Follow up verification issued >25 days too late is a loser

New York’s no-fault insurance system operates under strict timing requirements that protect both insurers and healthcare providers. When insurance companies request examinations under oath (EUOs) or independent medical examinations (IMEs), they must follow precise procedural rules outlined in the Insurance Department Regulations. One critical rule involves follow-up verification requests when an assignor fails to appear for a scheduled examination.

The Triangle “R” rule establishes timing parameters for these follow-up requests, but until 2012, courts had limited guidance on what constituted “timely” verification. The Appellate Term’s decision in Concourse Chiropractic provided the first comprehensive analysis of this timing requirement, establishing important precedent for New York no-fault insurance law practitioners.

Understanding these timing rules is crucial for both insurance carriers and healthcare providers navigating the no-fault system. When verification requests are sent too late, insurers risk having their claim denials deemed untimely, potentially resulting in automatic payment obligations.

Jason Tenenbaum’s Analysis:

Concourse Chiropractic, PLLC v Fiduciary Ins. Co. of Am., 2012 NY Slip Op 51058(U)(App. Term 2d Dept. 2012)

This is the first case where the Court expounded on the Triangle “R” rule, regarding late follow-up verification requests.

“On December 2, 2008, defendant requested that plaintiff’s assignor appear for an examination under oath (EUO) on January 8, 2009. Plaintiff’s assignor failed to appear for the EUO. However, defendant did not mail a second request until February 12, 2009. As this follow-up request was untimely (see Insurance Department Regulations § 65-3.6 ), defendant failed to toll the 30-day claim determination period (Insurance Department Regulations § 65-3.8 ), and, as a result, defendant’s denial of plaintiff’s claim was untimely.”

The Court was correct on this. I would venture to say that anything sent north of 20 days after the date of the first “EUO” or “IME” is probably going to violate the Triangle “R” rule.

Key Takeaway

The Concourse Chiropractic decision established that follow-up verification requests sent more than 25 days after a missed EUO violate timing requirements under Insurance Department Regulations. This failure to send timely follow-up requests prevents insurers from tolling the 30-day claim determination period, making subsequent denials untimely. Practitioners should note that requests sent more than 20 days after the original examination date likely violate the Triangle “R” rule.

This timing requirement also applies to IME no-show situations, where similar verification procedures must be followed. Healthcare providers should be aware that EUO objections may have limited effectiveness when procedural requirements aren’t properly met by insurance carriers.

Legal Update (February 2026): Since this 2012 post, New York’s no-fault regulations have undergone several revisions, particularly regarding EUO and IME procedural requirements and timing standards. The Insurance Department has updated various provisions within Title 11 NYCRR § 65, potentially affecting verification request deadlines and the Triangle “R” rule applications discussed here. Practitioners should verify current regulatory language and recent appellate decisions when applying these timing requirements to pending cases.