Obligations of Assignee and Authorized entity

Stracar Med. Servs., P.C. v State Farm Mut. Auto. Ins. Co., 2015 NY Slip Op 25079 (App. Term 2d Dept. 2015)

“Plaintiff’s main argument on appeal is that, because plaintiff was not the eligible injured person’s (EIP’s) assignee at the time plaintiff submitted the NF-3 forms to defendant, the language in the mandatory personal injury protection (PIP) endorsement (11 NYCRR 65-1.1), which requires “the eligible injured person or that person’s assignee or representative” to “submit to examinations under oath,” did not require plaintiff to submit to an EUO, and, thus, defendant’s proffered defense, that plaintiff failed to appear for duly scheduled EUOs, lacks merit. In our view, the Civil Court properly rejected this argument, as we find that, pursuant to the regulations, both the recipient of an assignment of benefits and the recipient of an authorization to pay are required to submit to a duly scheduled EUO.”

Holding #1:

“While an insurer is required to pay benefits directly to a provider “upon assignment by the applicant” pursuant to 11 NYCRR 65-3.11 (a), the word “assignment” in this context is not limited to a prescribed assignment, and indeed includes a prescribed authorization, since, pursuant to 11 NYCRR 65-3.11 (b), a provider demonstrates such “assignment” by submitting either a properly executed prescribed authorization or a properly executed prescribed assignment. Inasmuch as an “assignee” clearly must submit to an EUO, the regulations should be read to impose this obligation upon the recipient of both a properly executed prescribed authorization and a properly executed prescribed assignment.”

Holding #2:

“Even if we did not find that a prescribed authorization falls within the umbrella of the word “assignment” as used in 11 NYCRR 65-3.11 (a), we would still hold that the recipient of an authorization to pay is obligated to submit to an EUO. This is because, in addition to requiring the EIP or that person’s assignee to submit to an EUO, the PIP endorsement also obligates the EIP’s representative to submit to an EUO. Written proof of claim may be submitted to an insurer by the EIP’s representative (see 11 NYCRR 65-1.1), and the recipient of a properly executed prescribed authorization who submits proof of claim is clearly acting as the EIP’s representative under those circumstances since the EIP retains “all rights, privileges and remedies.” Accordingly, plaintiff, as the entity which submitted the claim forms to defendant, was obligated to submit to an EUO whether such entity be viewed as its patient’s assignee or as his representative.”

So if the provider wants to avoid an EUO, it can achieve this goal through the EIP directly submitting the billing to the insurance carrier.

Related Articles

• Understanding EUO requirements and regulations in New York no-fault insurance cases
• Challenging EUO no-show denials based on improper notice
• Consequences of failing to appear for scheduled examinations under oath
• When EUO demands are untimely under New York regulations
• New York No-Fault Insurance Law

Legal Update (February 2026): Since this 2015 post, the regulations governing no-fault insurance obligations, including 11 NYCRR 65-1 and 65-3, may have been amended or supplemented with new provisions affecting assignee and authorized entity EUO obligations. Additionally, subsequent appellate decisions may have further refined the interpretation of assignment versus authorization requirements under the current regulatory framework. Practitioners should verify the current versions of these regulations and recent case law developments when advising clients on EUO compliance obligations.