# Did the insurer prove the policy’s no-fault limits were properly exhausted before it became obligated to pay the claim?

**Short answer: The departments are split.** The core rule is settled in both departments that have decided it: once the insurer has paid the full no-fault limit its duties cease and it need not pay further claims (Presbyterian Hosp. v Liberty Mut., 2d Dept 1995; Countrywide v Sawh, 1st Dept 2000; NY & Presbyt. v Progressive and HJD v State Farm, 2d Dept 2004; DTR Country-Wide v Refill Rx, 1st Dept 2023), the defense is not precluded by an untimely denial (Presbyterian Hosp. v General Acc., 2d Dept 1996; NY & Presbyt. v Allstate, 2d Dept 2004, followed by both Appellate Terms), and an arbitration award beyond the limit exceeds the arbitrator's power (Brijmohan, Court of Appeals 1998). Under 11 NYCRR 65-3.15 'claims' means fully verified claims (Nyack Hosp. v GMAC, Court of Appeals 2007), so payments made while this claim was awaiting verification count. What divides the courts is a claim that was complete and DENIED before the limit ran out: the Appellate Term, Second Department (Alleviation 2017; First Am. Alliance 2018; S.O.V. 2020; North Queens 2025) holds that fully verified claims are payable in the order received, so later payments to other providers do not exhaust the policy as against the denied claim, and requires the insurer to show the dates each claim was received and verified; the Appellate Term, First Department (Harmonic 2015; Northeast Anesthesia 2016; Branch Med. 2022) holds the insurer may pay other legitimate claims after denying the plaintiff's and rely on exhaustion, and the Appellate Division, First Department (New Millennium v Progressive 2023; New Millennium v Garrison and Lam Quan 2024) holds that an arbitrator following Harmonic rather than Alleviation is not reversible and that an award after exhaustion exceeds the arbitrator's power. The Appellate Division, Second Department affirmed Alleviation on different grounds (2021, admissibility of the insurer's proof) and has not ruled on the priority point; its 2006 Montefiore and 2011 Mount Sinai decisions apply Nyack v GMAC to payments made during verification. The Third and Fourth Departments have no decision in the database.

Scope: Deciding this question means ruling on the insurer's defense that it owes nothing (or less) on the claim, judgment or award because it has already paid out the no-fault limit of the policy: the $50,000 basic economic loss limit, an optional/additional PIP limit, or the lower limit of an out-of-state policy. It covers whether the insurer's proof (affidavit, declarations page, payment log/ledger laying a business-record foundation, dates of receipt, verification and payment) established exhaustion; whether the exhausting payments were made in the order 11 NYCRR 65-3.15 requires, including whether only fully verified claims count (Nyack Hosp. v General Motors Acceptance Corp., Court of Appeals 2007) and whether an insurer that denied this claim may pay later claims and then rely on exhaustion (the Harmonic, App Term 1st Dept 2015 / Alleviation, App Term 2d Dept 2017 split); and whether the defense is available at all at that stage (it is not precluded by an untimely or missing denial; whether it can be raised after judgment, first on an article 75 petition, or after failing to raise it at trial). It also covers article 75 review of arbitration awards that granted a claim beyond the exhausted limit (excess of power, Brijmohan) or denied it on exhaustion.

- Decisions: 84 in the database, the most recent decided 2026-05-15
- Page: https://www.beynensonlaw.com/no-fault-topics/policy-exhaustion/

## Leading authorities

- [New York & Presbyt. Hosp. v Allstate Ins. Co. (2004 NY Slip Op 08669)](https://www.beynensonlaw.com/case-law/new-york-presbyt-hosp-v-allstate-ins-co-2004-ny-slip-op-08669/) — Appellate Division, Second Department, 2004. Untimely denial does not preclude the exhaustion defense: Reversing summary judgment for the hospital, the court held that the insurer's evidence raised issues of fact whether it had partially exhausted the policy by other no-fault payments made in compliance with 11 NYCRR 65.15 (n), and that its failure to deny within 30 days did not preclude the exhaustion defense.
- [Alleviation Med. Servs., P.C. v Allstate Ins. Co. (2021 NY Slip Op 08159)](https://www.beynensonlaw.com/case-law/alleviation-med-servs-p-c-v-allstate-ins-co-2021-ny-slip-op-08159/) — Appellate Division, Second Department, 2021. Exhaustion needs admissible proof; verified claims follow 65-3.15: An insurer need not pay once the limits are exhausted and verified claims are subject to 11 NYCRR 65-3.15, but the insurer's employee affidavit, describing a claim file not in evidence and lacking any information about this claim, did not establish exhaustion; issues of fact remained. Affirmed the Appellate Term on different grounds without reaching its priority rule.
- [New York & Presbyt. Hosp. v Allstate Ins. Co. (2006 NY Slip Op 02731)](https://www.beynensonlaw.com/case-law/new-york-presbyt-hosp-v-allstate-ins-co-2006-ny-slip-op-02731/) — Appellate Division, Second Department, 2006. What proves exhaustion: affidavits, denials, payment log, 65-3.15 order: The insurer was entitled to summary judgment dismissing the hospital's claim because its claims representatives' affidavits, the denial forms and its payment log showed it exhausted the coverage limits before it became obligated to pay the claim, in compliance with 11 NYCRR 65-3.15.
- [Matter of New Millennium Pain & Spine Medicine, P.C. v Progressive Cas. Ins. Co. (2023 NY Slip Op 05369)](https://www.beynensonlaw.com/case-law/matter-of-new-millennium-pain-spine-medicine-p-c-v-progressive-cas-ins-co-2023-ny-slip-op-05369/) — Appellate Division, First Department, 2023. First Department: arbitrator may follow Harmonic; no award after exhaustion: Where the provider conceded the policy was exhausted but argued that its claim, submitted and denied before exhaustion, kept priority, the arbitrator's choice to follow Harmonic (App Term 1st) rather than Alleviation (App Term 2d) did not warrant vacatur; an award after exhaustion would exceed the arbitrator's power (DTR Country-Wide v Refill Rx).
- [Alleviation Med. Servs., P.C. v Allstate Ins. Co. (2017 NY Slip Op 27097)](https://www.beynensonlaw.com/case-law/alleviation-med-servs-p-c-v-allstate-ins-co-2017-ny-slip-op-27097/) — Appellate Term, Second Department, 2017. Second Department: denied claim keeps priority over later payments: Reading Nyack Hosp. v GMAC to hold that fully verified claims are payable in the order received, the court held that an insurer that denied the claim (so treating it as verified) could not rely on exhaustion by payments of other claims made after the denial; the defense was not precluded but failed, expressly disagreeing with Harmonic.
- [Harmonic Physical Therapy, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 50525(U))](https://www.beynensonlaw.com/case-law/harmonic-physical-therapy-p-c-v-praetorian-ins-co-2015-ny-slip-op50525u/) — Appellate Term, First Department, 2015. First Department: insurer may pay later claims after a denial: The insurer established that, after timely denying the plaintiff's claim for lack of medical necessity, the limits were exhausted by paying other providers' arbitration awards in compliance with 11 NYCRR 65-3.15, and 65-3.15 did not bar paying those claims while the plaintiff's disputed claim was pending; complaint dismissed.
- Nyack Hosp. v General Motors Acceptance Corp., 8 NY3d 294 (not in the database). Leading case on 11 NYCRR 65-3.15: 'claims' means fully verified claims, so an insurer need not hold funds for claims awaiting verification and may pay verified claims as they come; cited by every later priority decision. Affirmed as modified 27 AD3d 96 (2d Dept 2005).
- Matter of Brijmohan v State Farm Ins. Co., 92 NY2d 821 (not in the database). An arbitration award beyond the policy limits exceeds the arbitrator's power (CPLR 7511 [b] [1] [iii]); the objection is not waived if raised in opposition to confirmation.
- Presbyterian Hosp. in City of N.Y. v Liberty Mut. Ins. Co., 216 AD2d 448 (not in the database). Source of the rule that once an insurer has paid the full monetary limits of the policy its duties under the contract cease.
- Presbyterian Hosp. in City of N.Y. v General Acc. Ins. Co. of Am., 229 AD2d 479 (not in the database). Failure to deny within 30 days does not preclude the defense that the coverage limits have been exhausted.
- Countrywide Ins. Co. v Sawh, 272 AD2d 245 (not in the database). First Department statement that the insurer's duties cease once it has paid the full monetary limits; basis for vacating awards beyond the limit.
- Nyack Hosp. v General Motors Acceptance Corp., 27 AD3d 96 (not in the database). Second Department decision affirmed as modified by the Court of Appeals; cited (e.g. Montefiore 2006, NY & Presbyt. v Allstate 2006) for paying other providers properly before the plaintiff under 65-3.15.

