What a verification request is
Under 11 NYCRR 65-3.5, the carrier can request additional information from the provider or claimant within 15 business days of receiving a bill (NF-3). The request tolls the carrier's 30-day decision clock until the requested information is received in full.
Common verification targets: complete treatment notes, prior-treatment history, imaging reports, AOB, no-fault application (NF-2), and policyholder eligibility documentation.
The 30-day follow-up rule
If the provider or claimant does not respond within 30 days of the initial verification request, the carrier must send a follow-up verification request within 10 calendar days. The follow-up is mandatory — if the carrier skips it, the toll ends and the 30-day decision clock resumes.
This is one of the most-litigated points in NY no-fault arbitration. Audit every verification chain for compliance with the follow-up rule.
The 120-day rule
If the claimant or provider fails to respond to both the initial and follow-up verification requests within 120 days of the original NF-3 receipt, the carrier can deny the claim on procedural grounds. Once the 120-day window closes without a complete response, recovery becomes extremely difficult.
What counts as a complete response
All documents specifically requested by the carrier. Partial responses do not stop the toll — and carriers will argue that an incomplete response equals no response. Keep a verification log: date received, date responded, what was sent, and proof of mailing.
Common carrier tactics
Requesting documents that don't exist or weren't generated, requesting documents previously provided, sending verification requests addressed to the wrong party, and issuing follow-up requests outside the 10-day window. Each is a potential defense at arbitration.
How to preserve the claim
Respond promptly and completely. Keep proof of mailing. Log every verification request and response. If the carrier issues an improper verification request, respond with what is reasonably available and document the objection in the same mailing.
Frequently asked questions
How long do I have to respond to a verification request?
There is no fixed claimant deadline, but failure to respond within 120 days from receipt of the original NF-3 can result in a procedural denial. Respond within 30 days when possible.
Does a verification request stop the 30-day clock?
Yes. A valid verification request tolls the carrier's 30-day decision window until the requested information is received in full.
What happens if the carrier doesn't send a follow-up verification?
If the carrier fails to send the mandatory 10-day follow-up after the initial 30-day non-response window, the toll ends and the carrier's 30-day decision clock resumes — often making the eventual denial untimely.
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