Key Takeaway
Court rules insurance carrier failed to prove timely EUO requests, highlighting critical procedural requirements in no-fault insurance defense cases.
No-fault insurance carriers must follow strict procedural requirements when requesting examinations under oath (EUOs) from medical providers. One critical requirement often overlooked is proving that EUO requests were sent within the proper timeframe. This procedural misstep can have significant consequences, as demonstrated in a 2014 Appellate Term decision that illustrates how carriers can lose their right to deny claims based on EUO no-shows when they fail to establish proper timing.
The case also highlights an interesting judicial observation about outdated legal precedents still being cited in New York No-Fault Insurance Law cases, particularly regarding EUO procedures that have evolved significantly over time.
Jason Tenenbaum’s Analysis:
When was the last time the Appellate Division cited Westchester v. Lincoln? This Court seeks citing dinosaurs, which have been extinct for awhile now.
Clove Med. Supply, Inc. v Ameriprise Ins. Co., 2014 NY Slip Op 50357(U)(App. Term 2d Dept. 2014)
In support of its motion, defendant was required, but failed, to demonstrate that its initial and follow-up requests for EUOs of plaintiff had been timely mailed (see Insurance Department Regulations §§ 65-3.5 ; 65-3.6 ), as the record is devoid of any reference to the dates on which defendant had received plaintiff’s claim forms. Consequently, defendant failed to demonstrate that it had tolled its time to pay or deny the claims, and, thus, that it is not precluded from raising its proffered defense that plaintiff had failed to appear for an EUO (see Presbyterian Hosp. in City of NY v Maryland Cas. Co., 90 NY2d 274, 282 ; Westchester Med. Ctr. v Lincoln Gen. Ins. Co., 60 AD3d 1045 ). In view of the foregoing, the Civil Court properly denied defendant’s motion”
Key Takeaway
Insurance carriers must maintain detailed records proving when they received claim forms and when EUO requests were mailed. Without this documentation, carriers cannot establish that their EUO requests were timely, effectively waiving their right to deny claims based on provider no-shows. This case reinforces that procedural compliance is just as important as substantive defenses in no-fault litigation.
Legal Update (February 2026): The EUO procedural requirements under Insurance Department Regulations §§ 65-3.5 and 65-3.6 referenced in this 2014 analysis may have been subject to regulatory amendments or clarifications in the intervening years. Given the evolving nature of no-fault insurance regulations and EUO procedures, practitioners should verify current timing requirements and procedural standards before relying on the specific regulatory provisions discussed in this post.