## Governing regulations

- [11 NYCRR 65-3.15](https://www.beynensonlaw.com/no-fault-regulations/11-nycrr-65-3-15/): Once claims exceed $50,000, basic economic loss is paid in the order services were rendered, for claims made before the limit is exhausted; claims received after the limit is paid are not owed. The Court of Appeals reads 'claims' as fully verified claims.
- [11 NYCRR 65-1.1 (d)](https://www.beynensonlaw.com/no-fault-regulations/11-nycrr-65-1-1/#d) (Basic Economic Loss): Basic economic loss of each eligible injured person for any single accident may not exceed $50,000 (the death benefit apart): the limit whose exhaustion ends the insurer's duty to pay.
- [11 NYCRR 65-3.8 (a) (1)](https://www.beynensonlaw.com/no-fault-regulations/11-nycrr-65-3-8/#a-1) [also relevant]: Benefits are overdue only 30 days after proof of claim, which includes all requested verification; on that basis the Court of Appeals held that a claim still awaiting verification is not yet a 'claim' in the 65-3.15 order, so payments made meanwhile count toward exhaustion.
- [11 NYCRR 65-3.8 (b) (3)](https://www.beynensonlaw.com/no-fault-regulations/11-nycrr-65-3-8/#b-3) [also relevant]: No denial before all requested verification is received (save under 65-3.8 (e) or after 120 days); the Appellate Term, Second Department reads a denial as treating the claim as verified, so it ranks ahead of later payments; the Appellate Term, First Department disagrees.
- [11 NYCRR 65-3.8 (c)](https://www.beynensonlaw.com/no-fault-regulations/11-nycrr-65-3-8/#c) [also relevant]: The insurer must pay or deny within 30 calendar days after proof of claim; under the case law the exhaustion defense is not precluded by a late or missing denial.
- [11 NYCRR 65-4.10 (a) (2)](https://www.beynensonlaw.com/no-fault-regulations/11-nycrr-65-4-10/#a-2) [also relevant]: A master arbitrator may vacate or modify an award requiring the insurer to pay beyond the policy limits; under the case law such an award also exceeds the arbitrator's power on article 75 review.

## Categories

- **Limits exhausted**: The court holds that the insurer established (prima facie without a triable issue in response, at trial, at a framed-issue hearing, or as a rational arbitral finding it upholds) that the applicable no-fault limit had been paid out before the insurer became obligated to pay the claim at issue, so the complaint is dismissed (wholly or for the claims/dates of service concerned), a judgment is reduced to the remaining coverage or satisfied, an award granting the claim is vacated as exceeding the arbitrator's power, or an award/master award denying the claim on exhaustion is confirmed. Includes holdings that the insurer may pay other providers' legitimate claims after denying the plaintiff's claim and then rely on exhaustion (Harmonic line), and holdings that unverified claims (e.g. EUO no-show) never gained priority under 65-3.15.
- **Coverage left when due**: The court rejects the exhaustion defense not for lack of proof but because, even accepting the insurer's account, the payments that used up the limit cannot be charged against this claim: the claim was complete/fully verified (or denied, which implies it was verified) before the exhausting payments, and fully verified claims are payable in the order received (Alleviation line: 'even if true, this allegation does not warrant summary judgment'; 'lacks merit'); or the insurer's own records show coverage remaining when the claim was received or became payable. Result: the defense is rejected and the claimant recovers or the insurer's motion is denied on that basis.
- **Exhaustion not proved**: The court holds that the insurer did not carry its burden on the exhaustion defense: the payment log or ledger was not admissible (no business-record foundation, not annexed, affiant lacked knowledge, out-of-state notary without CPLR 2309 certificate), the declarations page or the claimed (e.g. out-of-state) limit was not proved, the papers did not show the dates on which claims were received, verified and paid, or did not show that the policy was exhausted at the time the claim at issue was complete, or the insurer otherwise failed to show payments 'in accordance with 11 NYCRR 65-3.15'. Result: insurer's summary-judgment motion denied, plaintiff's judgment affirmed, a post-judgment motion to modify denied, or a finding for plaintiff after trial, on that ground.
- **Triable issue / hearing**: The court rules on exhaustion only to the extent of holding that it must be tried or determined later: it identifies a triable issue of fact on whether the limits were exhausted (or partially exhausted) or whether the payments complied with 65-3.15 / the old 65.15 (n), remands an article 75 matter for a framed-issue hearing on exhaustion, or holds that the defense survives (e.g. not precluded by a late or missing denial, sanction of preclusion unwarranted) and remits for a determination on the merits.
- **Defense not heard**: The court declines to reach exhaustion because of how or when it was raised: the insurer knew of exhaustion but did not raise it at trial and sought to cut down the judgment afterwards, raised it only after judgment so that modification in the interest of justice is not warranted, used an improper procedural vehicle (e.g. CPLR 5019 [a], which corrects only clerical errors), or is otherwise held to have waived or forfeited the defense. Result: the judgment or award stands without a merits ruling on exhaustion.

## Decisions (84)

Highest court first, then department, newest first. Each entry: court and date, the category, [central] where the result turns on this question or [also decides], then a one-sentence summary written by a language model from the decision and checked by a second reading.

