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EUO of a medical provider – untimely.
EUO issues

EUO of a medical provider – untimely.

By Jason Tenenbaum 8 min read

Key Takeaway

New York court rules that insurance company's EUO request for medical provider was untimely, failing to comply with 15-day requirement under no-fault regulations.

This article is part of our ongoing euo issues coverage, with 323 published articles analyzing euo issues issues across New York State. Attorney Jason Tenenbaum brings 24+ years of hands-on experience to this analysis, drawing from his work on more than 1,000 appeals, over 100,000 no-fault cases, and recovery of over $100 million for clients throughout Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx. For personalized legal advice about how these principles apply to your specific situation, contact our Long Island office at (516) 750-0595 for a free consultation.

Understanding the Timing Requirements for Medical Provider EUOs in No-Fault Cases

In New York’s no-fault insurance system, timing is everything. Insurance companies must follow strict deadlines when requesting additional verification from healthcare providers, including examinations under oath (EUOs). A recent appellate decision demonstrates how missing these deadlines can derail an insurer’s defense strategy and leave them liable for outstanding medical bills.

The case of Quality Psychological Services v. Utica Mutual Insurance Company highlights a critical procedural requirement that many insurers overlook: the 15-day window for requesting provider EUOs following an injured person’s examination. This timing rule, rooted in New York No-Fault Insurance Law, serves to protect healthcare providers from indefinite uncertainty about payment while ensuring insurers can still conduct necessary investigations within reasonable timeframes.

Jason Tenenbaum’s Analysis:

Quality Psychological Servs., P.C. v Utica Mut. Ins. Co., 2013 NY Slip Op 50148(U)(App. Term 1st Dept. 2013)

“We sustain the denial of defendant’s motion for summary judgment dismissing this first-party no-fault action. Defendant’s June 26, 2008 request for additional verification in the form of an examination under oath (EUO) of the plaintiff medical provider was untimely and did not serve to toll defendant’s time to pay or deny the claim, since the request was made well beyond the requisite 15-day time period following the assignor’s EUO”

Unitrin held that the IMEs (and EUOs through subsequent case law) must be in accordance with the no-fault regulations, irrespective of the receipt of the bills. In this case, the EUO of the EIP triggered the desire to perform the EUO’s of the providers. Thus, the no-fault regulations would require that the additional form of verification be within the time constraints of 65-3.5 and 65-3.8. Also, this would be consistent with established precedent: Nyack v. Gmac., 8 NY3d 294 (2007) and Keith v. Liberty, 118 A.D.2d 151 (2d Dept. 1986)

Key Takeaway

Insurance companies must request medical provider EUOs within 15 days of the injured person’s examination under oath. Untimely requests cannot toll the insurer’s obligation to pay or deny claims, leaving them vulnerable to summary judgment in favor of the healthcare provider. This strict timing requirement emphasizes the importance of coordinated investigation strategies in no-fault cases.


Legal Update (February 2026): The timing requirements and procedural standards for medical provider EUOs discussed in this 2013 post may have been subject to regulatory amendments or clarifications in subsequent years. Given the significance of these timing rules in no-fault practice and ongoing regulatory refinements to 11 NYCRR sections 65-3.5 and 65-3.8, practitioners should verify current provisions regarding EUO request deadlines and tolling effects before relying on the standards outlined in this analysis.

Legal Context

Why This Matters for Your Case

New York law is among the most complex and nuanced in the country, with distinct procedural rules, substantive doctrines, and court systems that differ significantly from other jurisdictions. The Civil Practice Law and Rules (CPLR) governs every stage of civil litigation, from service of process through trial and appeal. The Appellate Division, Appellate Term, and Court of Appeals create a rich and ever-evolving body of case law that practitioners must follow.

Attorney Jason Tenenbaum has practiced across these areas for over 24 years, writing more than 1,000 appellate briefs and publishing over 2,353 legal articles that attorneys and clients rely on for guidance. The analysis in this article reflects real courtroom experience — from motion practice in Civil Court and Supreme Court to oral arguments before the Appellate Division — and a deep understanding of how New York courts actually apply the law in practice.

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Common Questions

Frequently Asked Questions

What is an Examination Under Oath (EUO) in no-fault insurance?

An EUO is a sworn, recorded interview conducted by the insurance company's attorney to investigate a no-fault claim. The insurer schedules the EUO and asks detailed questions about the accident, injuries, treatment, and the claimant's background. Under 11 NYCRR §65-3.5(e), appearing for the EUO is a condition precedent to receiving no-fault benefits — failure to appear can result in claim denial.

What happens if I miss my EUO appointment?

Missing an EUO (known as an EUO 'no-show') can result in denial of your no-fault benefits. However, insurers must follow strict procedural requirements: they must send two scheduling letters by certified and regular mail, provide adequate notice, and submit a timely denial based on the no-show. If the insurer fails to comply with these requirements, the denial can be overturned at arbitration or in court.

