EUOs must be scheduled within 30-days of receipt of the bill (again)

New York Courts Reinforce Critical EUO Scheduling Deadline

Under New York No-Fault Insurance Law, insurance companies face strict deadlines when processing claims from medical providers. One of the most fundamental requirements is that any Examination Under Oath (EUO) must be scheduled within 30 days of receiving a claim. A recent Appellate Term decision serves as another reminder that insurers cannot use generic delay letters to extend this crucial deadline.

The case of Compas Med., P.C. v Farm Family Cas. Ins. Co. demonstrates how courts continue to hold insurance companies accountable for adhering to statutory timeframes, even when they send delay notices. This ruling aligns with established precedent and reinforces protections for medical providers operating under the no-fault system. Understanding these timing requirements is essential for both providers and insurers, as violations can result in automatic liability for the underlying claim.

Jason Tenenbaum’s Analysis:

Compas Med., P.C. v Farm Family Cas. Ins. Co., 2015 NY Slip Op 51631(U)(App. Term 2d Dept. 2015)

“Upon receiving the claim underlying the second cause of action, defendant sent letters notifying plaintiff that defendant was delaying payment thereon, but the letters did not request any specific verification. Consequently, contrary to defendant’s contention, these delay letters did not toll the statutory time period within which defendant was required to pay or deny the claim underlying the second cause of action (see Points of Health Acupuncture, P.C. v Lancer Ins. Co., 28 Misc 3d 133, 2010 NY Slip Op 51338 ). As the first letter that defendant sent to schedule plaintiff’s assignor’s examination under oath was sent more than 30 days after defendant had received the claim underlying the second cause of action, the 30-day period within which defendant was required to pay or deny this claim had already expired.”

This bolded statement represents good law in both First and Second Departments.

Key Takeaway

Insurance companies cannot rely on vague delay letters to extend the 30-day deadline for scheduling EUOs. The court made clear that only specific verification requests can toll the statutory time period. When insurers miss this deadline, they forfeit their right to deny the claim, regardless of whether they eventually discover legitimate grounds for denial. This principle remains consistently applied across New York’s appellate courts.

Related Articles

• Understanding EUO Requirements in New York No-Fault Insurance Cases
• New York EUO Requirements: When Examination Under Oath Demands Are Untimely
• Validity of EUO, Appellate Term, 2d Dept: Take two
• How to Challenge EUO No-Show Denials: When Improper Notice Can Reverse Insurance Denials in New York
• New York No-Fault Insurance Law