### Appellate Division, First Department

- [Matter of New Millennium Pain & Spine Medicine, P.C. v Garrison Prop. & Cas. Ins. Co. (2024 NY Slip Op 00599)](https://www.beynensonlaw.com/case-law/matter-of-new-millennium-pain-spine-medicine-p-c-v-garrison-prop-cas-ins-co-2024-ny-slip-op-00599/) — Appellate Division, First Department, 2024-02-06 — Limits exhausted [central]: Upheld master awards denying the claims on exhaustion because following Harmonic rather than Alleviation was not irrational, an award after exhaustion would exceed the arbitrator's power, and the 20% wage offset against the limit was statutorily allowed.
- [Matter of Lam Quan, MD, PC v GEICO Gen. Ins. Co. (2024 NY Slip Op 00174)](https://www.beynensonlaw.com/case-law/matter-of-lam-quan-md-pc-v-geico-gen-ins-co-2024-ny-slip-op-00174/) — Appellate Division, First Department, 2024-01-16 — Limits exhausted [central]: Upheld an award denying the claim after the policy was exhausted. The arbitrator could follow Harmonic's rule allowing payment of later claims, an award after exhaustion would exceed the arbitrator's power, and the wage-offset argument failed.
- [Matter of New Millennium Pain & Spine Medicine, P.C. v Progressive Cas. Ins. Co. (2023 NY Slip Op 05369)](https://www.beynensonlaw.com/case-law/matter-of-new-millennium-pain-spine-medicine-p-c-v-progressive-cas-ins-co-2023-ny-slip-op-05369/) — Appellate Division, First Department, 2023-10-24 — Limits exhausted [central]: Upheld the award denying the claim where the policy was conceded exhausted, rejecting the argument that a claim denied before exhaustion keeps priority, because an insurer's duties cease once it pays the policy limit.
- [Matter of DTR Country-Wide Ins. Co. v Refill Rx Pharm., Inc. (2023 NY Slip Op 00179)](https://www.beynensonlaw.com/case-law/matter-of-dtr-country-wide-ins-co-v-refill-rx-pharm-inc-2023-ny-slipop-00179/) — Appellate Division, First Department, 2023-01-17 — Limits exhausted [central]: Held the insurer's supervisor affidavit and payment ledger showed the $50,000 policy was properly exhausted under 65-3.15 before the arbitration, so the award was vacated.
- [Country-Wide Ins. Co. v Metro Pain Specialists P.C. (2022 NY Slip Op 06865)](https://www.beynensonlaw.com/case-law/country-wide-ins-co-v-metro-pain-specialists-p-c-2022-ny-slip-op06865/) — Appellate Division, First Department, 2022-12-01 — Limits exhausted [central]: Held the insurer proved exhaustion through its declarations page, a claim supervisor's affidavit laying a business-record foundation, and a ledger showing $50,000 paid, and needed no 65-3.15 compliance showing because defendants never pleaded that defense.
- [Matter of Ameriprise Ins. Co. v Kensington Radiology Group, P.C. (2020 NY Slip Op 00500)](https://www.beynensonlaw.com/case-law/matter-of-ameriprise-ins-co-v-kensington-radiology-group-p-c-2020-nyslip-op-00500/) — Appellate Division, First Department, 2020-01-23 — Triable issue / hearing [central]: Rejected the provider's claim of priority because its claims were never verified after its EUO no-show, and affirmed the remand for a framed-issue hearing on whether exhaustion preceded the insurer's obligation to pay.

