Key Takeaway
New York court rules that insurance companies cannot use EUO delay letters to extend the 30-day deadline for paying or denying no-fault claims under Insurance Law § 5106.
Insurance companies in New York no-fault cases often try to buy themselves extra time when processing claims by sending delay letters citing pending examinations under oath (EUOs). However, these tactical delays have legal limits. Under New York No-Fault Insurance Law, insurers must pay or deny claims within 30 days, and the Appellate Term has consistently held that certain types of delay notices cannot extend this crucial deadline.
The East Coast Acupuncture decision reinforces an important principle: insurers cannot simply send generic delay letters referencing EUO requirements to indefinitely postpone their obligation to make claim determinations. This ruling protects healthcare providers and other no-fault claimants from indefinite delays while EUO objections may prove futile anyway.
Jason Tenenbaum’s Analysis:
East Coast Acupuncture, P.C. v Clarendon Natl. Ins. Co., 2011 NY Slip Op 51229(U)(App. Term 2d Dept. 2011)
“With respect to the unpaid portions of the remaining bills which defendant claims were timely denied based upon the fee schedules, the letters from defendant to plaintiff which were annexed to defendant’s motion papers and which advised plaintiff that the processing of its bills was being delayed pending an examination under oath were insufficient to toll the 30-day period within which defendant was required to pay or deny those bills (see Insurance Law § 5106 ; Insurance Department Regulations § 65-3.5 ; see also Westchester Med. Ctr. v Lincoln Gen. Ins. Co., 60 AD3d 1045 )“
Key Takeaway
Generic delay letters citing pending EUO examinations cannot extend the statutory 30-day deadline for claim determinations under Insurance Law § 5106. Insurance companies must still comply with the mandatory timeframes for paying or denying no-fault claims, regardless of ongoing examination requirements. This protects providers from indefinite payment delays disguised as procedural necessities.
Legal Update (February 2026): Since this 2011 post, New York’s no-fault regulations under 11 NYCRR § 65-3.5 and related Insurance Law provisions may have been amended, particularly regarding claim determination deadlines, EUO procedures, and tolling provisions. Practitioners should verify current regulatory language and recent appellate decisions, as both procedural requirements and fee schedule provisions have undergone periodic updates since 2011.
