer's requests or proof were deficientRejected the insurer's prematurity defense because its letters merely stated it was awaiting specified documents without actually requesting verification, and for one claim were addressed to another provider.
American Kinetics Lab, Inc. v GEICO Gen. Ins. Co. (2022 NY Slip Op 51267(U)) Appellate Term, Second Department, December 2, 2022Timely requests went unanswered; the claim is not overdue and the action is prematureDismissed the complaint without prejudice as premature because the insurer timely mailed initial and follow-up verification requests, never received the verification, and the provider raised no triable issue.
John A. Nasrinpay 2 v Nationwide Affinity Ins. Co. of Am. (2022 NY Slip Op 51241(U)) Appellate Term, Second Department, November 18, 2022Timely requests went unanswered; the claim is not overdue and the action is prematureAffirmed dismissal of the complaint on the insurer's defense that the provider failed to provide requested verification, adopting the reasoning of a companion decision.
Veraso Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2022 NY Slip Op 51232(U)) Appellate Term, Second Department, November 18, 2022Insurer properly denied the claim because verification was not provided (120-day rule)Upheld, after a nonjury trial, the finding that the provider had not fully responded to the verification requests and that the insurer timely denied the claim on that ground under 11 NYCRR 65-3.5 (o).
Parisien v Travelers Ins. Co. (2022 NY Slip Op 51136(U)) Appellate Term, Second Department, September 30, 2022Fact issues remain on whether the verification defense appliesDenied both summary judgment motions because the provider's affidavit raised a fact issue as to whether the requested verification was mailed and received, leaving open whether the action was premature.
Remedy Chiropractic, P.C. v Nationwide Ins. (2022 NY Slip Op 50935(U)) Appellate Term, Second Department, September 23, 2022Timely requests went unanswered; the claim is not overdue and the action is prematureAffirmed dismissal as premature because verification remained outstanding; the owner's conditional mailing statement and counsel's partial response objecting to the remaining requests were neither compliance nor reasonable justification.
Gentlecare Ambulatory Anesthesia Servs. v MVAIC (2022 NY Slip Op 50785(U)) Appellate Term, Second Department, August 5, 2022Fact issues remain on whether the verification defense appliesHeld a triable issue existed as to whether the provider supplied the requested verification, defeating the insurer's 120-day nonresponse denial defense on three claims, since the provider's affidavit raised a presumption of mailing and receipt.
First Care Med. Equip., LLC v MVAIC (2022 NY Slip Op 50778(U)) Appellate Term, Second Department, July 22, 2022Fact issues remain on whether the verification defense appliesHeld a triable issue existed as to whether the action was premature because the provider's affidavit raised a presumption that the requested verification had been mailed and received.
Burke Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. (2022 NY Slip Op 50623(U)) Appellate Term, Second Department, July 1, 2022Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the provider failed to raise a triable issue because its owner only claimed mailing verification 'to the extent proper and in his possession,' showing neither compliance nor reasonable justification, so dismissal was affirmed.
Lefferts Gardens Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2022 NY Slip Op 50599(U)) Appellate Term, Second Department, June 17, 2022Timely requests went unanswered; the claim is not overdue and the action is prematureGranted the insurer summary judgment dismissing the action as premature because its timely, proper initial and follow-up requests went unanswered, and confusion about what was sought called for communication, not inaction.
JOA Chiropractic, P.C. v Hereford Ins. Co. (2022 NY Slip Op 50598(U)) Appellate Term, Second Department, June 17, 2022Defense rejected because the insurer's requests or proof were deficientHeld the insurer failed to show its verification requests were proper, because its letters merely said it was awaiting specified documents without actually requesting verification, so its prematurity motion was denied.
PFJ Med. Care, P.C. v Allstate Ins. Co. (2022 NY Slip Op 50361(U)) Appellate Term, Second Department, April 29, 2022Fact issues remain on whether the verification defense appliesDenied the insurer summary judgment despite its showing of timely requests, nonreceipt and a timely denial, because the provider's affidavit raised a fact issue as to whether verification was mailed and received.
A.C. Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2021 NY Slip Op 50841(U)) Appellate Term, Second Department, August 27, 2021Timely requests went unanswered; the claim is not overdue and the action is prematureDismissed the action as premature because verification on the original bills remained outstanding, and the provider's later bills omitting the disputed services were a nullity that created no new obligation to pay or deny.
Quality Rehab & P.T., P.C. v Tri State Consumers Ins. Co. (2021 NY Slip Op 50730(U)) Appellate Term, Second Department, July 23, 2021Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the insurer showed it had not received all requested verification for the first four causes of action, making them premature, and the provider's challenge to the adequacy of its responses lacked merit.
Wellmax Prods. Corp. v State Farm Mut. Auto. Ins. Co. (2021 NY Slip Op 50448(U)) Appellate Term, Second Department, May 14, 2021Timely requests went unanswered; the claim is not overdue and the action is prematureAffirmed dismissal after a trial limited to whether requested verification remained outstanding, deferring to the trial court's crediting of the insurer's only witness.
Active Care Med. Supply Corp. v MVAIC (2021 NY Slip Op 50450(U)) Appellate Term, Second Department, May 14, 2021Fact issues remain on whether the verification defense appliesHeld MVAIC prima facie showed unanswered timely verification requests making the action premature, but whether the requests were timely depended on when it received the claim, an issue remitted for a hearing.
JPF Med. Servs., P.C. v Hereford Ins. Co. (2020 NY Slip Op 51372(U)) Appellate Term, Second Department, November 13, 2020Fact issues remain on whether the verification defense appliesDenied the provider summary judgment because, although the insurer showed timely requests, nonreceipt and a timely denial, the provider's mailing affidavit created a triable issue as to whether verification was provided.
AOM Med. Supply, Inc. v Hereford Ins. Co. (2020 NY Slip Op 51366(U)) Appellate Term, Second Department, November 13, 2020Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the insurer showed prima facie that it had not received all requested verification and affirmed dismissal of the complaint without prejudice, so the provider's remaining contention was academic.
T & S Med. Supply Corp. v MVAIC (2020 NY Slip Op 51327(U)) Appellate Term, Second Department, November 6, 2020Fact issues remain on whether the verification defense appliesReversed a judgment for the insurer entered after trial without testimony on the provider's failure to prove compliance, and remitted for a new trial on whether the requested verification remained outstanding.
Solution Bridge, Inc. v Nationwide Ins. (2020 NY Slip Op 50988(U)) Appellate Term, Second Department, August 28, 2020Fact issues remain on whether the verification defense appliesHeld a triable issue existed as to prematurity because, although the insurer proved timely requests and nonreceipt, the provider's affidavit raised a presumption that the requested verification was mailed and received.
Clear Water Psychological Servs., P.C. v Hereford Ins. Co. (2020 NY Slip Op 50847(U)) Appellate Term, Second Department, July 10, 2020Defense rejected because the insurer's requests or proof were deficientHeld the insurer failed to show its verification requests were proper or timely because its letters merely said it was awaiting specified documents without actually requesting them, nor that verification remained outstanding.
Crystal Acupuncture, P.C. v Travelers Ins. (2019 NY Slip Op 52055(U)) Appellate Term, Second Department, December 13, 2019Insurer properly denied the claim because verification was not provided (120-day rule) (also decides)Upheld denials of several claims for failure to provide requested verification within 120 days because the insurer showed it never received all requested verification and the provider raised no triable issue.
Blackman v Nationwide Ins. (2019 NY Slip Op 52038(U)) Appellate Term, Second Department, December 13, 2019Fact issues remain on whether the verification defense appliesHeld a triable issue existed as to whether the provider supplied the requested verification, so the insurer's 120-day nonresponse denial could not support judgment either way.
Psychology YME, P.C. v Travelers Ins. (2019 NY Slip Op 51798(U)) Appellate Term, Second Department, November 1, 2019Insurer properly denied the claim because verification was not provided (120-day rule)Held the insurer entitled to dismissal because it timely mailed initial and follow-up requests, never received the verification, and timely denied the claim for failure to provide it within 120 days.
Chapa Prods. Corp. v MVAIC (2019 NY Slip Op 29341) Appellate Term, Second Department, November 1, 2019Timely requests went unanswered; the claim is not overdue and the action is prematureHeld a 120-day nonresponse denial issued more than 150 days after the initial request a nullity, but dismissed the action as premature without prejudice because the provider's response did not comply with the requests.
SAS Med., P.C. v Travelers Ins. Co. (2019 NY Slip Op 51759(U)) Appellate Term, Second Department, October 25, 2019Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the claims for two assignors premature because the insurer timely mailed initial and follow-up verification requests, never received the verification, and the provider raised no triable issue.
New Horizon Surgical Ctr., LLC v Travelers Ins. Co. (2019 NY Slip Op 51690(U)) Appellate Term, Second Department, October 18, 2019Timely requests went unanswered; the claim is not overdue and the action is prematureReversed and granted the insurer summary judgment because its presumptively mailed verification requests went unanswered, and it need not pay or deny upon a partial response since a claim need not be paid until all demanded verification is provided.
Right Aid Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2019 NY Slip Op 51409(U)) Appellate Term, Second Department, August 23, 2019Fact issues remain on whether the verification defense appliesReversed a judgment for the insurer entered after the trial court put the burden on the provider at a limited trial, and remitted for a new trial on whether requested verification remained outstanding, for reasons stated in a companion decision.
Island Life Chiropractic, P.C. v Travelers Ins. Co. (2019 NY Slip Op 51273(U)) Appellate Term, Second Department, August 2, 2019Fact issues remain on whether the verification defense appliesHeld the insurer bore the initial trial burden to show nonreceipt of the requested verification, so the directed verdict against the provider was reversed and a new trial ordered on whether verification remained outstanding.
Right Aid Med. Supply Corp. v Travelers Ins. Co. (2019 NY Slip Op 51184(U)) Appellate Term, Second Department, July 19, 2019Timely requests went unanswered; the claim is not overdue and the action is prematureAffirmed dismissal after a trial on whether requested verification was provided, holding the insurer's employee's testimony about mail-receipt procedures sufficient to show the verification was not received.
Masigla v Nationwide Ins. (2019 NY Slip Op 51170(U)) Appellate Term, Second Department, July 12, 2019Timely requests went unanswered; the claim is not overdue and the action is prematureAffirmed dismissal after a trial limited to whether requested verification remained outstanding, deferring to the trial court's crediting of the insurer's only witness.
Blackman v Hereford Ins. Co. (2019 NY Slip Op 51166(U)) Appellate Term, Second Department, July 12, 2019Fact issues remain on whether the verification defense appliesHeld a triable issue existed as to whether the verification was provided because the provider's affidavit raised a presumption that it was mailed to and received by the insurer.
Parisien v Travelers Ins. Co. (2019 NY Slip Op 51162(U)) Appellate Term, Second Department, July 12, 2019Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the causes of action premature because the insurer showed it timely mailed initial and follow-up verification requests and never received the requested verification.
Veraso Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2019 NY Slip Op 51149(U)) Appellate Term, Second Department, July 12, 2019Fact issues remain on whether the verification defense appliesHeld dismissal of the second cause of action improper because the provider's affidavit raised a presumption the verification was mailed and received, leaving a triable issue whether it was provided.
TAM Med. Supply Corp. v MVAIC (2019 NY Slip Op 51155(U)) Appellate Term, Second Department, July 12, 2019Timely requests went unanswered; the claim is not overdue and the action is prematureAffirmed judgment dismissing the complaint after a trial limited to verification, holding the insurer's witness, relying on its documented mail-handling practices and a records search, sufficiently established the requested verification was never received.
Active Care Med. Supply Corp. v Farmington Cas. Co. (2019 NY Slip Op 50987(U)) Appellate Term, Second Department, June 14, 2019Timely requests went unanswered; the claim is not overdue and the action is prematureHeld two causes of action premature because the provider acknowledged the requests for wholesale invoices but stated in letters that it would not provide them.
Solution Bridge, Inc. v State Farm Mut. Auto. Ins. Co. (2019 NY Slip Op 50749(U)) Appellate Term, Second Department, May 10, 2019Fact issues remain on whether the verification defense appliesHeld dismissal of the second cause of action improper because the provider's affidavit raised a presumption the verification was mailed and received, leaving a triable issue whether it was provided.
Chapa Prods. Corp. v 21st Century Ins. Co. (2019 NY Slip Op 50741(U)) Appellate Term, Second Department, May 10, 2019Fact issues remain on whether the verification defense appliesHeld the insurer showed timely requests and nonreceipt for the second claim, but the provider's proof raised a presumption that the verification was timely mailed, precluding summary judgment.
Solution Bridge, Inc. v State Farm Mut. Auto. Ins. Co. (2019 NY Slip Op 50739(U)) Appellate Term, Second Department, May 10, 2019Fact issues remain on whether the verification defense appliesHeld dismissal of the first cause of action improper because the provider's affidavit raised a presumption the verification was mailed and received, leaving a triable issue whether it was provided.
T & S Med. Supply Corp. v MVAIC (2019 NY Slip Op 50737(U)) Appellate Term, Second Department, May 10, 2019Fact issues remain on whether the verification defense appliesHeld the nonresponse defense unresolved because the provider's mailing affidavit raised a triable issue on whether it supplied the verification; for the other claim, the insurer failed to show its requests were timely.
Solution Bridge, Inc. v Nationwide Ins. (2019 NY Slip Op 50689(U)) Appellate Term, Second Department, May 3, 2019Fact issues remain on whether the verification defense appliesHeld the insurer not entitled to dismissal because the provider's affidavit raised a presumption the verification was mailed and received, leaving a triable issue whether it was provided.
CPM Med Supply, Inc. v State Farm Fire & Cas. Ins. Co. (2019 NY Slip Op 50576(U)) Appellate Term, Second Department, April 12, 2019Insurer properly denied the claim because verification was not provided (120-day rule)Held the provider's failure to respond, and its written reply that requested invoices were 'not needed,' insufficient, and stated that the insurer properly denied post-2013 claims for nonresponse within 120 days and was entitled to dismissal with prejudice.