### Appellate Division, Second Department

- [Matter of Fill Rx NY, Inc. v LM Gen. Ins. Co. (2025 NY Slip Op 04785)](https://www.beynensonlaw.com/case-law/matter-of-fill-rx-ny-inc-v-lm-gen-ins-co-2025-ny-slip-op-04785/) — Appellate Division, Second Department, 2025-08-27 — Limits exhausted [central]: Upheld as having evidentiary support and a rational basis the arbitral finding that the policy's no-fault limits were exhausted, so the provider's claim was denied in full.
- [Alleviation Med. Servs., P.C. v Allstate Ins. Co. (2021 NY Slip Op 08159)](https://www.beynensonlaw.com/case-law/alleviation-med-servs-p-c-v-allstate-ins-co-2021-ny-slip-op-08159/) — Appellate Division, Second Department, 2021-02-24 — Exhaustion not proved [central]: Held the insurer failed to establish exhaustion because its employee's affidavit gave no information about this claim and described a claim file not in evidence, leaving unproven when and how the claim was denied relative to the exhausting payments.
- [Matter of Acuhealth Acupuncture, P.C. v New York City Tr. Auth. (2018 NY Slip Op 08641)](https://www.beynensonlaw.com/case-law/matter-of-acuhealth-acupuncture-p-c-v-new-york-city-tr-auth-2018-ny-slip-op-08641/) — Appellate Division, Second Department, 2018-12-19 — Limits exhausted [central]: Upheld as rational the arbitral finding that the policy had been exhausted when the last bill was received, so awarding benefits beyond the contractual limits would have exceeded the arbitrator's authority.
- [Mount Sinai Hosp. v Country Wide Ins. Co. (2011 NY Slip Op 05680)](https://www.beynensonlaw.com/case-law/mount-sinai-hosp-v-country-wide-ins-co-2011-ny-slip-op-05680/) — Appellate Division, Second Department, 2011-06-28 — Triable issue / hearing [central]: Held the insurer raised triable issues of fact whether the policy limits were exhausted by paying claims for prior services while its 30-day period on this claim was tolled by a pending verification request, defeating the hospital's summary judgment.
- [Westchester Med. Ctr. v Lincoln Gen. Ins. Co. (2011 NY Slip Op 02379)](https://www.beynensonlaw.com/case-law/westchester-med-ctr-v-lincoln-gen-ins-co-2011-ny-slip-op-02379/) — Appellate Division, Second Department, 2011-03-22 — Defense not heard [central]: Held the insurer could not cut down the judgment for exhaustion because it raised the policy limit only after judgment, its evidence was not newly discovered under CPLR 5015 (a) (2), and interest-of-justice relief was unwarranted.
- [Mount Sinai Hosp. v Country Wide Ins. Co. (2011 NY Slip Op 01008)](https://www.beynensonlaw.com/case-law/mount-sinai-hosp-v-country-wide-ins-co-2011-ny-slip-op-01008/) — Appellate Division, Second Department, 2011-02-08 — Defense not heard [central]: Held the insurer could not use CPLR 5019 (a) to reduce the judgment on the belated ground that the policy limits were nearly exhausted, because that motion corrects only clerical errors, not substantive matters.
- [St. Barnabas Hosp. v Country Wide Ins. Co. (2010 NY Slip Op 09121)](https://www.beynensonlaw.com/case-law/st-barnabas-hosp-v-country-wide-ins-co-2010-ny-slip-op-09121/) — Appellate Division, Second Department, 2010-12-07 — Limits exhausted [central]: Upheld reducing the judgment to account for partial exhaustion of the policy limits by payments to other providers, holding the insurer was not collaterally estopped because the summary judgment decided only timeliness and verification.
- [Westchester Med. Ctr. v Philadelphia Indem. Ins. Co. (2010 NY Slip Op 00138)](https://www.beynensonlaw.com/case-law/westchester-med-ctr-v-philadelphia-indem-ins-co-2010-ny-slip-op00138/) — Appellate Division, Second Department, 2010-01-05 — Coverage left when due [also decides]: In denying vacatur of the insurer's default, found that by the insurer's own records sufficient funds remained under the policy to pay the bill when it was received, so no meritorious defense was shown.
- [Montefiore Med. Ctr. v Government Empls. Ins. Co. (2006 NY Slip Op 08953)](https://www.beynensonlaw.com/case-law/montefiore-med-ctr-v-government-empls-ins-co-2006-ny-slip-op-08953/) — Appellate Division, Second Department, 2006-11-28 — Triable issue / hearing [central]: Held that, although the insurer's admissible proof showed other providers were properly paid first under 65-3.15, a triable issue existed on exhaustion because its own payment register showed a balance exceeding the amount billed.
- [Mount Sinai Hosp. v Allstate Ins. Co. (2006 NY Slip Op 03060)](https://www.beynensonlaw.com/case-law/mount-sinai-hosp-v-allstate-ins-co-2006-ny-slip-op-03060/) — Appellate Division, Second Department, 2006-04-25 — Limits exhausted [central]: Held the insurer established entitlement to summary judgment dismissing the first cause of action because the policy limits had been exhausted, and the hospitals failed to raise a triable issue of fact.
- [New York & Presbyt. Hosp. v Allstate Ins. Co. (2006 NY Slip Op 02731)](https://www.beynensonlaw.com/case-law/new-york-presbyt-hosp-v-allstate-ins-co-2006-ny-slip-op-02731/) — Appellate Division, Second Department, 2006-04-11 — Limits exhausted [central]: Held the insurer's claims representatives' affidavits, denial forms and payment log showed the coverage limits were exhausted, by payments made in compliance with 65-3.15, before it became obligated to pay the hospital's claim.
- [Hospital for Joint Diseases v Hertz Corp. (2005 NY Slip Op 07932)](https://www.beynensonlaw.com/case-law/hospital-for-joint-diseases-v-hertz-corp-2005-ny-slip-op-07932/) — Appellate Division, Second Department, 2005-10-24 — Limits exhausted [central]: Held the judgment properly reduced and deemed satisfied because the insurer showed its payments to other providers and plaintiff, plus remitting the balance, exhausted the $50,000 limit, and it was not collaterally estopped from raising exhaustion.
- [New York & Presbyt. Hosp. v Government Empls. Ins. Co. (2005 NY Slip Op 02813)](https://www.beynensonlaw.com/case-law/new-york-presbyt-hosp-v-government-empls-ins-co-2005-ny-slip-op-02813/) — Appellate Division, Second Department, 2005-04-11 — Triable issue / hearing [central]: Held a triable issue existed whether the insurer's later payments to other providers exhausted the limit as against the hospital, because evidence that the claim arrived after the first verification request raised an issue whether that request was a nullity.
- [Mount Sinai Hosp. v Zurich Am. Ins. Co. (2005 NY Slip Op 01329)](https://www.beynensonlaw.com/case-law/mount-sinai-hosp-v-zurich-am-ins-co-2005-ny-slip-op-01329/) — Appellate Division, Second Department, 2005-02-22 — Triable issue / hearing [central]: Held summary judgment for the hospital properly denied because the insurer raised issues of fact whether other no-fault payments exhausted the coverage limits and whether those payments complied with 11 NYCRR 65.15 (n).
- [New York & Presbyt. Hosp. v Allstate Ins. Co. (2004 NY Slip Op 08669)](https://www.beynensonlaw.com/case-law/new-york-presbyt-hosp-v-allstate-ins-co-2004-ny-slip-op-08669/) — Appellate Division, Second Department, 2004-11-22 — Triable issue / hearing [central]: Held issues of fact existed whether the insurer partially exhausted the limits by other payments made in compliance with 11 NYCRR 65.15 (n), and that its failure to deny within 30 days did not preclude the exhaustion defense.
- [Hospital for Joint Diseases v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 05413)](https://www.beynensonlaw.com/case-law/hospital-for-joint-diseases-v-state-farm-mut-auto-ins-co-2004-ny-slip-op-05413/) — Appellate Division, Second Department, 2004-06-21 — Limits exhausted [central]: Held the insurer's evidence established that the PIP limits had been exhausted by prior claims, so its duties under the policy ceased and the hospital's cause of action was dismissed.
- [New York & Presbyt. Hosp. v Progressive Cas. Ins. Co. (2004 NY Slip Op 01750)](https://www.beynensonlaw.com/case-law/new-york-presbyt-hosp-v-progressive-cas-ins-co-2004-ny-slip-op-01750/) — Appellate Division, Second Department, 2004-03-15 — Limits exhausted [also decides]: Held the insurer showed as a matter of law that it had paid the claim up to the applicable policy limits, so it was not obligated to pay the claim in full and that cause of action was dismissed.

### Appellate Term, First Department

- [Advantage Radiology, P.C. v MVAIC (2023 NY Slip Op 50139(U))](https://www.beynensonlaw.com/case-law/advantage-radiology-p-c-v-mvaic-2023-ny-slip-op-50139u/) — Appellate Term, First Department, 2023-02-27 — Triable issue / hearing [central]: Held the insurer's own submissions raised triable issues whether it exhausted the coverage limits through payments to other providers and the assignor's lost wages, and whether those payments complied with 65-3.15.
- [Allstate Fire & Cas. Ins. Co. v Branch Med., P.C. (2022 NY Slip Op 50277(U))](https://www.beynensonlaw.com/case-law/allstate-fire-cas-ins-co-v-branch-med-p-c-2022-ny-slip-op50277u/) — Appellate Term, First Department, 2022-04-19 — Limits exhausted [central]: Held the insurer proved exhaustion at the framed-issue hearing through adjuster testimony, declarations page and chronological payment ledgers, and that 65-3.15 allowed paying other legitimate claims after denying this one.
- [Ameriprise Ins. Co. v Kensington Radiology Group, P.C. (2017 NY Slip Op 51911(U))](https://www.beynensonlaw.com/case-law/ameriprise-ins-co-v-kensington-radiology-group-p-c-2017-ny-slip-op51911u/) — Appellate Term, First Department, 2017-12-22 — Triable issue / hearing [central]: Held the insurer's attorney affirmation, declaration page and chronological payment ledger raised triable issues whether the $50,000 limit was exhausted before it became obligated to pay the claims, noting the defense survives a missing timely denial; framed-issue hearing ordered.
- [Easy Care Acupuncture, PC v MVAIC (2017 NY Slip Op 51346(U))](https://www.beynensonlaw.com/case-law/easy-care-acupuncture-pc-v-mvaic-2017-ny-slip-op-51346u/) — Appellate Term, First Department, 2017-10-11 — Triable issue / hearing [also decides]: Held the parties' submissions raised triable issues whether the insurer partially exhausted coverage by payments to another provider and whether those payments were proper under the regulations, and that an untimely denial did not preclude the defense.
- [Easy Care Acupuncture, PC v MVAIC (2016 NY Slip Op 51556(U))](https://www.beynensonlaw.com/case-law/easy-care-acupuncture-pc-v-mvaic-2016-ny-slip-op-51556u/) — Appellate Term, First Department, 2016-10-26 — Triable issue / hearing [also decides]: Held the insurer's own submission raised triable issues whether it partially exhausted coverage by payments to another provider and whether those payments complied with the regulations, and that the untimely denial did not preclude the defense.
- [Allstate Prop. & Cas. Ins. Co. v Northeast Anesthesia & Pain Mgt. (2016 NY Slip Op 50828(U))](https://www.beynensonlaw.com/case-law/allstate-prop-cas-ins-co-v-northeast-anesthesia-pain-mgt-2016ny-slip-op-50828u/) — Appellate Term, First Department, 2016-05-31 — Triable issue / hearing [central]: Held the declaration page and chronological payment ledger raised triable issues on exhaustion before the insurer was obligated to pay, and that 65-3.15 did not bar paying other legitimate claims after denying this one; framed-issue hearing ordered.
- [Harmonic Physical Therapy, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 50525(U))](https://www.beynensonlaw.com/case-law/harmonic-physical-therapy-p-c-v-praetorian-ins-co-2015-ny-slip-op50525u/) — Appellate Term, First Department, 2015-04-14 — Limits exhausted [central]: Held the insurer established that, after timely denying the claim, the limits were exhausted by paying other providers' arbitration awards in compliance with 65-3.15, which did not bar paying legitimate claims while the disputed claim was pending.
- [Allstate Ins. Co. v DeMoura (2011 NY Slip Op 50430(U))](https://www.beynensonlaw.com/case-law/allstate-ins-co-v-demoura-2011-ny-slip-op-50430u/) — Appellate Term, First Department, 2011-03-24 — Triable issue / hearing [central]: Held the insurer's submissions raised a triable issue whether the $50,000 limit was exhausted under 65-3.15 before payment could be made on the claim, the defense surviving the lack of a timely denial; framed-issue hearing ordered.
- [Pelham Parkway Neuro & Diagnostic, P.C. v Liberty Mut. Ins. Co. (2007 NY Slip Op 51336(U))](https://www.beynensonlaw.com/case-law/pelham-parkway-neuro-diagnostic-p-c-v-liberty-mut-ins-co-2007-ny-slip-op-51336u/) — Appellate Term, First Department, 2007-07-09 — Triable issue / hearing [central]: Held that precluding the exhaustion defense for a single discovery lapse was unwarranted absent willful conduct, and that triable issues existed whether the policy limits were exhausted when plaintiff submitted its claims.

