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.
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.
Related Articles
- Triable issue of fact as to non-appearance at EUO or IME
- Follow up verification issued more than 25 days too late
- Additional verification not produced is probative of nothing
- No-show failed the Alrof test for EUO non-appearance
- New York No-Fault Insurance Law
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.