New Horizon Surgical Ctr., L.L.C. v Travelers Ins. (2019 NY Slip Op 50283(U)) Appellate Term, Second Department, March 8, 2019Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the insurer entitled to summary judgment dismissing the complaint as premature because the provider had failed to provide requested verification, for the reasons stated in a companion appeal.
New Horizon Surgical Ctr., L.L.C. v Travelers Ins. (2019 NY Slip Op 50282(U)) Appellate Term, Second Department, March 8, 2019Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the insurer entitled to summary judgment dismissing the complaint as premature because the provider had failed to provide requested verification, for the reasons stated in a companion appeal.
New Horizon Surgical Ctr., L.L.C. v Travelers Ins. (2019 NY Slip Op 50281(U)) Appellate Term, Second Department, March 8, 2019Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the insurer timely requested verification and the provider's papers showed the requested signed informed consent form was never provided, raising no triable issue of compliance.
Lenox Hill Radiology & MIA, P.C. v Global Liberty Ins. Co. of N.Y. (2018 NY Slip Op 51810(U)) Appellate Term, Second Department, December 6, 2018Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the insurer timely mailed initial and follow-up requests, never received the verification, and the provider did not show it was provided before suit.
Solution Bridge, Inc. v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51784(U)) Appellate Term, Second Department, November 30, 2018Fact issues remain on whether the verification defense appliesHeld the insurer's 120-day nonresponse denial of the second claim could not be upheld on summary judgment because the provider's affidavit raised a presumption the verification was mailed and received.
Pavlova v Travelers Ins. Co. (2018 NY Slip Op 51778(U)) Appellate Term, Second Department, November 30, 2018Fact issues remain on whether the verification defense appliesHeld neither side entitled to judgment because the insurer showed timely requests and nonreceipt while the provider's affidavit raised a presumption that verification was mailed and received, leaving prematurity triable.
TAM Med. Supply Corp. v Hereford Ins. Co. (2018 NY Slip Op 51775(U)) Appellate Term, Second Department, November 30, 2018Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the provider's only proof that it mailed the requested verification was an unsigned, unsworn 'affidavit' of its owner, which could not raise a triable issue.
Solution Bridge, Inc. v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51648(U)) Appellate Term, Second Department, November 16, 2018Fact issues remain on whether the verification defense appliesHeld the 120-day nonresponse denial could not support summary judgment because the provider's affidavit raised a presumption the verification was mailed and received, leaving a triable issue whether it was provided.
Right Aid Med. Supply Corp. v Hereford Ins. Co. (2018 NY Slip Op 51641(U)) Appellate Term, Second Department, November 16, 2018Fact issues remain on whether the verification defense appliesHeld a triable issue existed as to prematurity because the provider's affidavit raised a presumption that the verification was mailed and received, despite the insurer's showing of nonreceipt.
T & S Med. Supply Corp. v Travelers Ins. Co. (2018 NY Slip Op 51597(U)) Appellate Term, Second Department, November 9, 2018Fact issues remain on whether the verification defense appliesHeld a triable issue existed as to prematurity because, although the insurer proved timely requests and nonreceipt, the provider owner's affidavit raised a presumption that verification was mailed and received.
Pavlova v Travelers Ins. Co. (2018 NY Slip Op 51555(U)) Appellate Term, Second Department, November 2, 2018Fact issues remain on whether the verification defense appliesHeld a triable issue existed whether the claim for $3,399.51 was premature because the provider's affidavit raised a presumption that the requested verification was mailed and received.
Pavlova v Travelers Ins. Co. (2018 NY Slip Op 50847(U)) Appellate Term, Second Department, June 1, 2018Fact issues remain on whether the verification defense appliesHeld a triable issue existed as to prematurity because, although the insurer proved mailed requests and nonreceipt, the provider's affidavit raised a presumption that the verification was mailed and received.
Right Aid Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51857(U)) Appellate Term, Second Department, December 22, 2017Fact issues remain on whether the verification defense appliesHeld a triable issue existed as to prematurity because, although the insurer proved timely requests and nonreceipt, the provider employee's affidavit raised a presumption that verification was mailed and received.
MT Servs. P.T., P.C. v Country-Wide Ins. Co. (2017 NY Slip Op 51851(U)) Appellate Term, Second Department, December 22, 2017Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the 30-day period never began to run because the insurer timely requested verification, showed it was not received, and the provider did not show it was supplied before suit.
Active Chiropractic, P.C. v Country-Wide Ins. Co. (2017 NY Slip Op 51850(U)) Appellate Term, Second Department, December 22, 2017Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the claim not overdue and properly dismissed because the insurer timely requested verification, never received it, and the provider did not show it was provided before suit.
City Care Acupuncture, P.C. v Allstate Prop. & Cas. Ins. Co. (2017 NY Slip Op 51839(U)) Appellate Term, Second Department, December 19, 2017Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the providers' own verification responses expressly declined to answer some of the insurer's requests, so the insurer had not received all requested verification.
Healthy Way Acupuncture, P.C. v NY Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 51828(U)) Appellate Term, Second Department, December 19, 2017Timely requests went unanswered; the claim is not overdue and the action is prematureUpheld dismissal as premature, holding the insurer's follow-up verification requests proper and that any confusion about what was sought had to be resolved by communication, not inaction.
Irina Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 51818(U)) Appellate Term, Second Department, December 19, 2017Timely requests went unanswered; the claim is not overdue and the action is prematureReversed a ruling that the insurer was precluded from asserting unanswered verification for want of a timely denial, and granted the insurer's motion dismissing the complaint, for reasons stated in a companion appeal.
Irina Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 51817(U)) Appellate Term, Second Department, December 19, 2017Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature, rejecting preclusion for lack of a timely denial, because the insurer timely mailed verification requests, never received the verification, and the provider raised no triable issue.
Gentlecare Ambulatory Anesthesia Servs. v Travelers Ins. Co. (2017 NY Slip Op 51802(U)) Appellate Term, Second Department, December 19, 2017Fact issues remain on whether the verification defense appliesHeld a triable issue existed as to whether the action was premature because the provider's affidavit raised a presumption that the requested verification had been mailed and received despite the insurer's non-receipt showing.
Doctor Goldshteyn Chiropractic, P.C. v Travelers Indem. Co. (2017 NY Slip Op 51816(U)) Appellate Term, Second Department, December 19, 2017Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the record showed the insurer never received the requested verification, the provider having only partially responded.
Parisien v Travelers Ins. Co. (2017 NY Slip Op 51750(U)) Appellate Term, Second Department, December 12, 2017Fact issues remain on whether the verification defense appliesHeld that although the insurer showed timely requests and non-receipt, the provider's affidavit presuming mailing of the verification created a triable issue whether the action was premature.
Active Care Med. Supply Corp. v Tri State Consumers Ins. Co. (2017 NY Slip Op 51721(U)) Appellate Term, Second Department, December 8, 2017Fact issues remain on whether the verification defense appliesHeld the insurer showed timely requests and non-receipt, but the provider employee's affidavit presuming mailing of the verification raised a triable issue whether the first cause of action was premature.
Right Aid Med. Supply Corp. v ELRAC, Inc. (2017 NY Slip Op 51714(U)) Appellate Term, Second Department, December 8, 2017Fact issues remain on whether the verification defense appliesHeld a triable issue existed as to whether the action was premature because the provider's affidavit raised a presumption that the requested verification had been mailed and received.
XVV, Inc. v Interboro Ins. Co. (2017 NY Slip Op 51468(U)) Appellate Term, Second Department, October 27, 2017Defense rejected because the insurer's requests or proof were deficientRejected the prematurity defense because the insurer's papers made no showing that the specific verification at issue, an affidavit of the assignor, had ever been requested from the provider.
Adelaida M. Laga, PT v Hereford Ins. Co. (2017 NY Slip Op 51462(U)) Appellate Term, Second Department, October 27, 2017Fact issues remain on whether the verification defense appliesHeld a triable issue existed whether verification remained outstanding because the provider's affidavit raised a presumption of mailing and receipt, so the insurer's prematurity motion was properly denied.
T & S Med. Supply Corp. v New York Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 51453(U)) Appellate Term, Second Department, October 27, 2017Fact issues remain on whether the verification defense appliesHeld a triable issue existed whether the action was premature because the provider's affidavit raised a presumption that the requested verification had been mailed and received.
Active Care Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51408(U)) Appellate Term, Second Department, October 20, 2017Fact issues remain on whether the verification defense appliesHeld a triable issue existed whether the action was premature because the provider's affidavit raised a presumption that the requested verification had been mailed and received.
Medex Health Supply, Inc. v Travelers Ins. Co. (2017 NY Slip Op 51261(U)) Appellate Term, Second Department, September 22, 2017Fact issues remain on whether the verification defense appliesHeld that although the insurer showed proper requests and non-receipt, the provider's affidavit presuming mailing of the verification raised a triable issue whether the action was premature.
TAM Med. Supply Corp. v Travelers Ins. Co. (2017 NY Slip Op 51251(U)) Appellate Term, Second Department, September 22, 2017Fact issues remain on whether the verification defense appliesHeld that although the insurer showed proper requests and non-receipt, the provider's affidavit presuming mailing of the verification raised a triable issue whether the action was premature.
TAM Med. Supply Corp. v New York Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 51248(U)) Appellate Term, Second Department, September 22, 2017Fact issues remain on whether the verification defense appliesHeld that although the insurer showed proper requests and non-receipt, the provider's affidavit presuming mailing of the verification raised a triable issue whether the action was premature.
TAM Med. Supply Corp. v Tri State Consumers Ins. Co. (2017 NY Slip Op 51247(U)) Appellate Term, Second Department, September 22, 2017Fact issues remain on whether the verification defense appliesReversed dismissal on the insurer's 120-day nonresponse denial because the provider's affidavit raised a presumption of mailing, creating a triable issue whether the requested verification was provided.
Compas Med., P.C. v American Tr. Ins. Co. (2017 NY Slip Op 51239(U)) Appellate Term, Second Department, September 22, 2017Fact issues remain on whether the verification defense appliesHeld a triable issue existed on whether the third through fifth causes of action were premature because the provider's affidavit raised a presumption that the requested verification was mailed and received despite the insurer's non-receipt showing.
Tam Med. Supply Corp. v Hereford Ins. Co. (2017 NY Slip Op 51196(U)) Appellate Term, Second Department, September 15, 2017Fact issues remain on whether the verification defense appliesHeld a triable issue existed whether verification remained outstanding because the provider's affidavit raised a presumption of mailing and receipt, so the insurer's prematurity motion was properly denied.
Compas Med., P.C. v American Tr. Ins. Co. (2017 NY Slip Op 51194(U)) Appellate Term, Second Department, September 15, 2017Fact issues remain on whether the verification defense appliesHeld that although the insurer showed non-receipt, the provider's affidavit presuming mailing of the verification raised a triable issue whether the causes of action were premature.
JCC Med., P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51140(U)) Appellate Term, Second Department, September 8, 2017Fact issues remain on whether the verification defense appliesHeld the second cause of action could not be dismissed as premature because the provider's affidavit presuming mailing of the verification raised a triable issue despite the insurer's non-receipt showing.
Active Care Med. Supply Corp. v Travelers Ins. Co. (2017 NY Slip Op 51034(U)) Appellate Term, Second Department, August 11, 2017Defense rejected because the insurer's requests or proof were deficientReversed summary judgment dismissing the complaint as premature for unanswered verification and denied the insurer's motion, for reasons stated in a companion appeal.
Active Care Med. Supply Corp. v Travelers Ins. Co. (2017 NY Slip Op 51033(U)) Appellate Term, Second Department, August 11, 2017Defense rejected because the insurer's requests or proof were deficientReversed summary judgment dismissing the complaint as premature for unanswered verification and denied the insurer's motion, for reasons stated in a companion appeal.
Renelique v American Tr. Ins. Co. (2017 NY Slip Op 51027(U)) Appellate Term, Second Department, August 11, 2017Fact issues remain on whether the verification defense appliesReversed dismissal of the action as premature and denied the insurer's summary judgment motion on its defense that the provider had failed to provide requested verification.
Chapa Prods. Corp. v Progressive Ins. Co. (2017 NY Slip Op 51026(U)) Appellate Term, Second Department, August 11, 2017Fact issues remain on whether the verification defense appliesReversed dismissal of the action as premature and denied the insurer's summary judgment motion on its defense that the provider had failed to provide requested verification.
Renelique v American Tr. Ins. Co. (2017 NY Slip Op 51022(U)) Appellate Term, Second Department, August 11, 2017Fact issues remain on whether the verification defense appliesHeld that although the insurer showed non-receipt, the provider's affidavit presuming mailing of the verification raised a triable issue whether the action was premature.
Y.A.M. Med. Supply, Inc. v Travelers Indem. Co. (2017 NY Slip Op 51039(U)) Appellate Term, Second Department, August 11, 2017Fact issues remain on whether the verification defense appliesLeft undisturbed the finding of a triable issue whether the provider's responses to the verification requests were adequate for one bill, so the insurer's prematurity motion failed.
Harbor Chiropractic, P.C. v Travelers Ins. Co. (2017 NY Slip Op 50959(U)) Appellate Term, Second Department, July 21, 2017Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature and granted the insurer summary judgment because it showed prima facie that it had not received the requested verification and the provider did not show it was provided before suit.
Daily Med. Equip. Distrib. Ctr., Inc. v Interboro Ins. Co. (2017 NY Slip Op 50958(U)) Appellate Term, Second Department, July 21, 2017Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the insurer showed it timely requested verification and never received it, and the provider did not show it was provided before suit, so the 30-day period never began to run.