### Appellate Term, Second Department

- [Big Apple Delivery Supply Corp. v Plymouth Rock Assur. Corp. of N.Y. (2026 NY Slip Op 50794(U))](https://www.beynensonlaw.com/case-law/big-apple-delivery-supply-corp-v-plymouth-rock-assur-corp-of-n-y-2026-ny-slip-op-50794u/) — Appellate Term, Second Department, 2026-05-15 — Triable issue / hearing [also decides]: Held that the insurer's failure to timely deny did not preclude its exhaustion defense, and remitted the unaddressed exhaustion branch of its summary judgment motion for determination after rejecting the medical-necessity ground.
- [Big Apple Delivery Supply Corp. v Plymouth Rock Assur. Corp. of N.Y. (2026 NY Slip Op 50795(U))](https://www.beynensonlaw.com/case-law/big-apple-delivery-supply-corp-v-plymouth-rock-assur-corp-of-n-y-2026-ny-slip-op-50795u/) — Appellate Term, Second Department, 2026-05-15 — Triable issue / hearing [also decides]: Held that the failure to deny within 30 days did not preclude the exhaustion defense and remitted the unaddressed exhaustion branch of the insurer's summary judgment motion for determination.
- [Acupuncture Now, P.C. v MVAIC (2026 NY Slip Op 50196(U))](https://www.beynensonlaw.com/case-law/acupuncture-now-p-c-v-mvaic-2026-ny-slip-op-50196u/) — Appellate Term, Second Department, 2026-01-23 — Exhaustion not proved [central]: Held the insurer failed to prove exhaustion under 65-3.15 because it did not set forth the dates on which it received the various claims and on which they became fully verified.
- [Healthway Med. Care, P.C. v MVAIC (2026 NY Slip Op 50200(U))](https://www.beynensonlaw.com/case-law/healthway-med-care-p-c-v-mvaic-2026-ny-slip-op-50200u/) — Appellate Term, Second Department, 2026-01-23 — Exhaustion not proved [central]: Held that the admissible payment log did not show when the various claims were received and became fully verified, so the insurer failed to prove exhaustion under 65-3.15 for the five causes of action it targeted.
- [Healthway Med. Care, P.C. v MVAIC (2026 NY Slip Op 50199(U))](https://www.beynensonlaw.com/case-law/healthway-med-care-p-c-v-mvaic-2026-ny-slip-op-50199u/) — Appellate Term, Second Department, 2026-01-23 — Exhaustion not proved [central]: Held that, although the payment log was admissible as a business record, it omitted the dates claims were received and became fully verified, so exhaustion in accordance with 65-3.15 was not established as a matter of law.
- [Acupuncture Now, P.C. v MVAIC (2026 NY Slip Op 50197(U))](https://www.beynensonlaw.com/case-law/acupuncture-now-p-c-v-mvaic-2026-ny-slip-op-50197u/) — Appellate Term, Second Department, 2026-01-23 — Exhaustion not proved [central]: Held that the admissible payment log omitted the dates claims were received and fully verified, so the insurer did not establish exhaustion in accordance with 65-3.15 as a matter of law.
- [Healthway Med. Care, P.C. v MVAIC (2026 NY Slip Op 50198(U))](https://www.beynensonlaw.com/case-law/healthway-med-care-p-c-v-mvaic-2026-ny-slip-op-50198u/) — Appellate Term, Second Department, 2026-01-23 — Exhaustion not proved [central]: Held that the payment log, though admissible, did not show the dates claims were received and became fully verified, so the insurer failed to establish exhaustion under 65-3.15 and its motion was properly denied.
- [Chiropractic Assoc. of Richmond Hill, P.C. v Nationwide Gen. Ins. Co. (2025 NY Slip Op 50506(U))](https://www.beynensonlaw.com/case-law/chiropractic-assoc-of-richmond-hill-p-c-v-nationwide-gen-ins-co-2025-ny-slip-op-50506u/) — Appellate Term, Second Department, 2025-04-04 — Exhaustion not proved [central]: Held the insurer not entitled to summary judgment on its exhaustion defense because it failed to show, as a matter of law, that the policy limits were exhausted under 65-3.15 before the provider's completed claims were received.
- [North Queens Surgical Ctr. v Lancer Ins. Co. (2025 NY Slip Op 50191(U))](https://www.beynensonlaw.com/case-law/north-queens-surgical-ctr-v-lancer-ins-co-2025-ny-slip-op-50191u/) — Appellate Term, Second Department, 2025-02-13 — Coverage left when due [central]: Rejected as meritless the insurer's argument that limits exhausted by paying claims received after it denied this claim relieved it of payment, because verified claims are payable in the order received under 65-3.15.
- [Pak Hong Sik, MD, Med. Care, P.C. v Mid-Century Ins. Co. (2024 NY Slip Op 50804(U))](https://www.beynensonlaw.com/case-law/pak-hong-sik-md-med-care-p-c-v-mid-century-ins-co-2024-ny-slip-op50804u/) — Appellate Term, Second Department, 2024-06-14 — Exhaustion not proved [also decides]: Agreed the insurer failed to lay a business-record foundation for the payment log relied on to prove exhaustion, but dismissal stood on the unchallenged fee-schedule ground.
- [JSJ Anesthesia Pain Mgt., PLLC v Nationwide Ins. Co. (2024 NY Slip Op 50203(U))](https://www.beynensonlaw.com/case-law/jsj-anesthesia-pain-mgt-pllc-v-nationwide-ins-co-2024-ny-slip-op-50203u/) — Appellate Term, Second Department, 2024-02-16 — Exhaustion not proved [central]: Held the insurer failed to establish exhaustion in accordance with 65-3.15 because its claim specialist laid no sufficient business-record foundation for the payment log, so it did not prove any payments were made.
- [LR Med., PLLC v Nationwide Ins. Co. (2024 NY Slip Op 50204(U))](https://www.beynensonlaw.com/case-law/lr-med-pllc-v-nationwide-ins-co-2024-ny-slip-op-50204u/) — Appellate Term, Second Department, 2024-02-16 — Exhaustion not proved [also decides]: Denied the insurer summary judgment on its exhaustion defense for the reasons stated in a companion appeal decided the same day, which found its payment log lacked a business-record foundation.
- [JFL Med. Care, P.C. v MVAIC (2024 NY Slip Op 50202(U))](https://www.beynensonlaw.com/case-law/jfl-med-care-p-c-v-mvaic-2024-ny-slip-op-50202u/) — Appellate Term, Second Department, 2024-02-16 — Exhaustion not proved [central]: Held the insurer failed to prove exhaustion in accordance with 65-3.15 because it did not set forth the dates it received the various claims and the dates they became fully verified.
- [JSJ Anesthesia Pain Mgt., PLLC v State Farm Mut. Auto. Ins. Co. (2024 NY Slip Op 50064(U))](https://www.beynensonlaw.com/case-law/jsj-anesthesia-pain-mgt-pllc-v-state-farm-mut-auto-ins-co-2024-ny-slip-op-50064u/) — Appellate Term, Second Department, 2024-01-12 — Exhaustion not proved [also decides]: Denied the insurer summary judgment on its exhaustion defense for the reasons stated in a companion appeal decided the same day, which found its payment log lacked a business-record foundation.
