Time frame to deny following EUO

Historical note: South Nassau Orthopedic concerned identified bills, a completed March 3, 2009 EUO and no other outstanding verification. Its result is not a universal deadline formula for claims with different requests, late scheduling or unresolved verification.

Last reviewed: September 2026.

When an examination under oath is complete, an insurer cannot leave the claim open on that ground alone. In South Nassau Orthopedic Surgery & Sports Medicine v Farm Family Casualty Insurance Co., decided August 5, 2015, the Appellate Term held the May 1, 2009 denials untimely. The key qualification was that no other verification remained outstanding.

The appeal covered a defined group of bills

The services at issue on appeal were rendered from December 2008 through February 2009. The insurer received the relevant bills between January 7 and March 12, 2009. The EUO took place on March 3, before the last of those bills arrived.

The court measured the denial period against those dates. For the claims already received when the EUO occurred, completion of that outstanding verification was significant. For the later-received claims, the bill receipt dates also had to be considered. The May 1 denials were more than 30 days after the relevant later event for each claim.

The original shorthand below leaves out that bill-by-bill comparison. It points toward comparing the denial date, the EUO date and the claim receipt date, but is not a complete formula. A reader should not simply add 30 days to an examination date without identifying the bill and any other verification.

What section 65-3.8 says about a completed examination

Under 11 NYCRR 65-3.8(a)(1), verification through an EUO or medical examination is deemed received on the day the examination is performed. The rule does not make an automatic extra waiting period out of later transcript handling.

The opinion found no additional verification outstanding in this record. That finding is essential. A different claim may involve another properly requested item, an examination that did not occur, or a dispute over whether the requests were timely. Those issues require their own analysis rather than being resolved by the mere presence of an EUO date.

The 120-day provisions for certain documentary verification requests are also not a substitute EUO timetable. Sections 65-3.5(o) and 65-3.8(b)(3) expressly distinguish EUO requests from the qualifying requests covered by that framework.

What the appellate court actually awarded

The court affirmed the denial of the insurer’s summary-judgment motion and the grant of the provider’s cross-motion concerning the bills at issue. Its holding resolved the timing defense on that record.

It did not decide every conceivable coverage defense, every bill in the litigation or the result in a later claim with different facts. Calling all late denials automatically payable would go beyond the question decided. The reason this provider prevailed must remain tied to the particular claims and defense before the court.

Three dates, with the supporting documents

List each bill’s receipt date alongside the examination date and the denial’s mailing date. It should then identify any separate verification alleged to have remained outstanding and the evidence supporting that assertion.

The distinction between a document’s typed date and its proven mailing or receipt date is important. An affidavit establishing an office mailing practice may support one event without establishing the other. A spreadsheet that silently treats every letter date as a receipt date can obscure the very dispute counsel needs to evaluate.

Recover Medical Services shows why the initial request’s timing still matters: the insurer lost its dismissal request for one group of bills because the EUO requests were late, even though it prevailed on other bills.

How this fits the verification library

Mount Sinai v Dust Transit addresses an effective request that was not properly followed up. Lenox Hill Radiology addresses films that had not been produced at all. Those are different reasons for evaluating whether the claim clock was suspended or running.

Reading them together makes the useful question more precise: what information remained outstanding for this bill, under which request, on the date of denial? That question is more reliable than a general assumption that attending an EUO either ends every dispute or leaves every claim open.

Jason’s original commentary

The original comments below are retained as historical commentary. The case-specific corrections and later developments are explained above.

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

Connect to the Encyclopedia

Start with the no-fault verification hub and 2026 Chapa update for the governing framework and case directory. Related case notes:

• Lenox Hill Radiology: MRI reproduction costs and the verification toll.
• Mount Sinai v Dust Transit: the NF-5 and the missing follow-up.
• Right Aid: reversal over the verification-trial burden.
• Recover Medical Services: attorney notice and late EUO requests.
• The recalled AIG opinion and its November replacement.

For review of a particular no-fault verification dispute, request a Free Case Review. Keep the requests, responses and relevant claim dates available for that review.