Compas Med., P.C. v American Tr. Ins. Co. (2017 NY Slip Op 50946(U)) Appellate Term, Second Department, July 21, 2017Timely requests went unanswered; the claim is not overdue and the action is premature (also decides)Held one claim premature because the insurer showed it had not received the requested verification.
New Way Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 50925(U)) Appellate Term, Second Department, July 14, 2017Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the insurer had not received requested verification; the provider's own affidavit listing what it sent showed it never supplied requested items such as wholesale invoices.
Compas Med., P.C. v American Tr. Ins. Co. (2017 NY Slip Op 50917(U)) Appellate Term, Second Department, July 14, 2017Fact issues remain on whether the verification defense appliesHeld that although the insurer showed timely requests and non-receipt, the provider's affidavit presuming mailing of the verification raised a triable issue whether the action was premature.
Excel Surgery Ctr., L.L.C. v Fiduciary Ins. Co. of Am. (2017 NY Slip Op 50408(U)) Appellate Term, Second Department, April 3, 2017Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the provider's generic letter saying it lacked medical records and referring the insurer to the treating provider did not answer any specific request, so verification remained outstanding.
Advantage Radiology, P.C. v Nationwide Mut. Ins. Co. (2017 NY Slip Op 27061) Appellate Term, Second Department, February 15, 2017Timely requests went unanswered; the claim is not overdue and the action is prematureUpheld dismissal for failure to provide requested verification, holding the insurer properly sent its requests to the provider despite counsel's letter and needed no delay letter to counsel when verification was sought from the provider itself.
Prime Diagnostic Med., P.C. v Liberty Mut. Fire Ins. Co. (2016 NY Slip Op 51612(U)) Appellate Term, Second Department, November 1, 2016Timely requests went unanswered; the claim is not overdue and the action is prematureAffirmed dismissal because the insurer's affidavit established timely verification requests and follow-ups and that the provider never responded to them.
Daily Med. Equip. Distrib. Ctr., Inc. v MVAIC (2016 NY Slip Op 51622(U)) Appellate Term, Second Department, November 1, 2016Defense rejected because the insurer's requests or proof were deficientRejected the prematurity defense because the initial verification request was sent more than 100 days after the last claim was received, so it did not toll the time to pay or deny.
Tam Med. Supply Corp. v National Liab. & Fire Ins. Co. (2016 NY Slip Op 51532(U)) Appellate Term, Second Department, October 13, 2016Fact issues remain on whether the verification defense appliesHeld that although the insurer showed non-receipt, the provider's affidavit presuming mailing of the verification raised a triable issue whether the action was premature.
Renelique v American Tr. Ins. Co. (2016 NY Slip Op 51546(U)) Appellate Term, Second Department, October 11, 2016Fact issues remain on whether the verification defense appliesReversed the dismissal of the action as premature and denied the insurer's verification-based summary judgment motion for the reasons in a companion decision, which found a triable issue whether the action was premature.
Compas Med., P.C. v American Tr. Ins. Co. (2016 NY Slip Op 51545(U)) Appellate Term, Second Department, October 11, 2016Fact issues remain on whether the verification defense appliesDenied the insurer's cross motion to dismiss five causes of action as premature for outstanding verification, while leaving the provider's summary judgment motion denied.
Arguelles, M.D., P.C. v American Tr. Ins. Co. (2016 NY Slip Op 51544(U)) Appellate Term, Second Department, October 11, 2016Fact issues remain on whether the verification defense appliesDenied the insurer's cross motion to dismiss five causes of action as premature for outstanding verification, while leaving the provider's summary judgment motion denied.
Laga v Hereford Ins. Co. (2016 NY Slip Op 51543(U)) Appellate Term, Second Department, October 11, 2016Fact issues remain on whether the verification defense appliesReversed dismissal of the action as premature and denied the insurer's summary judgment motion on its defense that the provider had failed to provide requested verification.
Island Life Chiropractic, P.C. v American Tr. Ins. Co. (2016 NY Slip Op 51541(U)) Appellate Term, Second Department, October 11, 2016Fact issues remain on whether the verification defense applies (also decides)Denied the insurer's cross motion to dismiss the action as premature for outstanding verification, for the reasons stated in a companion decision, while leaving the provider's summary judgment motion denied.
TAM Med. Supply Corp. v American Tr. Ins. Co. (2016 NY Slip Op 51513(U)) Appellate Term, Second Department, October 11, 2016Fact issues remain on whether the verification defense appliesDenied the insurer's cross motion to dismiss the action as premature for outstanding verification, while leaving the provider's summary judgment motion denied.
Island Life Chiropractic, P.C. v Travelers Ins. Co. (2016 NY Slip Op 51511(U)) Appellate Term, Second Department, October 11, 2016Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the insurer showed it properly mailed initial and follow-up verification requests and never received the requested verification, so dismissal was affirmed.
TAM Med. Supply Corp. v 21st Century Ins. Co. (2016 NY Slip Op 51509(U)) Appellate Term, Second Department, October 11, 2016Defense rejected because the insurer's requests or proof were deficientHeld the insurer was not entitled to summary judgment dismissing the complaint as premature for failure to provide requested verification, for reasons incorporated from a companion decision.
TAM Med. Supply Corp. v National Liab. & Fire Ins. Co. (2016 NY Slip Op 51506(U)) Appellate Term, Second Department, October 11, 2016Fact issues remain on whether the verification defense appliesHeld a triable issue existed as to prematurity because, although the insurer showed timely requests and non-receipt, the provider's affidavit raised a presumption that the requested verification was mailed and received.
Performance Plus Med., P.C. v Nationwide Ins. (2016 NY Slip Op 51500(U)) Appellate Term, Second Department, October 11, 2016Fact issues remain on whether the verification defense appliesHeld a triable issue existed as to whether the action was premature because the provider's affidavit raised a presumption that the requested verification had been mailed and received, despite the insurer's non-receipt proof.
Renelique v American Tr. Ins. Co. (2016 NY Slip Op 51495(U)) Appellate Term, Second Department, October 11, 2016Defense rejected because the insurer's requests or proof were deficientHeld the insurer was not entitled to summary judgment dismissing the complaint as premature for failure to provide requested verification, for reasons incorporated from a companion decision.
Mollo Chiropractic, PLLC v Farmington Cas. Co. (2016 NY Slip Op 51496(U)) Appellate Term, Second Department, October 11, 2016Fact issues remain on whether the verification defense appliesHeld a triable issue existed as to whether the action was premature, because the provider's affidavit presumptively showed the requested verification was mailed and received despite the insurer's proof of nonreceipt.
Daily Med. Equip. Distrib. Ctr., Inc. v Auto One Ins. Co. (2016 NY Slip Op 51443(U)) Appellate Term, Second Department, October 5, 2016Defense rejected because the insurer's requests or proof were deficientHeld the insurer not entitled to dismissal of two causes of action as premature because its affidavits did not establish that the verification requests were mailed.
Compas Med., P.C. v Travelers Ins. Co. (2016 NY Slip Op 51442(U)) Appellate Term, Second Department, October 5, 2016Timely requests went unanswered; the claim is not overdue and the action is prematureAffirmed dismissal of three causes of action because the provider had failed to provide the verification the insurer requested, for reasons incorporated from a companion decision.
Compas Med., P.C. v Travelers Ins. Co. (2016 NY Slip Op 51441(U)) Appellate Term, Second Department, October 5, 2016Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the insurer need not pay or deny on a partial response, the provider's unraised objections to the requests could not be heard, and the requests were properly mailed and unanswered, so dismissal was affirmed.
Compas Med., P.C. v American Tr. Ins. Co. (2016 NY Slip Op 51433(U)) Appellate Term, Second Department, September 27, 2016Fact issues remain on whether the verification defense appliesHeld that although the insurer showed it had not received requested verification, the provider's affidavit raising a presumption of mailing its response created a triable issue whether the two causes of action were premature.
Island Life Chiropractic, P.C. v Travelers Ins. Co. (2016 NY Slip Op 51413(U)) Appellate Term, Second Department, September 27, 2016Fact issues remain on whether the verification defense appliesHeld a triable issue existed as to prematurity because the provider's affidavit raised a presumption that the requested verification was mailed and received, countering the insurer's showing of non-receipt.
Treka Med., P.C. v Travelers Ins. Co. (2016 NY Slip Op 51411(U)) Appellate Term, Second Department, September 27, 2016Timely requests went unanswered; the claim is not overdue and the action is prematureHeld five causes of action premature because the insurer proved it mailed initial and follow-up verification requests and never received the requested verification.
Compas Med., P.C. v Travelers Insurance Company (2016 NY Slip Op 51424(U)) Appellate Term, Second Department, September 27, 2016Timely requests went unanswered; the claim is not overdue and the action is premature (also decides)Held the first cause of action premature because the insurer proved that it mailed the initial and follow-up verification requests and never received the requested verification.
Ultimate Health Prods., Inc. v Allstate Ins. Co. (2016 NY Slip Op 51353(U)) Appellate Term, Second Department, September 19, 2016Fact issues remain on whether the verification defense appliesHeld neither party entitled to judgment because the record established neither the timely mailing of the requests nor that the requests were untimely or that the verification was received.
TAM Med. Supply Corp. v 21st Century Ins. Co. (2016 NY Slip Op 51319(U)) Appellate Term, Second Department, September 15, 2016Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the insurer showed proper mailing of initial and follow-up verification requests and non-receipt of the requested verification.
Compas Med., P.C. v Praetorian Ins. Co. (2016 NY Slip Op 51000(U)) Appellate Term, Second Department, June 22, 2016Fact issues remain on whether the verification defense appliesHeld that despite proof of mailed verification and follow-up requests and non-receipt, the provider's owner's affidavit raised a presumption the verification was mailed and received, creating a triable issue on prematurity.
Daily Med. Equip. Distrib. Ctr., Inc. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 50929(U)) Appellate Term, Second Department, June 6, 2016Fact issues remain on whether the verification defense appliesReversed the dismissal of the action as premature for unanswered verification requests and denied the insurer's summary judgment motion, adopting a companion decision's reasoning that a triable issue existed as to whether the action was premature.
Island Life Chiropractic, P.C. v National Liab. & Fire Ins. Co. (2016 NY Slip Op 50927(U)) Appellate Term, Second Department, June 6, 2016Fact issues remain on whether the verification defense appliesDenied the insurer's cross motion to dismiss the action as premature for unanswered verification requests while leaving the denial of the provider's motion in place, adopting a companion decision's finding of a triable issue on prematurity.
Ultimate Health Prods., Inc. v Allstate Ins. Co. (2016 NY Slip Op 50921(U)) Appellate Term, Second Department, June 6, 2016Defense rejected because the insurer's requests or proof were deficientHeld the insurer was not entitled to summary judgment dismissing the complaint as premature for failure to provide requested verification, for reasons incorporated from a companion decision.
New Way Med. Supply Corp. v Praetorian Ins. Co. (2016 NY Slip Op 50920(U)) Appellate Term, Second Department, June 6, 2016Fact issues remain on whether the verification defense appliesDenied the insurer's cross motion to dismiss the action as premature for unanswered verification requests while leaving the denial of the provider's motion in place, adopting a companion decision's finding of a triable issue on prematurity.
Tam Med. Supply Corp. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 50914(U)) Appellate Term, Second Department, June 6, 2016Fact issues remain on whether the verification defense appliesReversed the dismissal of the action as premature for unanswered verification requests and denied the insurer's summary judgment motion, adopting a companion decision's finding of a triable issue as to whether verification was outstanding.
Renelique v Travelers Ins. Co. (2016 NY Slip Op 50911(U)) Appellate Term, Second Department, June 6, 2016Fact issues remain on whether the verification defense appliesHeld a triable issue existed as to prematurity because the provider's affidavit raised a presumption that the requested verification was mailed and received, despite the insurer's prima facie showing.
Great Health Care Chiropractic, P.C. v Hereford Ins. Co. (2016 NY Slip Op 50910(U)) Appellate Term, Second Department, June 6, 2016Fact issues remain on whether the verification defense appliesHeld a triable issue existed as to prematurity because the provider's affidavit raised a presumption that the requested verification was mailed and received, despite the insurer's prima facie showing.
Compas Med., P.C. v Farmington Cas. Co. (2016 NY Slip Op 50925(U)) Appellate Term, Second Department, June 6, 2016Timely requests went unanswered; the claim is not overdue and the action is premature (also decides)Affirmed dismissal of the $198 claim as premature because the insurer showed it never received the requested verification and the provider raised no triable issue.
Great Health Care Chiropractic, P.C. v Hereford Ins. Co. (2016 NY Slip Op 50858(U)) Appellate Term, Second Department, June 3, 2016Fact issues remain on whether the verification defense appliesHeld a triable issue existed as to prematurity because the provider's affidavit raised a presumption that the requested verification was mailed and received, so the insurer's motion was properly denied.
Vladenn Med. Supply Corp. v Travelers Ins. Co. (2016 NY Slip Op 50381(U)) Appellate Term, Second Department, March 17, 2016Fact issues remain on whether the verification defense appliesHeld a triable issue existed as to prematurity because the provider's affidavit raised a presumption that the requested verification was mailed and received, despite the insurer's prima facie showing.
Tam Med. Supply Corp. v American Tr. Ins. Co. (2016 NY Slip Op 50369(U)) Appellate Term, Second Department, March 16, 2016Fact issues remain on whether the verification defense appliesHeld a triable issue existed as to prematurity because the provider's affidavit raised a presumption that the requested verification was mailed and received, despite the insurer's prima facie showing.
Performance Plus Med., P.C. v Nationwide Ins. (2016 NY Slip Op 50366(U)) Appellate Term, Second Department, March 16, 2016Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the insurer established it had not received requested verification, so the second through tenth causes of action were premature and properly dismissed.