- [Pain Med., PLLC v State Farm Mut. Auto. Ins. Co. (2024 NY Slip Op 50065(U))](https://www.beynensonlaw.com/case-law/pain-med-pllc-v-state-farm-mut-auto-ins-co-2024-ny-slip-op-50065u/) — Appellate Term, Second Department, 2024-01-12 — Exhaustion not proved [also decides]: Denied the insurer summary judgment on its exhaustion defense for the reasons stated in a companion appeal decided the same day, which found its payment log lacked a business-record foundation.
- [Pain Med., PLLC v State Farm Mut. Auto. Ins. Co. (2024 NY Slip Op 50069(U))](https://www.beynensonlaw.com/case-law/pain-med-pllc-v-state-farm-mut-auto-ins-co-2024-ny-slip-op-50069u/) — Appellate Term, Second Department, 2024-01-12 — Exhaustion not proved [central]: Held the insurer failed to establish exhaustion in accordance with 65-3.15 because its claim specialist laid no sufficient business-record foundation for the payment log, so it did not prove any payments were made.
- [Heaven & Earth Acupuncture, P.C. v Hartford Ins. Co. of Ill. (2023 NY Slip Op 51236(U))](https://www.beynensonlaw.com/case-law/heaven-earth-acupuncture-p-c-v-hartford-ins-co-of-ill-2023-ny-slip-op-51236u-2/) — Appellate Term, Second Department, 2023-09-22 — Exhaustion not proved [central]: Held the insurer failed to establish exhaustion prima facie because its claim specialist relied on a payment log that was not annexed to the moving papers, so no payments under the policy were shown.
- [JPC Med., P.C. v State Farm Mut. Auto. Ins. Co. (2022 NY Slip Op 50562(U))](https://www.beynensonlaw.com/case-law/jpc-med-p-c-v-state-farm-mut-auto-ins-co-2022-ny-slip-op50562u/) — Appellate Term, Second Department, 2022-06-03 — Exhaustion not proved [central]: Held the insurer failed to establish exhaustion of the policy limits in accordance with 65-3.15 because its claim specialist laid no sufficient business-record foundation for the payment log on which it relied.
- [Spine Care of N.J., P.C. v MVAIC (2021 NY Slip Op 51172(U))](https://www.beynensonlaw.com/case-law/spine-care-of-n-j-p-c-v-mvaic-2021-ny-slip-op-51172u/) — Appellate Term, Second Department, 2021-12-03 — Exhaustion not proved [central]: Held the insurer did not demonstrate that the available coverage had been exhausted in accordance with 65-3.15 at the relevant point, so its exhaustion-based motion was properly denied.
- [S.O.V. Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2020 NY Slip Op 51365(U))](https://www.beynensonlaw.com/case-law/s-o-v-acupuncture-p-c-v-state-farm-mut-auto-ins-co-2020-ny-slip-op51365u/) — Appellate Term, Second Department, 2020-11-13 — Coverage left when due [central]: Reversed dismissal because, even if the insurer paid other claims after partially denying these claims and those payments used up coverage, later payments could not support an exhaustion defense under 65-3.15.
- [Metro Pain Specialist, P.C. v State Farm Mut. Auto. Ins. Co. PIP/BI Claims (2020 NY Slip Op 51381(U))](https://www.beynensonlaw.com/case-law/metro-pain-specialist-p-c-v-state-farm-mut-auto-ins-co-pip-bi-claims-2020-nyslip-op-51381u/) — Appellate Term, Second Department, 2020-11-13 — Limits exhausted [central]: Affirmed dismissal on the ground that available coverage had been exhausted, holding that the insurer's payment log was properly considered as proof of the payments.
- [JPF Med. Servs., P.C. v Nationwide Ins. (2020 NY Slip Op 51122(U))](https://www.beynensonlaw.com/case-law/jpf-med-servs-p-c-v-nationwide-ins-2020-ny-slip-op-51122u/) — Appellate Term, Second Department, 2020-09-18 — Exhaustion not proved [central]: Denied the insurer summary judgment on exhaustion because its claim specialist laid no sufficient business-record foundation for the payment log and the referenced supporting affidavit was not attached, so no payments under the policy were proved.
- [Metro Pain Specialist, P.C. v Hertz Co. (2019 NY Slip Op 52047(U))](https://www.beynensonlaw.com/case-law/metro-pain-specialist-p-c-v-hertz-co-2019-ny-slip-op-52047u/) — Appellate Term, Second Department, 2019-12-13 — Exhaustion not proved [central]: Held the insurer failed to establish exhaustion as a matter of law because it did not demonstrate that the policy had been exhausted at the time the claim at issue was complete.
- [Charles Deng Acupuncture, P.C. v MVAIC (2019 NY Slip Op 52049(U))](https://www.beynensonlaw.com/case-law/charles-deng-acupuncture-p-c-v-mvaic-2019-ny-slip-op-52049u/) — Appellate Term, Second Department, 2019-12-13 — Exhaustion not proved [also decides]: Held the insurer failed to establish exhaustion of the available limits because it did not show they had been exhausted when the claims at issue were complete under 65-3.15.
- [Masigla v 21st Century Ins. Co. (2019 NY Slip Op 50938(U))](https://www.beynensonlaw.com/case-law/masigla-v-21st-century-ins-co-2019-ny-slip-op-50938u/) — Appellate Term, Second Department, 2019-06-07 — Exhaustion not proved [central]: Held the insurer failed to show the lower Florida limit applied and, in any event, failed to establish the payment log as admissible business-record evidence of exhaustion, so dismissal of those claims was reversed.
- [Charles Deng Acupuncture, P.C. v 21st Century Ins. Co. (2018 NY Slip Op 51815(U))](https://www.beynensonlaw.com/case-law/charles-deng-acupuncture-p-c-v-21st-century-ins-co-2018-ny-slip-op-51815u/) — Appellate Term, Second Department, 2018-12-07 — Exhaustion not proved [central]: Held the insurer failed to show that a $10,000 Florida limit applied and, in any event, failed to prove that limit was exhausted because its affidavits did not establish the payment log as admissible business records.
- [First Am. Alliance, Inc. v Ameriprise Ins. Co. (2018 NY Slip Op 51765(U))](https://www.beynensonlaw.com/case-law/first-am-alliance-inc-v-ameriprise-ins-co-2018-ny-slip-op-51765u/) — Appellate Term, Second Department, 2018-11-30 — Coverage left when due [central]: Held that the insurer's claim that payments of other claims made after it denied these claims exhausted coverage, even if true, did not warrant summary judgment, because denied claims kept their priority under 65-3.15.
- [Karina K. Acupuncture, P.C. v Hertz Claim Mgt. Corp. (2018 NY Slip Op 51762(U))](https://www.beynensonlaw.com/case-law/karina-k-acupuncture-p-c-v-hertz-claim-mgt-corp-2018-ny-slip-op-51762u/) — Appellate Term, Second Department, 2018-11-30 — Limits exhausted [also decides]: Held the insurer established that the policy limits were exhausted more than three months before the later services were rendered, and the provider raised no triable issue, so those claims were dismissed.
