Time frame to deny following EUO

Understanding the 30-Day Denial Window Following Examinations Under Oath

New York’s no-fault insurance regulations impose strict deadlines on insurance carriers for processing and paying or denying claims. Under 11 NYCRR 65-3.8, carriers must pay or deny claims within 30 calendar days after receiving “proof of claim,” which includes verification of all relevant requested information. When carriers schedule examinations under oath as part of their investigation process, the regulation specifies that verification is deemed received on the day the examination was performed.

This regulatory framework creates a critical timing issue for carriers seeking to deny claims based on information obtained during EUO proceedings. The 30-day clock begins running from the EUO date, not from when the carrier receives transcripts or completes its analysis of the testimony. Carriers must act swiftly to issue denials within this compressed timeframe, or risk having their denials deemed untimely and thereby waived.

The timing calculation becomes more complex when multiple bills are submitted on different dates, some before and some after the EUO. Carriers must determine the applicable 30-day deadline for each individual bill, comparing the date 30 days from bill receipt against the date 30 days from the EUO, and ensuring denials issue by the later of these two dates. Miscalculation on even a single bill can result in the carrier forfeiting valuable defenses and becoming obligated to pay claims it would otherwise have legitimately denied.

Case Background

In South Nassau Orthopedic Surgery & Sports Medicine, P.C. v Farm Family Casualty Insurance Co., a healthcare provider submitted multiple bills for no-fault benefits, which the carrier received between January 7, 2009 and March 12, 2009. As part of its investigation, the carrier scheduled an examination under oath of the plaintiff’s assignor, who appeared and testified on March 3, 2009.

Following the EUO, the carrier issued denials dated May 1, 2009 for the bills in question. The provider then filed suit seeking to recover payment, arguing that the denials were untimely under the regulatory framework. The carrier defended on the ground that it properly denied the claims within the applicable statutory period.

The critical issue before the court involved calculating the deadline by which the carrier was required to issue its denials. For each bill, the carrier had 30 days from receipt of the bill or 30 days from completion of verification, whichever was later. Since the assignor appeared for the EUO on March 3, 2009, and no other verification remained outstanding, the question became whether May 1, 2009 denials satisfied the regulatory deadline of 30 days from the later of bill receipt or March 3, 2009.

Jason Tenenbaum’s Analysis

South Nassau Orthopedic Surgery & Sports Medicine, P.C. v Farm Family Cas. Ins. Co., 2015 NY Slip Op 51211(U)(App. Term 2d Dept. 2015)

“Defendant failed to demonstrate that its May 1, 2009 denials were timely with respect to the bills at issue, all of which had been received by defendant between January 7, 2009 and March 12, 2009. Plaintiff’s assignor appeared for an examination under oath (EUO) on March 3, 2009, and no other verification remained outstanding. Consequently, defendant was required to deny each of the bills at issue by the later of the following two dates: 30 days from the date of receipt of the bill or 30 days from March 3, 2009 (see 11 NYCRR 65-3.8 [“No-Fault benefits are overdue if not paid within 30 calendar days after the insurer receives proof of claim, which shall include verification of all of the relevant information requested … . In the case of an examination under oath … , the verification is deemed to have been received by the insurer on the day the examination was performed.”]), which it failed to do. In view of the foregoing, the [*2]branches of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought reimbursement for services rendered between December 2008 and February 2009 were properly denied, and the branches of plaintiff’s cross motion seeking summary judgment on that portion of the complaint were properly granted.”

Date of denial > EUO + 30 v. Date of reciept

Legal Significance

The Appellate Term’s decision clarifies that the 30-day deadline following EUO completion is firm and unforgiving. The regulation’s language stating that “verification is deemed to have been received by the insurer on the day the examination was performed” creates a bright-line rule that eliminates any ambiguity about when the deadline begins running. Carriers cannot argue for additional time based on transcript preparation, internal review processes, or administrative delays.

This strict application serves important policy objectives in the no-fault system. The Legislature designed no-fault insurance to provide prompt payment of legitimate claims without extensive investigation or litigation. While carriers retain the right to conduct reasonable investigation including EUOs, they must do so within compressed timeframes that prevent indefinite delay of benefit payments. The 30-day post-EUO deadline balances carriers’ investigation rights against claimants’ needs for timely payment.

The decision also demonstrates the importance of precise calculations when multiple bills are at issue. Carriers cannot apply blanket denial dates across all bills; they must calculate the applicable deadline for each individual billing separately, accounting for both when the bill was received and when verification was completed. This granular approach protects providers’ rights to timely payment while acknowledging that bills submitted at different times may have different payment or denial deadlines.

Practical Implications

Insurance carriers must implement rigorous systems for tracking EUO dates and calculating denial deadlines. When scheduling EUOs, carriers should anticipate the need to review testimony and issue denials within the 30-day window. This may require expedited transcript preparation, immediate post-EUO review procedures, and pre-drafted denial forms that can be quickly finalized once the legal basis for denial is confirmed.

Carriers should also maintain detailed tracking systems for bill receipt dates and verification completion dates. When multiple bills are involved, creating a chart showing each bill’s receipt date, the relevant verification completion date, the calculated deadline, and the actual denial date can help ensure compliance and provide evidence of timeliness if later challenged.

For providers, this decision underscores the importance of scrutinizing denial timing when carriers assert EUO-based defenses. Careful comparison of bill receipt dates, EUO dates, and denial dates can reveal untimely denials that waive carriers’ defenses and create liability for the denied claims. Providers should maintain comprehensive records of all bill submissions to support later challenges to denial timeliness.

Related Articles

• Understanding verification requests and mailing requirements in New York No-Fault claims
• The 150-day verification rule and its impact on claims processing
• How technical verification requirements can override common sense in No-Fault insurance
• Additional verification requirements and their practical implications
• New York No-Fault Insurance Law

Legal Update (February 2026): Since this 2015 post, 11 NYCRR 65-3.8 and related no-fault claim denial timeframes may have been subject to regulatory amendments or clarifications. Practitioners should verify current provisions regarding the 30-day denial period following examination under oath completion, as the Department of Financial Services has issued various updates to no-fault regulations in recent years.