Legal Questions

Could the insurer contest the validity of the provider’s assignment of benefits, or had it waived that defense?

Short answer: Settled statewide by the Court of Appeals. Hospital for Joint Diseases v Travelers (Court of Appeals 2007, 6-1) settled that a defect or deficiency in the assignment does not implicate a lack of coverage, so an insurer that does not timely seek verification of the assignment (65-3.5, 65-3.11 [c]) or deny on that ground is precluded from contesting it, and a claim form stating the signature is 'on file' satisfies any prima facie burden absent timely verification. It adopted the Second and Third Department line (New York Hosp. Med. Ctr. of Queens v NY Cent. 2004, Nyack v Metropolitan 2005, Hospital for Joint Diseases v Allstate 2005, LMK 2006). Before 2007 some trial courts held the assignment an essential, non-waivable element (Siegel, Civ Ct Kings 2004; T&G Med. Supplies v National Grange, Civ Ct 2005; Elite Med. Care, Civ Ct 2006) and an Appellate Term dissent (Golia, J., Medwide 2005, Davydov 2009) would not extend waiver to a paper that is not an assignment at all or names another entity; these are superseded or minority views. Open edges: whether waiver applies where no assignment exists at all (App Term 2d says yes: Urban Radiology 2013, Beal-Medea 2016; but AD2 in South Nassau 2025 upheld, as not irrational, a master arbitrator's lack-of-standing ruling on an objection first raised at the hearing), and the insurer wins when it timely requests a proper assignment and does not get it (Doshi 2006; Sound Shore 2013).

Scope. Deciding this question means ruling on an insurer's defense that the claimant (a provider, hospital or supplier suing or arbitrating as assignee) has no valid assignment of the injured person's no-fault benefits: the assignment is missing, unsigned or marked signature "on file", unauthenticated, undated, names no assignee or a different entity, was signed by or for a minor, is only an authorization to pay, or was revoked (11 NYCRR 65-3.11 [b]-[d]). It covers both whether the defense succeeds on the merits and whether the insurer forfeited it by not requesting verification of the assignment or the original assignment form in time (65-3.5, 65-3.11 [c]), not stating the defect in a timely denial, or not raising it in its answer or before the arbitrator, and whether proof of the assignment is part of the claimant's prima facie case. Categories record what the court held on the assignment challenge in this case.

Based on 109 decisions in our database, the most recent decided October 29, 2025.