- [Ortho Passive Motion, Inc. v Allstate Ins. Co. (2018 NY Slip Op 51749(U))](https://www.beynensonlaw.com/case-law/ortho-passive-motion-inc-v-allstate-ins-co-2018-ny-slip-op-51749u/) — Appellate Term, Second Department, 2018-11-29 — Exhaustion not proved [central]: Affirmed denial of the insurer's post-judgment motion to modify the judgment because its papers did not show the policy was exhausted when the claims became complete; the defense was not precluded by the denial's silence on exhaustion.
- [Advanced Recovery Equip. & Supplies, LLC v Park Ins. Co. (2018 NY Slip Op 51630(U))](https://www.beynensonlaw.com/case-law/advanced-recovery-equip-supplies-llc-v-park-ins-co-2018-ny-slipop-51630u/) — Appellate Term, Second Department, 2018-11-08 — Exhaustion not proved [central]: Affirmed denial of the insurer's summary judgment motion because it did not demonstrate that the policy had been exhausted at the time the claim at issue was complete.
- [Sharp View Diagnostic Imaging, P.C. v GEICO Gen. Ins. Co. (2017 NY Slip Op 50855(U))](https://www.beynensonlaw.com/case-law/sharp-view-diagnostic-imaging-p-c-v-geico-gen-ins-co-2017-ny-slip-op50855u/) — Appellate Term, Second Department, 2017-06-23 — Exhaustion not proved [central]: Held the insurer failed to prove exhaustion of the Georgia policy's $10,000 medical-payment limit because its affidavits laid no foundation for the payment printouts and it gave no information on South Carolina's required minimum coverage.
- [Island Life Chiropractic, P.C. v Commerce Ins. Co. (2017 NY Slip Op 50856(U))](https://www.beynensonlaw.com/case-law/island-life-chiropractic-p-c-v-commerce-ins-co-2017-ny-slip-op50856u/) — Appellate Term, Second Department, 2017-06-23 — Exhaustion not proved [central]: Held the insurer failed to establish exhaustion of the $50,000 coverage as a matter of law because it did not demonstrate the policy had been exhausted when the claim at issue was complete.
- [Performance Plus Med., P.C. v MVAIC (2017 NY Slip Op 50761(U))](https://www.beynensonlaw.com/case-law/performance-plus-med-p-c-v-mvaic-2017-ny-slip-op-50761u/) — Appellate Term, Second Department, 2017-06-02 — Limits exhausted [central]: Upheld dismissal for exhaustion of the no-fault limits because the payment log was properly considered and the claims representative's affidavit sufficiently established the dates the logged claims were received.
- [Ortho Passive Motion, Inc. v Allstate Ins. Co. (2017 NY Slip Op 50771(U))](https://www.beynensonlaw.com/case-law/ortho-passive-motion-inc-v-allstate-ins-co-2017-ny-slip-op-50771u/) — Appellate Term, Second Department, 2017-06-02 — Exhaustion not proved [central]: Affirmed denial of the insurer's post-judgment motion to modify because its papers did not show the policy had been exhausted when the claims at issue were deemed complete, and CPLR 5019(a) offered no basis.
- [Healthway Med. Care, P.C. v Commerce Ins. Co. (2017 NY Slip Op 50424(U))](https://www.beynensonlaw.com/case-law/healthway-med-care-p-c-v-commerce-ins-co-2017-ny-slip-op50424u/) — Appellate Term, Second Department, 2017-04-07 — Limits exhausted [central]: Held the insurer established prima facie that the Massachusetts policy limits had been exhausted under Massachusetts law before it became obligated to pay the claims, and the provider raised no triable issue.
- [Alleviation Med. Servs., P.C. v Allstate Ins. Co. (2017 NY Slip Op 27097)](https://www.beynensonlaw.com/case-law/alleviation-med-servs-p-c-v-allstate-ins-co-2017-ny-slip-op-27097/) — Appellate Term, Second Department, 2017-03-29 — Coverage left when due [central]: Held the exhaustion defense, though not precluded, lacked merit because by denying the claim the insurer treated it as fully verified, and verified claims are payable in order received, so later payments exhausting coverage could not defeat it.
- [Brand Med. Supply, Inc. v Infinity Ins. Co. (2016 NY Slip Op 50738(U))](https://www.beynensonlaw.com/case-law/brand-med-supply-inc-v-infinity-ins-co-2016-ny-slip-op50738u/) — Appellate Term, Second Department, 2016-05-05 — Triable issue / hearing [central]: Held the trial court erred in excluding the declaration page offered to prove the policy limits, since it needed only authentication rather than a business-record foundation, and remitted for a new trial on the exhaustion defense.
- [Charles Deng Acupuncture, P.C. v American Commerce Ins. Co. (2016 NY Slip Op 50596(U))](https://www.beynensonlaw.com/case-law/charles-deng-acupuncture-p-c-v-american-commerce-ins-co-2016-nyslip-op-50596u/) — Appellate Term, Second Department, 2016-04-08 — Limits exhausted [central]: Held the insurer proved through employee affidavits, the Massachusetts policy and its payment log a $13,000 medical limit, and the provider's own affidavit showed the claim was mailed after that limit was exhausted.
- [Flatbush Chiropractic, P.C. v GEICO Ins. Co. (2013 NY Slip Op 51104(U))](https://www.beynensonlaw.com/case-law/flatbush-chiropractic-p-c-v-geico-ins-co-2013-ny-slip-op51104u/) — Appellate Term, Second Department, 2013-07-01 — Limits exhausted [central]: Held the insurer showed by claims and underwriting affidavits and documents that Delaware law applied, the policy carried a $15,000 medical-expense limit, and that limit had been exhausted; the provider raised no triable issue.
- [Flushing Traditional Acupuncture, P.C. v Infinity Group (2012 NY Slip Op 22345)](https://www.beynensonlaw.com/case-law/flushing-traditional-acupuncture-p-c-v-infinity-group-2012-ny-slip-op-22345/) — Appellate Term, Second Department, 2012-11-26 — Exhaustion not proved [central]: Held the exhaustion defense, though not precluded by untimely denials, failed because the insurer did not show it was exempt from New York's minimum financial security requirements, so the Pennsylvania policy's $5,000 limit was not established.
- [Crossbridge Diagnostic Radiology v Encompass Ins. (2009 NY Slip Op 51415(U))](https://www.beynensonlaw.com/case-law/crossbridge-diagnostic-radiology-v-encompass-ins-2009-ny-slip-op51415u/) — Appellate Term, Second Department, 2009-06-23 — Exhaustion not proved [central]: Held that, although an untimely denial did not preclude the exhaustion defense, the insurer's claims representative affidavit sworn out of state lacked a CPLR 2309 (c) certificate and counsel's affirmation lacked personal knowledge, so exhaustion was not shown.
- [A.M. Med. Servs., P.C. v Allstate Ins. Co. (2006 NY Slip Op 51426(U))](https://www.beynensonlaw.com/case-law/a-m-med-servs-p-c-v-allstate-ins-co-2006-ny-slip-op-51426u/) — Appellate Term, Second Department, 2006-07-17 — Triable issue / hearing [also decides]: Held that, because the claim was denied on the ground that the maximum allowable policy benefits had already been paid, an issue of fact existed whether the applicable coverage limits were previously exhausted.