Emc Health Prods., Inc. v National Liab. & Fire Ins. Co. (2016 NY Slip Op 50132(U)) Appellate Term, Second Department, February 5, 2016Fact issues remain on whether the verification defense appliesHeld a triable issue existed as to whether four causes of action were premature because the provider's affidavit raised a presumption that the requested verification was mailed and received.
J.C. Healing Touch Rehab, P.C. v American Tr. Ins. Co. (2016 NY Slip Op 50033(U)) Appellate Term, Second Department, January 8, 2016Fact issues remain on whether the verification defense appliesHeld the insurer showed timely verification requests and non-receipt, but the provider's billing-company affidavit raised a presumption the verification was mailed and received, so whether the claims were premature was a triable issue.
Parkview Med. Advanced, P.C. v Travelers Ins. Co. (2015 NY Slip Op 51873(U)) Appellate Term, Second Department, December 9, 2015Timely requests went unanswered; the claim is not overdue and the action is prematureHeld eight causes of action premature because the insurer proved timely requests and follow-ups and non-receipt of verification, while the remaining claim, lacking proof of a timely request, was awarded to the provider.
Compas Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51776(U)) Appellate Term, Second Department, December 2, 2015Fact issues remain on whether the verification defense appliesHeld the insurer showed timely mailed verification and follow-up requests and nonreceipt, but the provider's owner's affidavit raised a presumption the verification was mailed and received, leaving a triable issue whether the claim was premature.
Compas Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51699(U)) Appellate Term, Second Department, November 19, 2015Fact issues remain on whether the verification defense applies (also decides)Held the insurer showed timely verification and follow-up requests and nonreceipt, but the provider's owner's affidavit gave rise to a presumption of mailing and receipt, raising a triable issue whether the first cause of action was premature.
New Way Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2015 NY Slip Op 51678(U)) Appellate Term, Second Department, November 13, 2015Fact issues remain on whether the verification defense appliesHeld a triable issue existed whether the second cause of action was premature because the provider's affidavit raised a presumption that it mailed the requested verification.
T & J Chiropractic, P.C. v American Tr. Ins. Co. (2015 NY Slip Op 51673(U)) Appellate Term, Second Department, November 13, 2015Fact issues remain on whether the verification defense appliesHeld a triable issue existed as to prematurity because the provider's affidavit raised a presumption that the requested verification was mailed and received, despite the examiner's non-receipt affidavit.
New Way Med. Supply Corp. v Praetorian Ins. Co. (2015 NY Slip Op 51632(U)) Appellate Term, Second Department, November 9, 2015Fact issues remain on whether the verification defense appliesHeld the insurer showed timely verification and follow-up requests and nonreceipt, but the provider's owner's affidavit raised a presumption the verification was mailed and received, so whether four causes of action were premature was a triable issue.
New Way Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2015 NY Slip Op 51627(U)) Appellate Term, Second Department, November 9, 2015Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the $909 supply claim premature because the insurer showed it never received the requested verification and the provider did not show it was provided before suit.
Compas Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51467(U)) Appellate Term, Second Department, September 17, 2015Timely requests went unanswered; the claim is not overdue and the action is premature (also decides)Held the third cause of action premature because the insurer timely mailed verification and follow-up requests, never received the verification, and the provider raised no triable issue.
Compas Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51408(U)) Appellate Term, Second Department, September 16, 2015Timely requests went unanswered; the claim is not overdue and the action is premature (also decides)Held the second cause of action premature because the insurer timely mailed verification and follow-up requests, never received the verification, and the provider raised no triable issue.
Compas Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51403(U)) Appellate Term, Second Department, September 16, 2015Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the fifth cause of action premature because the insurer timely mailed verification and follow-up requests, never received the verification, and the provider raised no triable issue.
Compas Med., P.C. v American Tr. Ins. Co. (2015 NY Slip Op 51240(U)) Appellate Term, Second Department, August 6, 2015Fact issues remain on whether the verification defense appliesHeld that, although the insurer showed the provider failed to respond to initial and follow-up verification requests, the provider's opposition raised a triable issue as to whether it had responded.
Tam Med. Supply Corp. v Lancer Ins. Co. (2015 NY Slip Op 51126(U)) Appellate Term, Second Department, July 27, 2015Defense rejected because the insurer's requests or proof were deficientHeld the insurer not entitled to dismissal as premature because, although its requests were timely mailed, it did not demonstrate prima facie that it had not received the requested verification.
New York Diagnostic Med. Care, P.C. v Country-Wide Ins. Co. (2015 NY Slip Op 50814(U)) Appellate Term, Second Department, May 19, 2015Fact issues remain on whether the verification defense appliesHeld neither party entitled to summary judgment because triable issues existed, including whether the provider adequately responded to the insurer's verification requests.
Emc Health Prods., Inc. v Geico Ins. Co. (2015 NY Slip Op 50800(U)) Appellate Term, Second Department, May 19, 2015Fact issues remain on whether the verification defense appliesHeld a triable issue of fact existed as to whether the provider responded to the insurer's verification requests, so the insurer's prematurity cross motion was properly denied.
New Way Med. Supply Corp. v National Liab. & Fire Ins. Co. (2015 NY Slip Op 50783(U)) Appellate Term, Second Department, May 18, 2015Fact issues remain on whether the verification defense appliesHeld a triable issue existed as to whether the provider responded to the timely mailed verification requests, so neither party was entitled to summary judgment.
Healthy Way Acupuncture, P.C. v NY Cent. Mut. Fire Ins. Co. (2015 NY Slip Op 50773(U)) Appellate Term, Second Department, May 18, 2015Timely requests went unanswered; the claim is not overdue and the action is prematureHeld a timely verification request tolls the time to pay or deny the entire claim form, so the unanswered requests made the action premature as to the portion billed under the second code too.
Longevity Med. Supply, Inc. v Allstate Ins. Co. (2015 NY Slip Op 50757(U)) Appellate Term, Second Department, May 6, 2015Fact issues remain on whether the verification defense appliesHeld the provider not entitled to summary judgment because the insurer's proof of nonreceipt and the provider's affidavit that responsive material was sent raised an issue of fact whether verification was provided.
Parkview Med. & Surgical, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 50491(U)) Appellate Term, Second Department, March 26, 2015Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the first cause of action premature because the insurer proved timely requests and non-receipt and the provider did not show it supplied the verification before suit.
Renelique v American Tr. Ins. Co. (2015 NY Slip Op 50482(U)) Appellate Term, Second Department, March 26, 2015Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the insurer proved timely requests and follow-ups and non-receipt of all requested verification, and the provider did not show the verification was provided before suit.
Longevity Med. Supply, Inc. v Praetorian Ins. Co. (2015 NY Slip Op 50401(U)) Appellate Term, Second Department, March 17, 2015Fact issues remain on whether the verification defense appliesHeld that the insurer proved mailing of verification requests and non-receipt, but the provider's employee affidavit raised a presumption the verification was mailed and received, creating a triable issue on prematurity.
Healing Health Prods., Inc. v New York Cent. Mut. Fire Ins. Co. (2015 NY Slip Op 50080(U)) Appellate Term, Second Department, January 15, 2015Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the claim for the knee support premature because the insurer proved timely requests and non-receipt of verification and the provider did not show it was provided before suit.
Right Solution Med. Supply, Inc. v NY Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 51860(U)) Appellate Term, Second Department, December 19, 2014Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the first cause of action premature because the insurer timely mailed verification and follow-up requests, had not received all the verification, and the provider did not show it was provided before suit.
Coney Is. Physician Care, P.C. v Praetorian Ins. Co. (2014 NY Slip Op 51859(U)) Appellate Term, Second Department, December 19, 2014Timely requests went unanswered; the claim is not overdue and the action is prematureHeld claims for four bills premature because the insurer timely mailed verification and follow-up requests, never received the verification, and the provider did not show it was provided.
EMC Health Prods., Inc. v Geico Ins. Co. (2014 NY Slip Op 51834(U)) Appellate Term, Second Department, December 17, 2014Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the insurer showed it never received the requested verification and the provider did not show it was furnished before suit, so the 30-day period never began.
Skymed Med., P.C. v Tri-State Consumer Ins. (2014 NY Slip Op 51833(U)) Appellate Term, Second Department, December 17, 2014Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the insurer timely mailed initial and follow-up verification requests, never received the verification, and the provider did not show it was provided before suit.
Northshore Chiropractic Diagnostics, P.C. v A. Cent. Ins. Co. (2014 NY Slip Op 51825(U)) Appellate Term, Second Department, December 17, 2014Fact issues remain on whether the verification defense appliesHeld the verification requests timely mailed but found a triable issue whether the provider adequately responded, so neither side obtained summary judgment on the prematurity defense.
True-Align Chiropractic Care, P.C. v Country Wide Ins. Co. (2014 NY Slip Op 51821(U)) Appellate Term, Second Department, December 17, 2014Timely requests went unanswered; the claim is not overdue and the action is premature (also decides)Held the first cause of action properly dismissed because the insurer timely mailed its verification requests, had not received the verification, and the provider did not show it was provided.
City Chiropractic, P.C. v Eveready Ins. Co. (2014 NY Slip Op 51802(U)) Appellate Term, Second Department, December 17, 2014Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the insurer timely mailed verification and follow-up requests, had not received all requested verification, and the provider did not show it was provided before suit.
Island Chiropractic Testing, P.C. v Praetorian Ins. Co. (2014 NY Slip Op 51795(U)) Appellate Term, Second Department, December 17, 2014Fact issues remain on whether the verification defense appliesHeld the insurer timely mailed initial and follow-up requests but found a triable issue whether the provider adequately responded, so the provider's cross motion was denied and the insurer's motion stayed denied.
Right Solution Med. Supply, Inc. v Praetorian Ins. Co. (2014 NY Slip Op 51793(U)) Appellate Term, Second Department, December 17, 2014Fact issues remain on whether the verification defense appliesHeld a triable issue existed as to whether the provider's responses to the verification requests were sufficient, so neither the insurer's prematurity motion nor the provider's motion could be granted.
SS Med. Care, P.C. v Eveready Ins. Co. (2014 NY Slip Op 51305(U)) Appellate Term, Second Department, August 20, 2014Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the insurer timely mailed verification and follow-up requests, never received the verification, and the provider did not oppose.
Healing Health Prods., Inc. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 24145) Appellate Term, Second Department, May 22, 2014Fact issues remain on whether the verification defense appliesHeld that tolling depends on mailing, not receipt, and that a triable issue on whether the requests were mailed precluded summary judgment dismissing the action as premature.
J.C. Healing Touch Rehab, P.C. v Eveready Ins. Co. (2014 NY Slip Op 50774(U)) Appellate Term, Second Department, April 30, 2014Fact issues remain on whether the verification defense applies (also decides)Affirmed that a triable issue of fact existed as to whether the verification the insurer requested remained outstanding, leaving that as the only trial issue after the insurer's medical-necessity cross motion and challenge to the CPLR 3212 (g) findings failed.
Rogy Med., P.C. v Clarendon Natl. Ins. Co. (2014 NY Slip Op 50629(U)) Appellate Term, Second Department, April 7, 2014Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the provider raised no triable issue on compliance with verification requests for two undenied bills, lacking an affidavit of personal knowledge that it responded, and could not challenge the requests' reasonableness after inaction.
Elmont Open MRI & Diagnostic Radiology, P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50607(U)) Appellate Term, Second Department, March 27, 2014Fact issues remain on whether the verification defense appliesHeld a triable issue of fact existed as to whether verification was outstanding, so the insurer's motion was denied and summary judgment for the provider was vacated.
Favorite Health Prods., Inc. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50467(U)) Appellate Term, Second Department, March 17, 2014Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the insurer had not received all requested verification and the provider did not show it was provided before commencing suit.
Westchester Med. Ctr. v A Cent. Ins. Co. (2014 NY Slip Op 50347(U)) Appellate Term, Second Department, February 28, 2014Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because timely initial and follow-up requests went unanswered, measured from the first receipt of the claim, since resubmitting the same bill did not restart the 30-day period.
Westchester Med. Ctr. v New S. Ins. Co. (2013 NY Slip Op 52085(U)) Appellate Term, Second Department, December 12, 2013Fact issues remain on whether the verification defense appliesHeld the provider not entitled to summary judgment because the insurer's proof of nonreceipt and the provider's affidavit that responsive material was sent raised an issue of fact.
Elite Med. NY, P.C. v American Tr. Ins. Co. (2013 NY Slip Op 51738(U)) Appellate Term, Second Department, October 8, 2013Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the insurer timely mailed verification and follow-up requests that the provider never answered before suit, so the time to pay or deny had not elapsed and the claim was dismissed as premature.
Colonia Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2013 NY Slip Op 51266(U)) Appellate Term, Second Department, July 12, 2013Defense rejected because the insurer's requests or proof were deficient (also decides)Held two claims not shown premature because the insurer's letters merely announced a delay pending investigation of the accident and did not request verification, so they did not toll the time to pay or deny.
Brooklyn Chiropractic & Sports Therapy, P.C. v A. Cent. Ins. Co. (2013 NY Slip Op 50904(U)) Appellate Term, Second Department, May 22, 2013Timely requests went unanswered; the claim is not overdue and the action is prematureHeld two claims premature because the insurer timely mailed initial and follow-up verification requests and never received responses, so its time to pay or deny had not begun.
Ortho Prods. & Equipments, Inc. v Eveready Ins. Co. (2013 NY Slip Op 50856(U)) Appellate Term, Second Department, May 14, 2013Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the provider's non-prescribed forms lacked substantially the same information as an NF-3, so the requested prescribed forms remained outstanding and the 30-day period never began.
Crotona Hgts. Med., P.C. v Clarendon Natl. Ins. Co. (2013 NY Slip Op 50473(U)) Appellate Term, Second Department, March 29, 2013Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the provider failed to respond to the insurer's timely verification requests and showed no responsive submission, so the third cause of action was dismissed as premature.