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

Leading authorities

  • Hospital for Joint Diseases v Travelers Prop. Cas. Ins. Co. (2007 NY Slip Op 09067) Court of Appeals, 2007Assignment defects are not coverage defenses; precluded without timely verificationAn insurer that received claim and assignment forms stating the patient's signature was 'on file' and neither sought verification of the assignment nor paid or denied within 30 days is precluded from contesting the assignment's validity, because a defective assignment does not implicate a lack of coverage; such a form satisfies any prima facie burden absent timely verification.
    In our view, any defect or deficiency in the assignment between Browne and the hospital simply does not implicate a lack of coverage warranting exemption from the preclusion rule. We therefore determine that the failure by Travelers to seek verification of the assignment in a timely manner prevents the carrier from litigating the issue now.
    Later history: Affirms Hospital for Joint Diseases v Travelers Prop. Cas. Ins. Co., 34 AD3d 532 (2d Dept 2006) (post 9796); dissent by Pigott, J.
  • Hospital for Joint Diseases v Allstate Ins. Co. (2005 NY Slip Op 06192) Appellate Division, Second Department, 2005'Signature on file' forms; no timely objection, so no standing defenseSupreme Court erred in holding the hospital lacked standing without proof of a valid assignment from each patient: the facility forms said the signatures were 'on file' and the insurer neither objected to the forms nor sought verification of the assignments, so it waived any defense based on them.
    The hospital facility forms submitted on behalf of the respective patients indicated that the signature of each patient/assignor was “on file.” There was no allegation or evidence that the defendant timely objected to the completeness of the forms or sought verification of the assignments as required by 11 NYCRR 65.15 (d). Accordingly, the defendant waived any defenses based thereon
    Later history: Cited with approval in Hospital for Joint Diseases v Travelers (9310); Beal-Medea (5024) cites it as 'affd 9 NY3d 312', but that decision affirmed 34 AD3d 532 (post 9796)
  • LMK Psychological Servs., P.C. v Liberty Mut. Ins. Co. (2006 NY Slip Op 04486) Appellate Division, Third Department, 2006Third Department: unauthenticated assignments; objection waived without 10-day verificationThe insurer's objection that the assignor's signatures on the assignment forms were not authenticated was waived because it did not request verification of the assignments within the 10-day period the regulation allows.
    Inasmuch as defendant failed to request verification of the assignments at issue within the 10-day period proscribed by regulation, its objection to the assignments was waived.
    Later history: Cited with approval in Hospital for Joint Diseases v Travelers (9310, fn 5)
  • New York & Presbyt. Hosp. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 05336) Appellate Division, Second Department, 2006Unsigned assignment forms at trial: hospitals lacked standingAfter a nonjury trial, the judgment for the hospitals was reversed and the complaint dismissed because the proof at trial included only unsigned assignment of benefit forms, so the hospitals lacked standing; the decision does not discuss verification or waiver.
    The defendant correctly contends that the plaintiff hospitals lacked standing. The proof adduced at trial included unsigned assignment of benefit forms (see Leon v Martinez, 84 NY2d 83 [1994]).
  • Beal-Medea Prods., Inc. v Geico Gen. Ins. Co. (2016 NY Slip Op 50594(U)) Appellate Term, Second Department, 2016Assignment not part of prima facie case unless timely raisedDismissing at trial because the assignment of benefits was not admitted was error: a no-fault plaintiff need not submit an executed assignment to make its prima facie case, and the assignment becomes a subject of inquiry only if the insurer first shows it timely and properly raised the issue.
    Rather, for the assignment of benefits to become a subject of inquiry, a defendant must first demonstrate that it timely and properly raised an issue with respect to the assignment
  • Doshi Diagnostic Imaging Servs. v Progressive Ins. Co. (2006 NY Slip Op 51430(U)) Appellate Term, Second Department, 2006Timely verification request for proper assignment tolls; claim not overdueWhere the insurer timely requested and followed up for a proper assignment, and the NF-AOB supplied lacked the provider's signature, the claimant's failure to supply the requested assignment tolled the insurer's time, so benefits were not overdue and the complaint was dismissed.
    Since plaintiff has yet to provide the requested verification consisting of an assignment with the provider’s signature, the statutory period in which defendant has to pay or deny the claim has been tolled
  • Presbyterian Hosp. in City of N.Y. v Maryland Cas. Co. 90 NY2d 27430-day preclusion rule on which the waiver of assignment objections rests.Not in our database.
  • Central Gen. Hosp. v Chubb Group of Ins. Cos. 90 NY2d 195Lack-of-coverage exception to preclusion; Hospital for Joint Diseases held an assignment defect is not within it.Not in our database.
  • Presbyterian Hosp. in City of N.Y. v Aetna Cas. & Sur. Co. 233 AD2d 433, lv dismissed 89 NY2d 1030Early holding that an invalid-assignment defense not preserved by timely objection is lost; cited in Hospital for Joint Diseases fn 5 and many App Term memoranda.Not in our database.
  • Leon v Martinez 84 NY2d 83An assignment requires a perfected transaction vesting a present right in the assignee; relied on in 9820 and the Hospital for Joint Diseases dissent.Not in our database.
  • St. Clare's Hosp. v Allcity Ins. Co. 201 AD2d 718Failure to object to claim-form completeness within 10 days waives defects; ancestor of the assignment-waiver line (cited in 10480, 10484).Not in our database.

Governing regulations

Whether the insurer lost the defense by not seeking verification or denying in time comes from the case law, not from Part 65.

  • 11 NYCRR 65-3.11 (b) For direct payment a provider must submit an authorization to pay benefits or a properly executed assignment on the NF-3, NF-4, NF-5 or NF-AOB; an authorization to pay does not transfer all rights from the injured person to the provider.
  • 11 NYCRR 65-3.11 (c) The insurer may request the original assignment or authorization to pay in writing to establish proof of claim; under the case law an insurer that does not seek it in time, or deny on the defect, may not contest the assignment.

Also relevant

Chosen by us from the regulation text and the decisions on this question that cite it. Each link opens our copy of the regulation, which is unofficial; the official text is in the NYCRR.

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.

Insurer barred from contesting the assignment because it did not timely object, verify, deny or plead on that groundOn the merits, the assignment or the claimant's showing is adequate, or the alleged defect is not a defectClaimant lacks a valid assignment, or failed to prove one where the issue was preserved; claim fails or is not yet dueValidity of the assignment, the assignee's identity, or the timeliness of the insurer's objection cannot be decided on this recordRing: rules on the question, but another ground decided the caseContrasted, distinguished or limitedDeclined to follow, questioned, overruled or reversedCited
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How the rule was applied, by court

Decisions (109)

Every decision in our database that rules on this question: highest court first, then by department, newest first. 40 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.

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