Key Takeaway
New York court ruling clarifies medical providers' independent arbitration rights and insurer EUO denial requirements in no-fault insurance cases.
Medical Providers Have Independent Rights in No-Fault Arbitration Cases
In New York’s complex no-fault insurance system, medical providers often find themselves navigating intricate legal requirements when seeking reimbursement for services rendered to accident victims. Two important principles emerged from a 2012 Appellate Term decision that clarify both the independence of medical providers in choosing their legal remedies and insurers’ obligations regarding examination under oath (EUO) procedures.
The case of Alev Med. Supply, Inc. v Allstate Prop. & Cas. Ins. Co. addressed fundamental questions about whether one medical provider’s arbitration decision affects another provider’s rights, and how insurers must properly handle EUO-related claim denials. These issues frequently arise when multiple providers treat the same patient and assign benefits from a single accident, creating potential conflicts over procedural choices and coverage determinations.
Jason Tenenbaum’s Analysis:
Alev Med. Supply, Inc. v Allstate Prop. & Cas. Ins. Co., 2012 NY Slip Op 51294(U)(App. Term 2d Dept. 2012)
Since each medical provider as assignee of a purportedly injured party has its own right to chose litigation or arbitration, the decision of one medical provider cannot prejudice another medical provider or assignor.
Roggio
“A prior arbitration proceeding involving one claimant provider seeking reimbursement of assigned first-party no-fault benefits does not preclude another provider from commencing its own action seeking reimbursement of assigned no-fault benefits, even where the claims have been assigned by the same individual and have arisen from the same accident”
Westchester Lincoln
“Defendant failed to demonstrate that it had timely denied the claims at issue based upon plaintiff’s assignor’s failure to appear for an EUO, and therefore that it is not precluded from asserting its proffered defense that plaintiff failed to comply with a condition precedent to coverage”
Key Takeaway
Medical providers maintain independent procedural rights when pursuing no-fault benefits, regardless of other providers’ litigation choices involving the same patient. Additionally, insurers must demonstrate timely EUO-based claim denials or risk waiving their right to assert coverage defenses, emphasizing the importance of proper procedural compliance in EUO proceedings.
Legal Update (February 2026): The arbitration procedures and EUO requirements discussed in this 2012 decision may have been modified through subsequent regulatory amendments to 11 NYCRR 65 or procedural updates to the no-fault arbitration process. Practitioners should verify current provisions regarding medical provider arbitration rights and EUO denial procedures, as these areas have seen periodic regulatory refinements since this case was decided.