Triangle R, Inc. v Tri-State Consumer Ins. Co. (2013 NY Slip Op 50256(U)) Appellate Term, Second Department, February 19, 2013Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the provider never answered the timely mailed verification requests before suit, so the insurer's time to pay or deny never began to run.
Compas Med., P.C. v Praetorian Ins. Co. (2013 NY Slip Op 50251(U)) Appellate Term, Second Department, February 19, 2013Timely requests went unanswered; the claim is not overdue and the action is prematureHeld four claims premature because the insurer proved it timely mailed initial and follow-up verification requests and the provider did not show it supplied the verification before suit, so the 30 days never began.
Compas Med., P.C. v Praetorian Ins. Co. (2013 NY Slip Op 50249(U)) Appellate Term, Second Department, February 19, 2013Timely requests went unanswered; the claim is not overdue and the action is prematureHeld four claims premature because the insurer proved timely initial and follow-up verification requests and the provider did not show it supplied the verification before suit.
Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co. (2013 NY Slip Op 50199(U)) Appellate Term, Second Department, February 11, 2013Timely requests went unanswered; the claim is not overdue and the action is prematureHeld three claims premature because the insurer timely mailed initial and follow-up verification requests and the provider did not show it supplied the verification before suit.
All Boro Psychological Servs., P.C. v Allstate Ins. Co. (2013 NY Slip Op 50069(U)) Appellate Term, Second Department, January 14, 2013Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the insurer entitled to summary judgment dismissing the complaint because it timely mailed initial and follow-up verification requests and the provider undisputedly never responded, so the 30 days never began.
Infinity Health Prods., Ltd. v Liberty Mut. Fire Ins. Co. (2012 NY Slip Op 52396(U)) Appellate Term, Second Department, December 21, 2012Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the insurer proved timely verification requests and follow-ups and that the provider never responded, so the 30-day period to pay or deny never began.
Huntington Hosp. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 52274(U)) Appellate Term, Second Department, December 7, 2012Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the insurer showed timely initial and follow-up verification requests that went unanswered, tolling its time to pay or deny; the general denial the provider submitted did not address the bill at issue.
Alev Med. Supply, Inc. v Eveready Ins. Co. (2012 NY Slip Op 52184(U)) Appellate Term, Second Department, November 26, 2012Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the insurer timely requested and followed up on verification, had not received all of it, and the provider showed no response before suit.
Oriental World Acupuncture, P.C. v American Tr. Ins. Co. (2012 NY Slip Op 52181(U)) Appellate Term, Second Department, November 26, 2012Timely requests went unanswered; the claim is not overdue and the action is prematureUpheld dismissal as premature because the insurer timely mailed verification requests and follow-ups and never received the verification, and the provider did not show it was provided before suit, so the 30 days never ran.
AIM Acupuncture, P.C. v Travelers Ins. Co. (2012 NY Slip Op 51773(U)) Appellate Term, Second Department, September 5, 2012Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the insurer proved timely verification requests and follow-ups that it never received answers to, and the provider did not show the verification was provided before suit.
Compas Med., P.C. v Delos Ins. Co. (2012 NY Slip Op 51715(U)) Appellate Term, Second Department, August 31, 2012Fact issues remain on whether the verification defense appliesHeld the insurer not entitled to summary judgment dismissing the complaint because a triable issue of fact existed as to whether verification remained outstanding.
Quality Health Prods. v Country-Wide Ins. Co. (2012 NY Slip Op 51641(U)) Appellate Term, Second Department, August 23, 2012Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the insurer timely mailed initial and follow-up verification requests and had not received the verification, and the provider did not show it was provided before suit.
Dr. Stephen Matrangolo, D.C., P.C. v Encompass Indem. Co. (2012 NY Slip Op 51338(U)) Appellate Term, Second Department, July 12, 2012Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature and granted the insurer summary judgment because it timely mailed verification requests and follow-ups and the provider did not respond before suing, so the time to pay or deny had not elapsed.
Infinity Health Prods., Ltd. v Travelers Ins. Co. (2012 NY Slip Op 51063(U)) Appellate Term, Second Department, June 11, 2012Fact issues remain on whether the verification defense appliesHeld the insurer's conclusory assertions that the provider's responses were insufficient did not warrant dismissal, left a triable issue whether verification was still outstanding, and found no issue as to the requests' propriety.
Med-Tech Prod., Inc. v Progressive Northeastern Ins. Co. (2012 NY Slip Op 50930(U)) Appellate Term, Second Department, May 15, 2012Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the third and sixth causes of action premature because the insurer timely requested and followed up on verification and the provider did not show it supplied the verification before suit.
Infinity Health Prods. Ltd. v Liberty Mut. Fire Ins. Co. (2012 NY Slip Op 50774(U)) Appellate Term, Second Department, April 27, 2012Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the insurer's affidavit established timely verification requests and follow-ups and the provider's failure to respond, which the provider never denied.
Jesa Med. Supply, Inc. v American Tr. Ins. Co. (2012 NY Slip Op 50052(U)) Appellate Term, Second Department, January 13, 2012Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the insurer timely requested and followed up on verification, had not received it, and the provider showed none was provided before suit.
Psychology YM, P.C. v Progressive Northeastern Ins. Co. (2011 NY Slip Op 52275(U)) Appellate Term, Second Department, December 16, 2011Timely requests went unanswered; the claim is not overdue and the action is prematureUpheld dismissal as premature because the insurer timely mailed verification requests and follow-ups that the provider did not answer before suit, so the time to pay or deny had not elapsed.
D & R Med. Supply v American Tr. Ins. Co. (2011 NY Slip Op 51727(U)) Appellate Term, Second Department, September 19, 2011Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the supplier's responses only said the supplies were prescribed, without naming or locating the prescribing doctor, so the requested verification was not provided.
Jesa Med. Supply, Inc. v Progressive Ins. Co. (2011 NY Slip Op 51603(U)) Appellate Term, Second Department, August 16, 2011Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the insurer never received the verification it timely requested and followed up on, and the provider showed none was provided before suit, so the action on two claims was premature.
Radiology Today, P.C. v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 52452(U)) Appellate Term, Second Department, July 27, 2011Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the insurer showed timely requests for the MRI films and other items, and the provider's papers never addressed the films, so verification remained outstanding.
Five Boro Psychological Servs., P.C. v Utica Mut. Ins. Co. (2011 NY Slip Op 51119(U)) Appellate Term, Second Department, June 14, 2011Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the provider failed to respond to the insurer's timely initial and follow-up verification requests, so the 30-day period never began and the cause of action on that bill was premature.
Pomona Med. Diagnostics, P.C. v Travelers Ins. Co. (2011 NY Slip Op 50447(U)) Appellate Term, Second Department, March 17, 2011Timely requests went unanswered; the claim is not overdue and the action is prematureUpheld dismissal because the insurer timely mailed its verification request and follow-up and the provider served no responses before suit, so the time to pay or deny had not begun.
Sound Shore Med. Ctr. v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 50033(U)) Appellate Term, Second Department, January 10, 2011Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the initial request followed receipt of a UB-04, the functional equivalent of an NF-5, so it was timely, and the hospital never answered either request.
Triangle R, Inc. v Clarendon Ins. Co. (2010 NY Slip Op 52159(U)) Appellate Term, Second Department, December 10, 2010Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the requests were properly mailed and unanswered; copies sent to the assignor's wrong address did not void requests that sought verification from the provider.
St. Vincent's Hosp. & Med. Ctr. v American Tr. Ins. Co. (2010 NY Slip Op 52063(U)) Appellate Term, Second Department, November 26, 2010Defense rejected because the provider supplied the verification or justified noncomplianceRejected the prematurity defense because the requests for NF-5 forms signed by the assignors were satisfied when the hospital supplied the signed release authorizations and assignments; counsel's affirmation of non-receipt lacked personal knowledge.
Delta Diagnostic Radiology, P.C. v Interboro Ins. Co. (2010 NY Slip Op 52022(U)) Appellate Term, Second Department, November 19, 2010Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the provider failed to respond to the insurer's timely initial and follow-up verification requests, so the 30-day period never ran and the third cause of action was premature.
Eagle Surgical Supply, Inc. v Travelers Indem. Co. (2010 NY Slip Op 51775(U)) Appellate Term, Second Department, October 5, 2010Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the insurer timely requested additional verification and the record unequivocally showed the provider failed to provide all of it, despite the responses it annexed.
Eagle Surgical Supply, Inc. v Travelers Indem. Co. (2010 NY Slip Op 51456(U)) Appellate Term, Second Department, August 12, 2010Defense rejected because the insurer's requests or proof were deficientDenied the insurer summary judgment because no one with personal knowledge stated that the requested verification remained outstanding; the examiner did not allege it and counsel lacked personal knowledge of non-receipt.
Proscan Imaging, P.C. v Travelers Indem. Co. (2010 NY Slip Op 51176(U)) Appellate Term, Second Department, July 7, 2010Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature and dismissed it without prejudice because the provider did not show it supplied the requested verification before suing, so the 30-day period never began to run.
Urban Radiology, P.C. v Tri-State Consumer Ins. Co. (2010 NY Slip Op 50987(U)) Appellate Term, Second Department, June 8, 2010Timely requests went unanswered; the claim is not overdue and the action is prematureHeld two claims premature because the provider undisputedly never responded to timely verification requests, and its view that the requests belonged with the referring physician did not excuse its inaction.
Triangle R, Inc. v GEICO Ins. Co. (2010 NY Slip Op 50885(U)) Appellate Term, Second Department, May 13, 2010Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the insurer timely mailed its request and follow-up and the provider did not show it supplied the verification before suit, so the 30-day period never began; dismissed without prejudice.
D.S. Chiropractic, P.C. v Country-Wide Ins. Co. (2010 NY Slip Op 50649(U)) Appellate Term, Second Department, April 9, 2010Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the insurer timely mailed initial and follow-up verification requests that went unanswered, the follow-up sent on day 30 being effective, so the 30-day period never began to run.
First Aid Occupational Therapy, PLLC v Country-Wide Ins. Co. (2010 NY Slip Op 50594(U)) Appellate Term, Second Department, April 2, 2010Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature on most claims because the insurer timely mailed initial and follow-up verification requests that went unanswered, and a follow-up sent on day 29 or 30 was effective, so the 30-day period never began.
Ambrister v Integon Natl. Ins. Co. (2010 NY Slip Op 50489(U)) Appellate Term, Second Department, March 19, 2010Timely requests went unanswered; the claim is not overdue and the action is prematureUpheld dismissal of the action as premature, rejecting the argument that the insurer failed to prove its initial request because the stamped follow-up letter, explained by the examiner's practice, showed the original request.
St. Vincent Med. Care, P.C. v Country Wide Ins. Co. (2010 NY Slip Op 50488(U)) Appellate Term, Second Department, March 19, 2010Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature on most claims because the insurer undisputedly mailed an initial verification request and a follow-up on day 30 that went unanswered, so its 30-day period to pay or deny never began.
St. Vincent Med. Care, P.C. v Country-Wide Ins. Co. (2010 NY Slip Op 50444(U)) Appellate Term, Second Department, March 10, 2010Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature on seven causes of action because the insurer timely mailed initial and follow-up verification requests that went unanswered, and a follow-up sent on day 30 was effective, so the 30-day period never began.
First Aid Occupational Therapy, PLLC v Country-Wide Ins. Co. (2010 NY Slip Op 50149(U)) Appellate Term, Second Department, January 29, 2010Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature on three causes of action because the insurer timely mailed initial and follow-up verification requests, the follow-up on day 30 being effective, and the provider never supplied the requested information.
Quality Rehab & P.T., P.C. v GEICO Ins. Co. (2010 NY Slip Op 50067(U)) Appellate Term, Second Department, January 12, 2010Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature and dismissed it without prejudice because the provider did not show it supplied the timely requested verification before suit, so the 30-day period never began.
Velen Med. Supply, Inc. v Country-Wide Ins. Co. (2009 NY Slip Op 52630(U)) Appellate Term, Second Department, December 23, 2009Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the provider never answered the timely initial request or the follow-up mailed on the 29th day, which was effective, so the 30-day period never began to run.
D.S. Chiropractic, P.C. v Country-Wide Ins. Co. (2009 NY Slip Op 51584(U)) Appellate Term, Second Department, July 14, 2009Defense rejected because the insurer's requests or proof were deficientHeld the insurer's follow-up verification requests, mailed on the 30th day after the initial requests, were premature and without effect, so the 30-day period was not tolled and its denial was untimely.
D.S. Chiropractic, P.C. v Country-Wide Ins. Co. (2009 NY Slip Op 51579(U)) Appellate Term, Second Department, July 14, 2009Defense rejected because the insurer's requests or proof were deficientHeld the follow-up verification requests, mailed on the 30th day after the initial requests, were premature and without effect, so the claim period was not tolled and the prematurity defense failed.
Alur Med. Supply, Inc. v Eveready Ins. Co. (2009 NY Slip Op 51492(U)) Appellate Term, Second Department, July 9, 2009Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the insurer timely mailed verification and follow-up requests and the provider served no responses before suing, so the time to pay or deny had not elapsed.
A.B. Med. Servs., PLLC v Country-Wide Ins. Co. (2009 NY Slip Op 51016(U)) Appellate Term, Second Department, May 19, 2009Defense rejected because the insurer's requests or proof were deficientHeld the insurer's litigation supervisor's affidavit too unspecific about non-receipt to show that requested verification remained outstanding, so the claims were overdue and the providers won summary judgment.
Delta Diagnostic Radiology, P.C. v Country-Wide Ins. Co. (2009 NY Slip Op 52501(U)) Appellate Term, Second Department, May 8, 2009Defense rejected because the insurer's requests or proof were deficientHeld the follow-up verification requests, mailed on the 30th calendar day after the initial requests, premature and without effect, so the insurer's summary judgment motion on the verification defense was properly denied.