### Trial courts in the First Department

- [Breeze Acupuncture, P.C. v Allstate Ins. Co. (2018 NY Slip Op 50138(U))](https://www.beynensonlaw.com/case-law/breeze-acupuncture-p-c-v-allstate-ins-co-2018-ny-slip-op-50138u/) — Civil Court of the City of New York, Bronx County, 2018-02-01 — Defense not heard [central]: Denied the insurer's post-judgment motion to reduce the judgment to zero because it knew the policy was exhausted years before trial yet never raised the defense at trial, so it waived exhaustion.

### Trial courts in the Second Department

- [334 Grand Concourse Med., P.C. v Plymouth Rock Assur. (2026 NY Slip Op 50539(U))](https://www.beynensonlaw.com/case-law/334-grand-concourse-med-p-c-v-plymouth-rock-assur-2026-ny-slip-op-50539u/) — Civil Court of the City of New York, Kings County, 2026-04-15 — Exhaustion not proved [also decides]: Held the insurer failed to raise a triable issue on exhaustion because no affiant with knowledge of its record-keeping laid a business-record foundation for the policy, its limits, or the exhaustion ledger.
- [Stark Med. Supply Inc. v Foremost Prop. & Cas. Ins. (2024 NY Slip Op 50002(U))](https://www.beynensonlaw.com/case-law/stark-med-supply-inc-v-foremost-prop-cas-ins-2024-ny-slip-op-50002u-2/) — Civil Court of the City of New York, Kings County, 2024-01-08 — Exhaustion not proved [central]: Held after trial that the insurer failed to prove exhaustion because its payment log carried erroneous dates and nothing beyond the witness's testimony showed the exhausting payment preceded the claim when it was complete.
- [American Tr. Ins. Co. v Trinity Pain Mgt. of Staten Is., PLLC (2023 NY Slip Op 51337(U))](https://www.beynensonlaw.com/case-law/american-tr-ins-co-v-trinity-pain-mgt-of-staten-is-pllc-2023-ny-slip-op-51337u/) — Supreme Court, Kings County, 2023-12-08 — Exhaustion not proved [central]: Upheld the arbitral finding that the insurer failed to prove exhaustion because it submitted only a bare payment ledger, so the award requiring payment was not beyond the arbitrator's power.
- [Matter of Spartan Med. Supply v Liberty Mut. Ins. Co. (2019 NY Slip Op 50862(U))](https://www.beynensonlaw.com/case-law/matter-of-spartan-med-supply-v-liberty-mut-ins-co-2019-ny-slip-op50862u/) — District Court of Nassau County, 2019-06-03 — Limits exhausted [central]: Confirmed the award upholding the insurer's exhaustion denial, holding that applying Harmonic, which allows exhaustion by later payments after a good-faith denial of the claim, was not irrational.
- [Island Life Chiropractic Pain Care PLLC v Amica Mut. Ins. Co. (2019 NY Slip Op 51589(U))](https://www.beynensonlaw.com/case-law/island-life-chiropractic-pain-care-pllc-v-amica-mut-ins-co-2019-ny-slip-op51589u/) — Civil Court of the City of New York, Kings County, 2019-05-17 — Exhaustion not proved [central]: Denied the insurer's exhaustion-based summary judgment because its payment ledger lacked a CPLR 4518 business-record foundation, did not show when prior bills were received or paid, and did not show payments followed proper priority under 65-3.15.
- [All Healthy Style Med., P.C. v ELRAC, Inc. (2018 NY Slip Op 51333(U))](https://www.beynensonlaw.com/case-law/all-healthy-style-med-p-c-v-elrac-inc-2018-ny-slip-op-51333u/) — Civil Court of the City of New York, Kings County, 2018-05-16 — Exhaustion not proved [also decides]: Held the insurer failed to establish exhaustion when it received the bills because the ledger did not show when prior bills were received or paid and its ambiguous date headings were unexplained.
- [Ortho Passive Motion Inc. v Allstate Ins. Co. (2017 NY Slip Op 27057)](https://www.beynensonlaw.com/case-law/ortho-passive-motion-inc-v-allstate-ins-co-2017-ny-slip-op-27057/) — District Court of Nassau County, Third District, 2017-03-01 — Defense not heard [central]: Denied the insurer's post-judgment motion to modify the judgment to zero because it pleaded exhaustion, knew the limits were exhausted years before trial, but failed to raise or prove the defense at trial.
- [Acuhealth Acupuncture, P.C. v New York City Tr. Auth. (2016 NY Slip Op 50297(U))](https://www.beynensonlaw.com/case-law/acuhealth-acupuncture-p-c-v-new-york-city-tr-auth-2016-ny-slip-op-50297u/) — Supreme Court, Kings County, 2016-03-01 — Limits exhausted [central]: Confirmed an award denying the claim because the policy was exhausted, holding that an award beyond the limits would exceed the arbitrator's power and that the provider's Nyack priority argument showed at most an unreviewable error of law.
- [Westchester Med. Ctr. v Allstate Ins. Co. (2007 NY Slip Op 52257(U))](https://www.beynensonlaw.com/case-law/westchester-med-ctr-v-allstate-ins-co-2007-ny-slip-op-52257u/) — Supreme Court, Nassau County, 2007-10-22 — Limits exhausted [central]: Held the insurer proved exhaustion through its claims representative's affidavit and a business-record payment log showing nearly the full $150,000 limit paid, and that paying other providers while verification of plaintiff's claim was outstanding was permissible.