Key Takeaway
New York appellate court clarifies strict 15-day deadline for no-fault insurers to request EUOs, ruling that late scheduling letters are nullities under regulations.
Understanding No-Fault Insurance EUO Timing Requirements
In New York’s no-fault insurance system, insurance companies often request Examinations Under Oath (EUOs) to verify claims. However, these requests must comply with strict regulatory deadlines. The Appellate Term’s decision in O & M Med., P.C. v Travelers Indem. Co. provides crucial guidance on these timing requirements, establishing that insurers cannot simply schedule EUOs whenever convenient.
The case involves a medical provider’s claim that was denied after the insurer scheduled an EUO nearly three months after receiving the claim. This significant delay raised important questions about whether insurance companies can extend the regulatory timeframes at will. The court’s analysis reinforces that EUO procedures must follow specific protocols, and timing violations can invalidate an insurer’s denial.
Jason Tenenbaum’s Analysis:
O & M Med., P.C. v Travelers Indem. Co., 2015 NY Slip Op 50476(U)(App. Term 2d Dept. 2015)
“Pursuant to the No-Fault Regulations, “any additional verification required by the insurer to establish proof of claim shall be requested within 15 business days of receipt of the ” (11 NYCRR 65-3.5 ). This rule applies to requests for EUOs (see e.g. Longevity Medical Supply, Inc. v IDS Property & Cas. Ins. Co., 44 Misc 3d 137, 2014 NY Slip Op 51244 ). Here, there was no duly scheduled EUO at which plaintiff failed to appear, since defendant mailed its first EUO scheduling letter nearly three months after having received the claim at issue, rendering the letter a nullity. Consequently, defendant failed to demonstrate that it had properly denied the claim based upon plaintiff’s failure to comply with a condition precedent to coverage”
Key Takeaway
Insurance companies must request EUOs within 15 business days of receiving a no-fault claim. When insurers fail to meet this deadline, their EUO scheduling letters become nullities, and they cannot deny claims based on non-appearance at improperly scheduled examinations. This ruling protects healthcare providers and injured parties from delayed insurance company tactics.
Legal Update (February 2026): Since this 2015 post, the No-Fault Regulations under 11 NYCRR 65-3 may have been amended, particularly regarding EUO timing requirements and verification procedures under section 65-3.5. Practitioners should verify current regulatory provisions and recent appellate decisions interpreting EUO deadlines, as procedural requirements and timing standards may have evolved.