Vista Surgical Supplies, Inc. v Liberty Mut. Ins. Co. (2009 NY Slip Op 52500(U)) Appellate Term, Second Department, May 8, 2009Timely requests went unanswered; the claim is not overdue and the action is prematureAffirmed dismissal of the action as premature for failure to respond to verification requests after finding the insurer's mailing of those requests sufficiently established.
St. Vincent Med. Care, P.C. v Country-Wide Ins. Co. (2009 NY Slip Op 29508) Appellate Term, Second Department, May 8, 2009Defense rejected because the insurer's requests or proof were deficientHeld the verification requests did not toll the claim periods because the follow-up requests went out on the 30th calendar day after the initial requests, so they were premature and without effect and the insurer was precluded.
Audobon Physical Med & Rehab, P.C. v GEICO Ins. Co. (2009 NY Slip Op 50456(U)) Appellate Term, Second Department, March 16, 2009Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the second cause of action premature because the insurer proved timely mailed verification and follow-up requests and the provider did not show it supplied the verification.
A.B. Med. Servs., PLLC v Country-Wide Ins. Co. (2008 NY Slip Op 52651(U)) Appellate Term, Second Department, November 26, 2008Defense rejected because the insurer's requests or proof were deficientHeld the insurer's litigation supervisor's affidavit too unspecific about non-receipt to show that requested verification remained outstanding, so the claims were overdue and the providers won summary judgment.
Nyack Hosp. v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 52184(U)) Appellate Term, Second Department, November 5, 2008Defense rejected because the insurer's requests or proof were deficientRejected the prematurity defense because the insurer had to accept the hospital facility form in lieu of an application and requested verification of the assignment untimely, so it was not entitled to that verification.
Mary Immaculate Hosp. v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 52046(U)) Appellate Term, Second Department, October 9, 2008Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the second cause of action premature because the timely mailed verification and follow-up requests for an assignment form went unanswered, while verification for the first cause of action was supplied or not required.
Align for Health Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 51862(U)) Appellate Term, Second Department, September 3, 2008Defense rejected because the insurer's requests or proof were deficientHeld the insurer did not establish prematurity because it failed to prove timely mailing of its verification and follow-up requests, so its cross motion should have been denied.
Horton Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 51682(U)) Appellate Term, Second Department, July 30, 2008Defense rejected because the insurer's requests or proof were deficientDenied the insurer's prematurity cross motion on the seven claim-form causes of action because it did not prove its verification requests were timely mailed.
Infinity Health Prods., Ltd. v Eveready Ins. Co. (2008 NY Slip Op 28271) Appellate Term, Second Department, July 10, 2008Defense rejected because the insurer's requests or proof were deficientHeld the insurer's follow-up verification request, mailed 27 days after the initial request, premature and without effect, so the 30-day period was not tolled and the prematurity defense failed.
Vista Surgical Supplies, Inc. v Autoone Ins. Co. (2008 NY Slip Op 51460(U)) Appellate Term, Second Department, July 8, 2008Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the $350 claim premature because the insurer proved timely verification and follow-up requests and the provider did not show it supplied the requested verification, so the claim was not overdue.
Rockaway Med. & Diagnostic, P.C. v Utica Mut. Ins. Co. (2008 NY Slip Op 51033(U)) Appellate Term, Second Department, April 30, 2008Defense rejected because the insurer's requests or proof were deficient (also decides)Held the insurer did not demonstrate as a matter of law that the provider's causes of action were premature, so its cross motion was properly denied.
Rj Professional Acupuncturist, P.C. v MVAIC (2008 NY Slip Op 51472(U)) Appellate Term, Second Department, April 29, 2008Defense rejected because the insurer's requests or proof were deficientHeld the claims not tolled and overdue because MVAIC first requested verification more than a year after receiving them, so the arbitrator's prematurity ruling was contrary to settled law.
Kings Highway Diagnostic Imaging, P.C. v MVAIC (2008 NY Slip Op 28157) Appellate Term, Second Department, April 14, 2008Defense rejected because the insurer's requests or proof were deficient (also decides)Held that MVAIC's denial-of-claim form, even if treated as a verification request, came after payment was already overdue and so could not toll the payment due date or postpone accrual of the claim.
Boulevard Multispec Med., P.C. v MVAIC (2008 NY Slip Op 50872(U)) Appellate Term, Second Department, April 14, 2008Defense rejected because the insurer's requests or proof were deficient (also decides)Held that MVAIC's verification request, sent after the payment due date had passed, could not toll that date, and the provider's gratuitous compliance could not make the belated request timely, so the claim accrued 30 days after receipt.
Infinity Health Prods., Ltd. v Progressive Ins. Co. (2008 NY Slip Op 50345(U)) Appellate Term, Second Department, February 21, 2008Defense rejected because the insurer's requests or proof were deficientRejected the insurer's outstanding-verification defense because its proof did not show the follow-up verification request was timely mailed.
Allstate Social Work & Psychological Servs., P.L.L.C. v Utica Mut. Ins. Co. (2007 NY Slip Op 52042(U)) Appellate Term, Second Department, October 19, 2007Defense rejected because the insurer's requests or proof were deficientHeld the insurer did not show the provider's causes of action were premature because it failed to prove it mailed the verification and follow-up requests.
GMV Med. Supplies, Inc. v MVAIC (2007 NY Slip Op 50601(U)) Appellate Term, Second Department, March 26, 2007Defense rejected because the insurer's requests or proof were deficient (also decides)Held MVAIC not entitled to summary judgment because it did not establish that it timely requested verification and did not receive it.
Doshi Diagnostic Imaging Servs. v State Farm Ins. Co. (2007 NY Slip Op 27193) Appellate Term, Second Department, March 16, 2007Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because medical-necessity verification requested from the prescribing physician, with notice letters to the provider, remained unsatisfied; the regulations permit requests to non-applicants if the applicant is informed.
Metroscan Med. Diagnostics, P.C. v Progressive Cas. Ins. Co. (2007 NY Slip Op 50500(U)) Appellate Term, Second Department, March 15, 2007Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the provider answered requests for a proper assignment with another incomplete form and never supplied a properly completed assignment, so the 30 days remained tolled; the requests were sufficiently specific.
DSL Med. Practice, P.C. v American Tr. Ins. Co. (2007 NY Slip Op 50398(U)) Appellate Term, Second Department, March 5, 2007Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the claims premature because timely initial and follow-up requests for the assignor's social security number, a proper verification subject, remained unanswered.
Olympic Chiropractic, P.C. v American Tr. Ins. Co. (2007 NY Slip Op 50011(U)) Appellate Term, Second Department, January 2, 2007Timely requests went unanswered; the claim is not overdue and the action is prematureHeld three claims premature because the insurer validly requested the assignor's social security number and followed up, and the provider never supplied it, so those claims were severed and dismissed.
A.M. Med. Servs., P.C. v New York Cent. Mut. Ins. (2006 NY Slip Op 51662(U)) Appellate Term, Second Department, August 15, 2006Defense rejected because the insurer's requests or proof were deficientHeld the insurer failed to prove mailing of its verification requests, so the 30-day period was not tolled and it was precluded from most defenses on four claims.
Doshi Diagnostic Imaging Servs. v Progressive Ins. Co. (2006 NY Slip Op 51430(U)) Appellate Term, Second Department, July 17, 2006Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the claim not overdue because the provider answered timely verification requests with an assignment form lacking the provider's signature and never supplied a signed one, so the payment period remained tolled.
A.M. Med. Servs., P.C. v Progressive Cas. Ins. Co. (2006 NY Slip Op 51036(U)) Appellate Term, Second Department, May 19, 2006Defense rejected because the insurer's requests or proof were deficientRejected the insurer's claim that verification remained outstanding because it failed to prove mailing of its follow-up request, so the 30-day period was not tolled and the claim was overdue.
Vista Surgical Supplies, Inc. v General Assur. Co. (2006 NY Slip Op 51034(U)) Appellate Term, Second Department, May 19, 2006Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the insurer mailed timely initial and follow-up verification requests and the supplier did not controvert that it never responded before suing.
Ocean Diagnostic Imaging, P.C. v Nationwide Mut. Ins. Co. (2006 NY Slip Op 50477(U)) Appellate Term, Second Department, March 27, 2006Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the claim premature, and on searching the record dismissed the complaint, because the provider and its assignor never responded to the insurer's timely verification requests in the form of an EUO, so the 30 days never began.
Chi-Ti Acupuncture, P.C. v Hartford Acc. & Indem. Co. (2006 NY Slip Op 50148(U)) Appellate Term, Second Department, February 6, 2006Defense rejected because the insurer's requests or proof were deficient (also decides)Held the insurer's verification demands, made before it received the claims, were ineffective to toll the 30-day claim determination period.
Ocean Diagnostic Imaging P.C. v Allstate Ins. Co. (2006 NY Slip Op 50140(U)) Appellate Term, Second Department, February 3, 2006Defense rejected because the insurer's requests or proof were deficientHeld the insurer's EUO verification request untimely, so it did not toll the 30-day period; even if it had been timely, the insurer abandoned it by sending no follow-up after the nonappearance.
Fair Price Med. Supply Corp. v Travelers Indem. Co. (2005 NY Slip Op 25343) Appellate Term, Second Department, August 11, 2005Defense rejected because the provider supplied the verification or justified noncomplianceRejected the insurer's tolling defense because the provider proved it mailed the requested letters of medical necessity, so the claim was not timely denied and summary judgment went to the provider.
Struhl v Progressive Cas. Ins. Co. (2005 NYSlipOp 50864(U)) Appellate Term, Second Department, June 3, 2005Defense rejected because the insurer's requests or proof were deficient (also decides)Held the insurer's verification requests did not toll the 30-day period because it offered no proof of mailing or of a timely initial request, so its follow-up 'second notice' was of no significance.
Careplus Med. Supply Inc. v Travelers Home & Mar. Ins. Co. (2005 NYSlipOp 50648(U)) Appellate Term, Second Department, April 29, 2005Defense rejected because the insurer's requests or proof were deficientRejected the tolling defense because one initial request was untimely, the other requests were not shown mailed, and the follow-up EUO requests could not toll absent proof the policy contained the revised endorsement.
King's Med. Supply Inc. v Allstate Ins. Co. (2005 NYSlipOp 50451(U)) Appellate Term, Second Department, March 31, 2005Defense rejected because the insurer's requests or proof were deficientRejected denials for failure to provide requested narrative reports because the insurer sent no timely follow-up request, so the toll lapsed and the premature denials were of no effect.
King's Med. Supply Inc. v Kemper Auto & Home Ins. Co. (2005 NYSlipOp 50450(U)) Appellate Term, Second Department, March 31, 2005Fact issues remain on whether the verification defense appliesHeld a triable issue existed whether the insurer timely mailed two verification requests that, if mailed, meant it need not pay or deny until verification was received, so summary judgment was denied on that claim.
A.B. Med. Servs. PLLC v Country-Wide Ins. Co. (2005 NY Slip Op 50255(U)) Appellate Term, Second Department, March 2, 2005Defense rejected because the insurer's requests or proof were deficientHeld the insurer's letters merely announcing a delay pending investigation, without specifying the verification sought or from whom, were not verification requests and did not toll the 30-day period for 55 claims.
Contemp. Med. Diag. & Treatment, P.C. v Government Employees Ins. Co. (2005 NY Slip Op 50254(U)) Appellate Term, Second Department, March 2, 2005Defense rejected because the insurer's requests or proof were deficientHeld the 30-day period was not tolled because the insurer failed to prove by competent evidence that its verification letters were timely mailed, although letter requests themselves would have been permissible.
S&m Supply Inc. v Lancer Ins. Co. (2004 NY Slip Op 50695(U)) Appellate Term, Second Department, June 30, 2004Defense rejected because the insurer's requests or proof were deficientRejected the tolling defense because the insurer did not show a policy endorsement authorizing EUOs and, in any event, did not prove its verification requests were mailed, so the 30-day period was not tolled.
S & M Supply v Geico Ins. (2004 NY Slip Op 50502(U)) Appellate Term, Second Department, February 26, 2004Defense rejected because the insurer's requests or proof were deficientRejected the tolling defense because the insurer failed to prove by competent evidence that it timely sent a verification request, so the claim was overdue and the provider won summary judgment.
Abraham v Country-Wide Ins. Co. (2004 NY Slip Op 50388(U)) Appellate Term, Second Department, February 10, 2004Timely requests went unanswered; the claim is not overdue and the action is premature (also decides)Held summary judgment properly denied on one claim because the provider failed to rebut proof of timely initial and follow-up verification requests or show compliance, so the insurer had no obligation to act.
A.B. Med. Servs. v GEICO Ins. (2003 NY Slip Op 23949) Appellate Term, Second Department, December 9, 2003Defense rejected because the insurer's requests or proof were deficient (also decides)Held verification requests sent about six months after the provider mailed two claims untimely, so summary judgment was granted on them, and that the insurer waived defenses to another claim by not acting after the provider timely responded to verification.
Y & T Supply Inc. v Aiu Ins. Co. (2003 NY Slip Op 51579(U)) Appellate Term, Second Department, October 21, 2003Fact issues remain on whether the verification defense appliesHeld that the provider's failure to respond to the insurer's valid and timely verification requests raised a triable issue of fact defeating the provider's motion for summary judgment for nonpayment within 30 days.

Trial courts in the First Department (6 decisions)

Baldwin Med. Servs., P.C. v Maya Assur. Co (2026 NY Slip Op 51329(U)) Civil Court of the City of New York, Bronx County, August 19, 2026Fact issues remain on whether the verification defense appliesDenied the insurer's summary judgment on its verification nonresponse defense, leaving for trial whether the requests were timely and properly mailed, while rejecting arguments that the requests lacked good reason or had to be sent separately to both provider and counsel.