What questions will be asked at a no-fault EUO?

EUO questions typically cover your personal background, employment history, the circumstances of the accident, your injuries and symptoms, treatment received, prior accidents or injuries, and insurance history. The insurer's attorney may also ask about your daily activities and financial arrangements with medical providers. You have the right to have your attorney present, and your attorney can object to improper questions.

Can an insurance company require multiple EUOs for the same claim?

Yes, under 11 NYCRR §65-3.5(e), an insurer may request additional EUOs as reasonably necessary to investigate a claim. However, repeated EUO requests may be challenged as harassing or unreasonable. Courts have found that insurers cannot use EUOs as a tool to delay claims indefinitely. Each EUO request must be properly noticed with adequate time for the claimant to appear.

Do I have the right to an attorney at my EUO?

Yes. You have the right to have an attorney represent you at an EUO, and it is strongly recommended. Your attorney can prepare you for the types of questions asked, object to improper or overly broad questions, and ensure the insurer follows proper procedures. Having experienced no-fault counsel at your EUO can help protect your claim from being unfairly denied.

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Attorney Jason Tenenbaum

About the Author

Jason Tenenbaum, Esq.

Jason Tenenbaum is the founding attorney of the Law Office of Jason Tenenbaum, P.C., headquartered at 326 Walt Whitman Road, Suite C, Huntington Station, New York 11746. With over 24 years of experience since founding the firm in 2002, Jason has written more than 1,000 appeals, handled over 100,000 no-fault insurance cases, and recovered over $100 million for clients across Long Island, Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, the Bronx, and Staten Island. He is one of the few attorneys in the state who both writes his own appellate briefs and tries his own cases.

Jason is admitted to practice in New York, New Jersey, Florida, Texas, Georgia, and Michigan state courts, as well as multiple federal courts. His 2,353+ published legal articles analyzing New York case law, procedural developments, and litigation strategy make him one of the most prolific legal commentators in the state. He earned his Juris Doctor from Syracuse University College of Law.

24+ years in practice 1,000+ appeals written 100K+ no-fault cases $100M+ recovered

Disclaimer: This article is published by the Law Office of Jason Tenenbaum, P.C. for informational and educational purposes only. It does not constitute legal advice, and no attorney-client relationship is formed by reading this content. The legal principles discussed may not apply to your specific situation, and the law may have changed since this article was last updated.

New York law varies by jurisdiction — court decisions in one Appellate Division department may not be followed in another, and local court rules in Nassau County Supreme Court differ from those in Suffolk County Supreme Court, Kings County Civil Court, or Queens County Supreme Court. The Appellate Division, Second Department (which covers Long Island, Brooklyn, Queens, and Staten Island) and the Appellate Term (which hears appeals from lower courts) each have distinct procedural requirements and precedents that affect litigation strategy.

If you need legal help with a euo issues matter, contact our office at (516) 750-0595 for a free consultation. We serve clients throughout Long Island (Huntington, Babylon, Islip, Brookhaven, Smithtown, Riverhead, Southampton, East Hampton), Nassau County (Hempstead, Garden City, Mineola, Great Neck, Manhasset, Freeport, Long Beach, Rockville Centre, Valley Stream, Westbury, Hicksville, Massapequa), Suffolk County (Hauppauge, Deer Park, Bay Shore, Central Islip, Patchogue, Brentwood), Queens, Brooklyn, Manhattan, the Bronx, Staten Island, and Westchester County. Prior results do not guarantee a similar outcome.

Jason Tenenbaum, Personal Injury Attorney serving Long Island, Nassau County and Suffolk County

About the Author

Jason Tenenbaum

Jason Tenenbaum is a personal injury attorney serving Long Island, Nassau & Suffolk Counties, and New York City. Admitted to practice in NY, NJ, FL, TX, GA, MI, and Federal courts, Jason is one of the few attorneys who writes his own appeals and tries his own cases. Since 2002, he has authored over 2,353 articles on no-fault insurance law, personal injury, and employment law — a resource other attorneys rely on to stay current on New York appellate decisions.

Education
Syracuse University College of Law
Experience
24+ Years
Articles
2,353+ Published
Licensed In
7 States + Federal

Discussion

Comments (3)

Archived from the original blog discussion.

