Delay for IME and EUO no shows

Understanding Delay Tolling in No-Fault Insurance Claims

New York’s no-fault insurance regulations impose strict time limits on insurers to pay or deny claims. Under 11 NYCRR 65-3.8, carriers must generally act within 30 days of receiving proof of claim. However, specific regulatory provisions permit insurers to toll these deadlines when requesting examinations under oath (EUOs) or independent medical examinations (IMEs). The interplay between multiple examination requests and the 30-day denial deadline creates complex procedural questions.

When assignors fail to appear for multiple scheduled examinations, insurers must determine which non-appearance triggers the 30-day denial period. The regulations provide that timely EUO and IME requests suspend the insurer’s obligation to pay or deny claims, but the precise mechanics of calculating denial deadlines when multiple examinations are scheduled remains subject to judicial interpretation.

Case Background

In Power Supply, Inc. v Praetorian Insurance Co., the healthcare provider sued to recover no-fault benefits for treatment provided to an accident victim. The insurance carrier denied the claims based on the patient’s failure to appear for scheduled examinations. The carrier had initially requested both an EUO and IMEs within the regulatory 15-day window after receiving the claim forms.

The assignor failed to appear for chiropractic/acupuncture IMEs scheduled for October 5 and October 26, 2010, and orthopedic IMEs scheduled for October 7 and November 3, 2010. The assignor also failed to appear for EUOs scheduled for October 27 and November 22, 2010. The carrier issued its denial within 30 days after the November 22, 2010 EUO non-appearance, but more than 30 days had elapsed since the earlier IME non-appearances.

The healthcare provider argued the carrier’s denial came too late because more than 30 days passed since the first IME non-appearances. The Appellate Term, Second Department, considered whether the carrier properly maintained the claims in delay status until the final EUO no-show.

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 ), and subsequently mailed timely follow-up requests (see 11 NYCRR 65-3.6 ), 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 ), 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.

Legal Significance

The Power Supply decision establishes that when insurers properly request multiple examinations within regulatory timeframes, each pending examination continues to toll the denial deadline. The carrier need not issue a denial within 30 days of the first non-appearance if other properly scheduled examinations remain outstanding. Instead, the 30-day denial period begins running from the final examination non-appearance.

This ruling provides insurers significant procedural flexibility when managing claims involving multiple examination requests. Carriers can schedule both IMEs and EUOs simultaneously, and the failure to appear at any single examination does not trigger an immediate obligation to deny within 30 days. The tolling continues until the assignor fails to appear at the final scheduled examination.

The decision also clarifies that different types of examinations—chiropractic IMEs, orthopedic IMEs, and EUOs—can each independently toll the denial deadline. An assignor’s failure to attend a chiropractic IME in early October does not require the carrier to issue a denial by early November if an EUO remains scheduled for late November. The regulatory framework treats each properly noticed examination as an independent basis for tolling.

Practical Implications

Insurance carriers should implement systematic procedures for scheduling multiple examinations when claims warrant comprehensive investigation. Rather than scheduling only a single IME, carriers benefit from requesting both medical examinations and EUOs during the initial 15-day window. This approach maximizes the period during which claims remain in tolled status, providing additional time to investigate potential fraud or other coverage defenses.

Healthcare providers and their counsel must recognize that challenging examination-based denials requires demonstrating procedural defects in the initial examination requests, not merely showing that substantial time elapsed between the first and last non-appearances. If the carrier properly requested multiple examinations within regulatory deadlines, the denial remains timely even if issued months after the first non-appearance. Providers should focus discovery on whether initial requests complied with notice requirements rather than the sequence of subsequent no-shows.

Related Articles

• Triable issue of fact as to non-appearance for EUO and IME
• No-show failed the Alrof test
• No-show substantiated
• EUO of a medical provider issued untimely
• New York No-Fault Insurance Law

Legal Update (February 2026): Since this 2015 post, the regulations governing IME and EUO scheduling procedures under 11 NYCRR 65-3 may have been subject to amendments affecting timing requirements, notice provisions, or denial procedures. Practitioners should verify current provisions in sections 65-3.5, 65-3.6, and 65-3.8 to ensure compliance with any updated scheduling and delay tolling requirements.