Compas Med., P.C. v Travelers Ins. Co., 2016 NY Slip Op 51441(U)(App. Term 2d Dept. 2016)
“Contrary to plaintiff’s contention, defendant was not required to pay or deny plaintiff’s claims upon receipt of a “partial response” to defendant’s verification requests (see 11 NYCRR 65-3.8 [a] [1]; [b] [3]; New York & Presbyt. Hosp. v Progressive Cas. Ins. Co., 5 AD3d 568, 570 [2004] [“A claim need not be paid or denied until all demanded verification is provided”]). To the extent that plaintiff asserts that certain of defendant’s requests were inappropriate, that argument also lacks merit, as plaintiff did not allege, much less demonstrate, that it objected to such requests during claims processing (see Rogy Med., P.C. v Clarendon Natl. Ins. Co., 43 Misc 3d 133[A], 2014 NY Slip Op 50629[U], *2 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2014] [“inaction is an improper response to a verification request, and therefore plaintiff’s objections regarding the requests will not now be heard”]).”
Consider two examples where this plays out. Example one: Plaintiff says: I do not have these records search somewhere else and the defendant failed to search. This would be a loser to the carrier.
Example two: The carrier sought verification directly from the correct parties and following this Plaintiff says: “I do not have these records search somewhere else and the defendant failed to search.” This would be at best a partial response or a non response since the carrier has done everything it is supposed to do.
I raise these two issues because they play out often. AAA gets example #1 correct. AAA often gets example #2 incorrect.
