Power Supply, Inc. v Praetorian Ins. Co., 2015 NY Slip Op 50218(U)(App. Term 2d Dept. 2015)
“Defendant demonstrated that it had timely mailed initial EUO and IME requests within 15 business days of receipt of the claim forms at issue (see 11 NYCRR 65-3.5 [b]), and subsequently mailed timely follow-up requests (see 11 NYCRR 65-3.6 [b]), thereby tolling its time to pay or deny the claims. While plaintiff’s assignor failed to appear for chiropractic/acupuncture IMEs on October 5 and October 26, 2010 and orthopedic IMEs on October 7 and November 3, 2010, he also failed to attend EUOs on October 27 and November 22, 2010. As defendant denied the claims within 30 days after the assignor had failed to appear at the November 22, 2010 EUO (see 11 NYCRR 65-3.8 [a]), the claims at issue were timely denied on the ground that plaintiff’s assignor had failed to appear for properly scheduled IMEs and EUOs, regardless of the fact that the IME nonappearances had occurred more than 30 days prior to the issuance of the denial”
My understanding in this case was that the billing was timely and properly delayed for EUOs and IMEs. Thus, the carrier had the right to keep the matter in delay status until the final EUO no show occurred.