State Farm Mut. Auto. Ins. Co. v Garden Med. Care, P.C. (2023 NY Slip Op 50762(U)) Supreme Court, New York County, July 25, 2023Defense rejected because the insurer's requests or proof were deficientDenied the insurers' default-judgment motion for a no-coverage declaration because they did not submit the EUO transcript, the post-EUO verification demands, or the provider's responses, so noncompliance with proper verification requests was not shown.
Lenox Hill Radiology & MIA, P.C. v Hereford Ins. Co. (2021 NY Slip Op 21157) Civil Court of the City of New York, New York County, June 1, 2021Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the toll continued because the provider never sent the requested MRI films, and its demand for prepayment of the ground rule 8 reproduction fee was not compliance; complaint dismissed without prejudice as premature.
HKP Physical Therapy, P.C. v Government Empls. Ins. Co. (2019 NY Slip Op 29381) Civil Court of the City of New York, New York County, December 2, 2019Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the insurer's post-EUO requests for corporate, payroll and purchase records were justified by good cause and the pharmacy's objections were no reasonable justification, so the actions were premature while items remained outstanding.
Lenox Hill Radiology & MIA P.C. v Global Liberty Ins. (2008 NY Slip Op 28197) Civil Court of the City of New York, New York County, May 21, 2008Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the provider's attorneys ignored timely, properly mailed requests for a letter of medical necessity and signed claim form, so the 30-day period never began to run.
Lenox Hill Radiology MIA, P.C. v American Tr. Ins. Co. (2008 NY Slip Op 28053) Civil Court of the City of New York, New York County, February 20, 2008Defense rejected because the insurer's requests or proof were deficientRejected the prematurity defense because the insurer's affidavits did not state when the bill was received, so the timeliness of the verification requests could not be shown, and an untimely request does not toll.

Trial courts in the Second Department (68 decisions)

Burke 2 Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. PIP/BI Claims (2026 NY Slip Op 26164) Civil Court of the City of New York, Kings County, September 24, 2026Insurer properly denied the claim because verification was not provided (120-day rule)Upheld the denial for failure to provide the requested verification within 120 days, because the provider neither proved it supplied the items nor gave a reasonable justification, and dismissed the complaint with prejudice.
Medical Supply Depot Group Corp v State Farm Mut. Auto. Ins. Co. PI/BI Claims (2026 NY Slip Op 51339(U)) Civil Court of the City of New York, Kings County, August 20, 2026Insurer properly denied the claim because verification was not provided (120-day rule)Upheld the denial because post-EUO written verification requests continued the toll and the provider supplied nothing within 120 days, its late promise to respond in the future not being a response.
334 Grand Concourse Med., P.C. v Plymouth Rock Assur. (2026 NY Slip Op 50539(U)) Civil Court of the City of New York, Kings County, April 15, 2026Fact issues remain on whether the verification defense appliesHeld the provider owner's affidavit that it fully complied with the verification requests raised a triable issue whether verification remained outstanding, defeating the insurer's cross-motion.
Medical Supply of NY Direct Servs. Corp. v State Farm Ins. Co. (2026 NY Slip Op 50513(U)) Civil Court of the City of New York, Richmond County, April 13, 2026Timely requests went unanswered; the claim is not overdue and the action is prematureGranted the insurer summary judgment dismissing the action because its timely initial and follow-up verification requests were proved mailed by an adequate standard-practice affidavit and it was undisputed the requests remained unanswered.
Yumi Acupuncture, P.C. v 21st Century Ins. Co. (2026 NY Slip Op 50433(U)) Civil Court of the City of New York, Kings County, March 23, 2026Defense rejected because the insurer's requests or proof were deficientHeld the insurer's sole verification request, for the assignor's Declaration of No Other Insurance, a nullity because interinsurer priority is immaterial to the claim, so it did not toll the 30 days and the action was not premature.
Pedro Torres-Jimenez, MD PC v Nationwide Affinity Ins. Co. of Am. (2026 NY Slip Op 50073(U)) Civil Court of the City of New York, Kings County, January 13, 2026Defense rejected because the insurer's requests or proof were deficientDenied the insurer's 120-day nonresponse defense because the post-EUO written verification requests were untimely, the EUO date counting as receipt of verification and the toll not permitting new otherwise-late requests.
Queens Radiology Imaging v GEICO (2025 NY Slip Op 51823(U)) Civil Court of the City of New York, Queens County, September 21, 2025Insurer properly denied the claim because verification was not provided (120-day rule)Upheld the insurer's denial for failure to provide verification within 120 days because written requests made before and after the EUO were timely, followed up, and only partially answered, and the provider raised no triable issue.
Medical Supply of NY Corp. v State Farm Mut. Auto. Ins. Co. (2025 NY Slip Op 50412(U)) Civil Court of the City of New York, Kings County, April 1, 2025Fact issues remain on whether the verification defense appliesHeld that, although the insurer timely issued its denials, the provider's affidavit attesting that all verification requests were timely answered, admitted despite a notarial defect, raised a triable issue of fact on the outstanding verification requests.

Show all 68 decisions

First Stop P.T., P.C. v GEICO Ins. Co. (2025 NY Slip Op 50947(U)) Civil Court of the City of New York, Richmond County, March 26, 2025Fact issues remain on whether the verification defense appliesDenied the insurer's motion on its 120-day nonresponse denial because whether the provider's response satisfied the timely June request was a fact issue; new items demanded in a later letter were untimely nullities.
Burke Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. PIP/BI Claims (2025 NY Slip Op 50376(U)) Civil Court of the City of New York, Kings County, March 24, 2025Insurer properly denied the claim because verification was not provided (120-day rule)Dismissed the complaint with prejudice because the insurer showed nonreceipt of verification within 120 days, while the provider's qualified 'to the extent proper' mailing affidavit and objection letters were neither compliance nor a reasonable justification.
Titan Diagnostic Imaging Servs. Inc. v State Farm Mut. Auto Ins. Co (2024 NY Slip Op 24209) Civil Court of the City of New York, Richmond County, July 15, 2024Insurer properly denied the claim because verification was not provided (120-day rule)Upheld the denial issued after the provider failed to respond within 120 days because the post-EUO verification request, one day late, only reduced the time to pay or deny and was followed up timely.
Jiang Acupuncture PC v State Farm Ins. Co. (2023 NY Slip Op 50961(U)) Civil Court of the City of New York, Queens County, September 11, 2023Fact issues remain on whether the verification defense appliesDenied the insurer's motion on its 120-day nonresponse denial because its good cause for the ownership-related document requests rested on hearsay of an unsigned EUO transcript, yet denied the provider's motion because the requested documents remained outstanding.
American Tr. Ins. Co. v PDA NY Chiropractic, P.C. (2023 NY Slip Op 50938(U)) Supreme Court, Kings County, September 1, 2023Timely requests went unanswered; the claim is not overdue and the action is prematureHeld that no substantial-compliance standard exists, that requests for sign-in sheets and livery-fund information were reasonable, and that, absent those items and any 120-day denial, the pended bills were premature and should have been dismissed without prejudice.
Kolb Radiology, P.C. v Hereford Ins. Co. (2022 NY Slip Op 22089) Civil Court of the City of New York, Richmond County, March 22, 2022Timely requests went unanswered; the claim is not overdue and the action is prematureDismissed the action without prejudice as premature because requested MRI films were never provided, and the insurer's failure to prepay the ground rule 8 reproduction fee did not justify withholding them.
Medalliance Med. Health Servs. v Travelers Prop. Cas. Ins. Co. (2021 NY Slip Op 50737(U)) District Court of Suffolk County, Fourth District, June 30, 2021Defense rejected because the insurer's requests or proof were deficientRejected the outstanding-verification defense because the insurer mailed its verification requests to an address differing from the one on the claim forms, so receipt could not be presumed, no toll arose and the claims were overdue.
Burke Physical Therapy, PC v State Farm Mut. Auto. Ins. Co. (2021 NY Slip Op 50624(U)) Civil Court of the City of New York, Kings County, June 30, 2021Fact issues remain on whether the verification defense appliesHeld the outstanding-verification defense an issue of fact for trial: the insurer proved timely mailing of its post-EUO requests, but the provider's detailed objection letters raised an issue of compliance, while the provider's conclusory mailing affidavit did not establish compliance.
Burke 2 Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. PIP/BI Claims (2021 NY Slip Op 50523(U)) Civil Court of the City of New York, Kings County, June 8, 2021Insurer properly denied the claim because verification was not provided (120-day rule)Held the denials for nonresponse valid because the timely requests and follow-ups gave the 120-day warning, and the provider showed neither the responses it claimed to have sent nor a timely written justification.
Apazidis, M.D., P.C. v State Farm Mut. Auto. Ins. Co. (2021 NY Slip Op 50498(U)) Civil Court of the City of New York, Queens County, May 26, 2021Defense rejected because the insurer's requests or proof were deficientRejected the insurer's 120-day nonresponse denial because its good-cause showing rested on hearsay and its letters' 120-day advisory named a different provider; the provider's cross-motion failed separately on unresolved eligibility issues.
Arthur Ave. Med. Servs., PC v GEICO Ins. Co. (2021 NY Slip Op 21108) Civil Court of the City of New York, Kings County, April 20, 2021Fact issues remain on whether the verification defense appliesAdhered on reargument to holding that the reasonableness of the insurer's post-EUO requests for Mallela-type corporate and financial documents was an issue of fact, and the insurer did not identify what remained outstanding after partial production.
Bronx Chiropractic Rehabilitation, P.C. v Progressive Ins. Co. (2020 NY Slip Op 20285) Civil Court of the City of New York, Kings County, October 29, 2020Defense rejected because the insurer's requests or proof were deficientHeld the recorded-statement verification requests did not toll the insurer's time because it failed to prove a representative placed the scheduled calls, so the requests were incomplete and the denial untimely.
Precise Physical Therapy Solutions v State Farm Mut. Auto. Ins. Co. (2020 NY Slip Op 20254) Civil Court of the City of New York, Queens County, October 8, 2020Defense rejected because the insurer's requests or proof were deficient (also decides)Held the insurer not entitled to dismissal for the assignor's failure to return a signed EUO transcript within 120 days, because it showed no policy term imposing that deadline and had not exhausted its remedies, so the motion was premature.
Big Apple Med. Supply, Inc. v Nationwide Affinity Ins. Co. of Am. (2018 NY Slip Op 51659(U)) Civil Court of the City of New York, Kings County, November 21, 2018Defense rejected because the insurer's requests or proof were deficientDenied the insurer's 120-day nonresponse motion because its adjuster lacked personal knowledge of the mail vendor's receipt practices, the vendor's affidavit was vague and never stated no response arrived, and the out-of-state affidavits lacked proper certificates of conformity.
Pro-Align Chiropractic, P.C. v Travelers Prop. Cas. Ins. Co. (2017 NY Slip Op 27415) District Court of Suffolk County, Third District, December 19, 2017Defense rejected because the insurer's requests or proof were deficientRejected the verification defense because the insurer showed no good reasons for its 34 unnumbered demands, its requests lacked the 120-day warning, and the provider's objection letters were a reasonable justification for not complying.
Lenox Hill Radiology v Global Liberty Ins. Co. of N.Y. (2017 NY Slip Op 50978(U)) District Court of Suffolk County, Fourth District, July 6, 2017Defense rejected because the insurer's requests or proof were deficientDenied the insurer's prematurity motion because its affidavit did not prove the verification requests were mailed or show good reason for them, and the provider had responded with all available documents.
Global Liberty Ins. Co. v Jonathan Lewin, M.D., P.C. (2017 NY Slip Op 50897(U)) Supreme Court, Nassau County, June 22, 2017Insurer properly denied the claim because verification was not provided (120-day rule)Granted the insurer a declaration that the provider was not entitled to reimbursement because timely requested MRI films were never supplied, and a letter calling the request overly burdensome and enclosing an authorization was not a response.
Zwanger & Pesiri Radiology Group, LLP v Mapfre Ins. Co. (2017 NY Slip Op 50981(U)) District Court of Suffolk County, Third District, June 14, 2017Defense rejected because the insurer's requests or proof were deficientDenied the insurer's motion because it did not prove mailing of its verification requests, its own exhibits showed the medical-necessity letter was supplied, and it did not show notice to the applicant and attorney.
Right Aid Med. Supply, Corp. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 27181) Civil Court of the City of New York, Kings County, May 30, 2017Defense rejected because the insurer's requests or proof were deficientHeld after trial that the insurer bore the burden on its outstanding-verification defense and failed to meet it, because it presented no witness showing it never received a response; proof of mailing the 120-day denial did not suffice.
St. Barnabas Hosp. v Government Empls. Ins. Co. (2017 NY Slip Op 27056) Supreme Court, Nassau County, February 1, 2017Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the insurer properly requested a breakdown of emergency-service charges for an intoxicated patient, the hospital's response was vague, and it ignored the follow-up, so the 30 days never ran.
Meridian Psychological Servs., PC v Government Empls. Ins. Co. (2014 NY Slip Op 24177) District Court of Nassau County, First District, July 7, 2014Defense rejected because the insurer's requests or proof were deficientHeld the insurer had no verification defense because, after receiving the unsigned application, it neither paid, denied nor requested further verification, and in any event never followed up its initial request, so its time was not extended.
Garden State Anesthesia Assoc., PA v Progressive Cas. Ins. Co. (2013 NY Slip Op 23332) District Court of Nassau County, First District, September 26, 2013Fact issues remain on whether the verification defense appliesHeld questions of fact whether the insurer's letters were verification requests or mere delay letters, since they sought no specific items from the provider and showed no relation to its claims, defeating the insurer's motion.
Advanced Neurological Care, P.C. v State Farm Mut. Auto. Ins. Co. (2012 NY Slip Op 22373) District Court of Nassau County, First District, December 12, 2012Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the provider admittedly received timely verification requests and never responded or objected, so the insurer's failure to copy the provider's designated attorneys on the requests was immaterial.
