Key Takeaway
Court ruling clarifies timing requirements for EUO follow-up requests in no-fault cases, emphasizing proper application of verification timeframes under NY insurance regulations.
Understanding EUO Follow-Up Request Timing Requirements
The timing of Examination Under Oath (EUO) requests and follow-up communications plays a crucial role in New York No-Fault Insurance Law cases. Insurance companies must carefully navigate specific regulatory timeframes when requesting EUOs from healthcare providers, and failure to comply with these requirements can result in the waiver of important defenses.
The Avicenna Med. Arts decision provides important clarification on how courts should evaluate the timing of EUO follow-up requests, particularly the application of the 10-day follow-up period outlined in New York’s no-fault regulations. This case demonstrates how procedural missteps in EUO administration can lead to significant consequences for insurance carriers, including the loss of their right to deny claims based on non-appearance.
Jason Tenenbaum’s Analysis:
Avicenna Med. Arts, PLLC v Unitrin Advantage Ins. Co.,
“However, as the Civil Court found, the papers submitted in support of defendant’s cross motion demonstrated that defendant’s follow-up EUO requests were untimely (see 11 NYCRR 65-3.6 ; Concourse Chiropractic, PLLC v Fiduciary Ins. Co. of Am., 35 Misc 3d 146, 2012 NY Slip Op 51058 ). As the claims at issue were not denied within 30 days of their receipt (see 11 NYCRR 65-3.8 ), defendant is precluded from asserting its defense that there had been a failure to appear for EUOs as to those claims (see Westchester Med. Ctr. v Lincoln Gen. Ins. Co., 60 AD3d 1045 ), and, thus, plaintiff was properly granted judgment on its first six causes of action.”
This is the application of Westchester/Lincoln that I agree with, i.e., the timing of the letters as to each other determines whether the verification time=frames were adhered to, except that the 10-day period for the service of the follow-up letter should not be strictly scrutinized in accordance with relevant precedent.
Key Takeaway
The Avicenna decision reinforces that insurance companies must strictly comply with EUO timing requirements under New York’s no-fault regulations. When follow-up EUO requests are untimely and claims aren’t denied within the 30-day statutory period, insurers lose their right to assert non-appearance defenses, resulting in automatic judgment for healthcare providers.
Legal Update (February 2026): Since this 2015 post, 11 NYCRR 65-3 has undergone several regulatory amendments that may have modified EUO timing requirements, follow-up procedures, and related compliance standards. The specific provisions governing the 10-day follow-up period for EUO requests may have been updated or clarified through subsequent regulatory changes. Practitioners should verify current regulatory language in sections 65-3.6 and 65-3.8 and review recent case law interpreting these timing requirements.