A
Anonymous
excellent analysis jt however, the carrier’s very right to an euo of the provider is stated in the regs in the same breath as the right to examine the claimant. that one breach is a failure to meet condition precedent and one is apparently not is legal fiction.
J
JT Author
I think the court was saying that if you are going to start seeking verification through an EUO and your investigation leads to the provider, then you have to abide by the timelines as it relates to verifications in the Keith v. Liberty sense. It is true that Unitrin stated that the carrier had to abide by the timelines for verification, but again, Unitrin dealt with scheduling follow-up IMEs within 10 days of the first default. Quality narrows the holding because now it takes away from the unfettered right to state that a breach of a condition precedent is a coverage defense. I think the case should be narrowly construed on its facts. As a practitioner, I believe the better way for the court to have reached this conclusion was to say that Defendant’s papers on their own raised an issue of fact as to whether its actions were unreasonable. A plaintiff’s showing that an EUO or IME is unreasonable is sufficient to warrant a trial on the issue. Clearly, a Defendant can raise an issue of fact through its own submissions. The problem of course is every Plaintiff now says that Quality means that every IME unitrin defense and EUO Unitrin defense is invalid unless there is evidence to show “timeliness”. Putting aside why counsel for Utica pushed this issue, there are now many red herrings floating around in the Unitrin sea.
AK
ALAN Klaus
As matter of law we don’t need Quality bc Unitrin states that the verification must be in accordance with the regs dowhen carriers ddon’t follow the Lawtthey should not be allowed to use it. I have cases where the carrier wants an euo of the provider 2 yrs after the receipt of the bill and when the provider doesn’t show tgey argue Unitrin and lose when it’s in front of a knowledgeable arbitrator and lose on appeal also. Reasonableness comes into play. Carriers want to rely on Unitrin for everything and I am happy we are seeing case law slowly dwindle that away.

Legal Resources

Understanding New York EUO issues Law

New York has a unique legal landscape that affects how euo issues cases are litigated and resolved. The state's court system includes the Civil Court (for claims up to $25,000), the Supreme Court (the primary trial court for unlimited jurisdiction), the Appellate Term (which hears appeals from lower courts), the Appellate Division (divided into four Departments, with the Second Department covering Long Island, Brooklyn, Queens, Staten Island, and several upstate counties), and the Court of Appeals (the state's highest court). Each court has its own procedural requirements, local rules, and case-assignment practices that can significantly impact the outcome of your case.

For euo issues matters on Long Island, cases are typically filed in Nassau County Supreme Court (at the courthouse in Mineola) or Suffolk County Supreme Court (in Riverhead). No-fault arbitrations are heard through the American Arbitration Association, which assigns arbitrators throughout the metropolitan area. Workers' compensation claims go to the Workers' Compensation Board, with hearings at district offices across the state. Understanding which forum is appropriate for your case — and the specific procedural rules that apply — is essential for a successful outcome.

The procedural landscape in New York also includes important timing requirements that can affect your case. Most civil actions are subject to statutes of limitations ranging from one year (for intentional torts and claims against municipalities) to six years (for contract actions). Personal injury cases generally have a three-year deadline under CPLR 214(5), while medical malpractice claims must be filed within two and a half years under CPLR 214-a. No-fault insurance claims have their own regulatory deadlines, including 30-day filing requirements for applications and 45-day deadlines for provider claims. Understanding and complying with these deadlines is critical — missing a filing deadline can permanently bar your claim, regardless of how strong your case may be on the merits.

Attorney Jason Tenenbaum regularly practices in all of these venues. His office at 326 Walt Whitman Road, Suite C, Huntington Station, NY 11746, is centrally located on Long Island, providing convenient access to courts and offices throughout Nassau County, Suffolk County, and New York City. Whether you need representation in a no-fault arbitration, a personal injury trial, an employment discrimination hearing, or an appeal to the Appellate Division, the Law Office of Jason Tenenbaum, P.C. brings $24+ years of real courtroom experience to your case. If you have questions about the legal issues discussed in this article, call (516) 750-0595 for a free, no-obligation consultation.

New York's substantive law also presents distinct challenges. In motor vehicle cases, the no-fault system under Insurance Law Article 51 provides first-party benefits regardless of fault, but limits the right to sue for non-economic damages unless the plaintiff establishes a "serious injury" under one of nine statutory categories. This threshold — codified at Insurance Law Section 5102(d) — requires medical evidence showing more than a minor or subjective injury, and courts have developed detailed standards for each category. Fractures must be documented through imaging studies. Claims of permanent consequential limitation or significant limitation of use require quantified range-of-motion testing with comparison to norms. The 90/180-day category demands proof that the plaintiff was unable to perform substantially all of their usual daily activities for at least 90 of the 180 days following the accident.

In employment discrimination cases, the legal standards vary depending on whether the claim arises under state or local law. The New York State Human Rights Law employs a burden-shifting framework: the plaintiff must first establish a prima facie case by showing membership in a protected class, qualification for the position, an adverse employment action, and circumstances giving rise to an inference of discrimination. The burden then shifts to the employer to articulate a legitimate, non-discriminatory reason for its decision. If the employer meets this burden, the plaintiff must demonstrate that the stated reason is pretextual. The New York City Human Rights Law, by contrast, applies a broader standard, asking whether the plaintiff was treated less well than other employees because of a protected characteristic.

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