Advanced Neurological Care, P.C. v State Farm Mut. Auto. Ins. Co. (2012 NY Slip Op 52203(U)) District Court of Nassau County, First District, November 26, 2012Fact issues remain on whether the verification defense appliesHeld questions of fact existed whether the verification and follow-up requests were properly addressed (not sent to the provider's attorney) and timely mailed, so neither the insurer's prematurity motion nor the provider's cross motion could be granted.
Elmont Open MRI & Diagnostic Radiology, P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 22242) District Court of Nassau County, First District, August 17, 2012Defense rejected because the provider supplied the verification or justified noncomplianceHeld the provider proved it mailed the requested MRI films and materials, so verification was not outstanding, the prematurity defense failed and the claim was overdue.
Back to Back Chiropractor, P.C. v State Farm Mut. Auto. Ins. Co. (2012 NY Slip Op 51088(U)) District Court of Suffolk County, Third District, June 15, 2012Timely requests went unanswered; the claim is not overdue and the action is prematureDismissed the claim as premature because the provider ignored timely mailed verification requests and never objected to the improper document demand, so the insurer's time to pay remained tolled.
Island Chiropractic Testing, P.C. v Nationwide Ins. Co. (2012 NY Slip Op 51001(U)) District Court of Suffolk County, Third District, June 6, 2012Defense rejected because the insurer's requests or proof were deficientRejected the prematurity defense because the insurer did not prove it timely mailed its requests, the Mallela document demands could not toll, and the provider's objection stating it lacked the documents was a sufficient response.
Victory Med. Diagnostics, P.C. v Nationwide Prop. & Cas. Ins. Co. (2012 NY Slip Op 22149) District Court of Nassau County, First District, June 4, 2012Fact issues remain on whether the verification defense appliesHeld the insurer not entitled to dismissal for unanswered requests for leases and management agreements because the provider objected, leaving the propriety of the request and objection as questions of fact on the insurer's good-faith basis.
Exclusive Med. Supply, Inc. v MVAIC (2012 NY Slip Op 50616(U)) Civil Court of the City of New York, Kings County, April 11, 2012Defense rejected because the insurer's requests or proof were deficientHeld MVAIC's qualification letters seeking a notarized statement from the vehicle owner were not verification requests, since they sought eligibility rather than proof of the claim and went to the assignee, so the 30 days were never tolled.
Brownsville Advance Med., P.C. v Country-Wide Ins. Co. (2011 NY Slip Op 52255(U)) District Court of Nassau County, First District, December 19, 2011Defense rejected because the insurer's requests or proof were deficientDenied the insurer's prematurity motion because its repeated verification demands sought a properly completed NF-3 already received, documents previously supplied or publicly available, and Mallela material not obtainable through verification, so nonresponse did not toll.
Lenox Hill Hosp. v Allstate Ins. Co. (2011 NY Slip Op 50800(U)) District Court of Nassau County, First District, May 3, 2011Defense rejected because the insurer's requests or proof were deficient (also decides)Rejected the outstanding-verification defense because the initial request was sent after the 10-business-day period and the insurer offered no proof of an office practice ensuring mailing of the initial and follow-up requests.
VIT Acupuncture, P.C. v State Farm Auto. Ins. Co. (2010 NY Slip Op 51560(U)) Civil Court of the City of New York, Kings County, August 25, 2010Defense rejected because the insurer's requests or proof were deficient (also decides)Rejected the insurer's suggestion that the action was premature because EUO verification was outstanding, since the insurer had already denied the claim on the no-show ground.
Cambridge Med., P.C. v Progressive Cas. Ins. Co. (2010 NY Slip Op 20272) Civil Court of the City of New York, Richmond County, March 5, 2010Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the insurer need not notify the assignor when following up with the assignee provider, which is the applicant, and because the provider never supplied the verification, the 30 days never ran and the action was premature.
Perfect Point Acupuncture, P.C. v Auto One Ins. Co. (2010 NY Slip Op 50010(U)) Civil Court of the City of New York, Kings County, January 6, 2010Timely requests went unanswered; the claim is not overdue and the action is prematureDismissed the action without prejudice as premature because the assignor ignored two IME requests, holding a follow-up sent before 30 days elapsed still kept the 30-day period from running.
Custom Orthotics, Ltd. v Government Empls. Ins. Co. (2009 NY Slip Op 29317) Civil Court of the City of New York, Queens County, July 27, 2009Timely requests went unanswered; the claim is not overdue and the action is prematureDismissed one action as premature because a boilerplate 'compliance letter' supplying nothing requested was no response, but awarded the other claim because the insurer ignored a marginally adequate reply directing it to the party holding the records.
Pine Hollow Med., P.C. v Global Liberty Ins. Co. of N.Y. (2009 NY Slip Op 29264) Civil Court of the City of New York, Richmond County, June 30, 2009Timely requests went unanswered; the claim is not overdue and the action is prematureHeld a follow-up request mailed one day late did not forfeit the toll, since the regulations attach no preclusion to late follow-ups; because the provider never responded, the 30 days had not begun and the action was premature.
D & R Med. Supply v Progressive Ins. Co. (2009 NY Slip Op 29139) Civil Court of the City of New York, Kings County, March 31, 2009Defense rejected because the provider supplied the verification or justified noncomplianceRejected the prematurity defense because the supplier unequivocally told the insurer it did not possess the requested referring-physician reports, and a provider need not produce materials outside its possession, custody or control.
New York Hosp. Med. Ctr. of Queens v Countrywide Ins. Co. (2009 NY Slip Op 50764(U)) Supreme Court, Nassau County, March 17, 2009Defense rejected because the insurer's requests or proof were deficientRejected the prematurity defense because the insurer's objections to the forms and its verification requests were untimely, so the defense was waived and the claims were overdue.
D & R Med. Supply, Inc. v Clarendon Natl. Ins. Co. (2009 NY Slip Op 50306(U)) Civil Court of the City of New York, Kings County, February 26, 2009Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature and dismissed it because the insurer proved a timely initial request and two follow-ups for CPT codes and medical records, and the provider sent only an invoice and never supplied the rest.
Westchester Med. Ctr. v One Beacon Ins. Co. (2008 NY Slip Op 52580(U)) Supreme Court, Nassau County, December 1, 2008Timely requests went unanswered; the claim is not overdue and the action is premature (also decides)Held the insurer's timely intoxication verification requests, including follow-ups, went unanswered with no factual dispute about the provider's noncompliance, which defeated the provider's summary judgment motion.
A.B. Med. Servs. PLLC v GEICO Gen. Ins. Co. (2008 NY Slip Op 52641(U)) Nassau District Court, November 24, 2008Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the last six claims premature because timely verification requests and EUO requests went unanswered and the provider's conditioned refusal to appear meant the insurer's time to pay or deny never ran.
Media Neurology, P.C. v Countrywide Ins. Co. (2008 NY Slip Op 51902(U)) Civil Court of the City of New York, Kings County, September 15, 2008Defense rejected because the insurer's requests or proof were deficientRejected the prematurity defense because the provider had responded to the verification request and the insurer, which considered the response incomplete, never told the provider so or requested anything further.
Westchester Med. Ctr. v Mercury Cas. Co. (2008 NY Slip Op 28287) Supreme Court, Nassau County, June 27, 2008Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the insurer timely requested blood-alcohol and related intoxication verification from the hospital and insured, followed up, and never received it; the information was obtainable with reasonable effort.
Park Slope Med. & Surgical Supply, Inc. v Country-Wide Ins. Co. (2008 NY Slip Op 51063(U)) Civil Court of the City of New York, Richmond County, May 27, 2008Timely requests went unanswered; the claim is not overdue and the action is prematureHeld a follow-up request sent on the 30th day after the initial request timely, and because the requested NF-3s and assignment were never provided, dismissed the action as premature.
All-Boro Med. Supplies, Inc. v Progressive Northeastern Ins. Co. (2008 NY Slip Op 50766(U)) Civil Court of the City of New York, Kings County, April 11, 2008Timely requests went unanswered; the claim is not overdue and the action is prematureDismissed the claim as premature because the insurer may demand a prescribed NF-3 form as verification even after receiving equivalent materials, and the provider never furnished it despite stipulated proper requests.
Cambridge Med., P.C. v Nationwide Prop. & Cas. Ins. Co. (2008 NY Slip Op 50629(U)) Civil Court of the City of New York, Richmond County, March 21, 2008Defense rejected because the insurer's requests or proof were deficientDenied the insurer's motion to dismiss the action as premature because its verification requests for corporate ownership documents asserted no conduct suggesting fraudulent incorporation, so the provider did not need to respond further.
Westchester Med. Ctr. v Progressive Cas. Ins. Co. (2008 NY Slip Op 50675(U)) Supreme Court, Nassau County, February 28, 2008Fact issues remain on whether the verification defense appliesHeld the insurer was entitled to the timely requested autopsy report as available intoxication information, so a triable issue existed as to whether proof of claim was complete, defeating the provider's motion.
Complete Orthopedic Supplies, Inc. v State Farm Ins. Co. (2007 NY Slip Op 27192) Civil Court of the City of New York, Queens County, May 14, 2007Defense rejected because the insurer's requests or proof were deficient (also decides)Rejected the insurer's unanswered-verification ground because the insurer had issued a denial while the request was outstanding, so the request was deemed waived and the insurer offered no argument otherwise.
DWP Pain Free Med. P.C. v Progressive Northeastern Ins. Co. (2006 NY Slip Op 26531) District Court of Suffolk County, Third District, December 7, 2006Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the claim premature because the insurer properly demanded hard-copy signatures on the assignment and NF-3 instead of electronic or 'on file' signatures, and the provider never responded, so the 30-day period never began.
Sea Side Med., P.C. v State Farm Mut. Auto Ins. Co. (2006 NY Slip Op 26246) Civil Court of the City of New York, Richmond County, June 22, 2006Defense rejected because the insurer's requests or proof were deficientHeld the toll from timely initial verification requests dissipated ab initio because the follow-up request was sent only 28 days later rather than within the regulatory follow-up window, so the nonresponse denials were untimely and precluded.
West Tremont Med. Diagnostics P.C. v Travelers Indem. Co. (2005 NY Slip Op 51909(U)) Nassau District Court, November 22, 2005Defense rejected because the provider supplied the verification or justified noncompliance (also decides)Rejected the prematurity defense because the insurer acknowledged receiving verification responses and later issued a denial, which it could not do before receiving all verification, so the claim was complete on that date and the denial untimely.
Function Supply v Progressive Ins. Co. (2005 NY Slip Op 51755(U)) Civil Court of the City of New York, Queens County, October 24, 2005Defense rejected because the insurer's requests or proof were deficientRejected the prematurity defense because the insurer did not prove by competent evidence that it mailed its verification and follow-up requests, so the 30-day period was not tolled and the provider won summary judgment.
A.T. Med., P.C. v State Farm Mut. Ins. Co. (2005 NY Slip Op 25461) Civil Court of the City of New York, Queens County, September 14, 2005Defense rejected because the insurer's requests or proof were deficient (also decides)Held the insurer's denials for failure to provide requested verification were untimely or improper, since a denial issued before all verification is provided is not a proper denial, so the provider made a prima facie showing.
Doshi Diagnostic Imaging Servs. v Progressive Ins. Co. (2005 NY Slip Op 50416(U)) District Court, Nassau County, March 29, 2005Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the provider failed to comply with the insurer's request for a properly executed assignment because the resubmitted form lacked a provider signature, so the time to pay or deny never began and the complaint was dismissed.
Dilon Med. Supply Corp. v Travelers Ins. Co. (2005 NY Slip Op 25113) Civil Court of the City of New York, Kings County, March 24, 2005Timely requests went unanswered; the claim is not overdue and the action is prematureHeld that a supplier must respond to a proper, timely request for a letter of medical necessity even if it lacks clinical expertise; because it ignored the requests, the claims were not overdue and the action was dismissed as premature.
First Choice Acupuncture, P.C. v Progressive Ins. Co. (2005 NY Slip Op 50354(U)) District Court, Nassau County, March 22, 2005Timely requests went unanswered; the claim is not overdue and the action is prematureHeld on reconsideration that the action was premature because the provider sued without first responding to the insurer's verification demands, so the insurer had no duty to deny and the complaint was dismissed.
Westchester Med. Ctr. v Progressive Cas. Ins. Co. (2005 NY Slip Op 50348(U)) District Court of Nassau County, First District, March 21, 2005Defense rejected because the insurer's requests or proof were deficientRejected the prematurity defense because the insurer offered no competent proof that any timely verification request was actually mailed, so the claim was overdue.
PDG Psychological P.C. v State Farm Mut. Ins. Co. (2005 NY Slip Op 50150(U)) Civil Court of the City of New York, Kings County, February 10, 2005Defense rejected because the insurer's requests or proof were deficientHeld the 30-day period was never tolled because the insurer did not prove its requests were mailed and its letters only announced a delay pending an IME without asking the provider to verify anything.
Psych. & Massage Therapy Assoc., PLLC v Progressive Cas. Ins. Co. (2004 NY Slip Op 24432) Civil Court, Queens County, November 4, 2004Timely requests went unanswered; the claim is not overdue and the action is prematureHeld the action premature because the insurer's initial and follow-up verification requests were timely and proper, a follow-up sent 25 days after the initial request being permissible, and the provider never responded.
All Health Med. Care v Government Empls. Ins. Co. (2004 NY Slip Op 24008) Civil Court of the City of New York, Queens County, January 16, 2004Defense rejected because the provider supplied the verification or justified noncomplianceHeld after trial that the provider's late but arguably responsive submission ended the toll, so the insurer, which neither paid, denied nor sought further verification within 30 days of receiving it, was precluded and owed the claim.

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