Time frame to deny following EUO

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

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.