Key Takeaway
New York's no-fault insurance regulations require insurers to request EUOs within 15 days of receiving a claim. Courts strictly enforce this timing requirement.
Understanding EUO Timing Requirements Under New York No-Fault Law
Examinations Under Oath (EUOs) are a crucial component of New York No-Fault Insurance Law, allowing insurers to investigate claims before approving payment. However, insurers must follow strict procedural requirements when requesting these examinations. The timing of EUO requests has become a frequent point of litigation, with courts consistently holding insurers to precise regulatory deadlines.
The Court of Appeals has established clear precedent that insurance companies cannot indefinitely delay scheduling EUOs while continuing to investigate claims. This timing requirement protects healthcare providers and patients from unnecessary delays in receiving payment for legitimate no-fault benefits. When insurers fail to comply with these deadlines, they may lose their right to deny claims based on EUO objections or non-compliance.
Understanding these timing requirements is essential for both healthcare providers submitting no-fault claims and insurers processing them, as violations can result in automatic claim approval regardless of the underlying merits.
Jason Tenenbaum’s Analysis:
Great Health Care Chiropractic, P.C. v Travelers Ins. Co., 2015 NY Slip Op 51665(U)(App. Term 2d Dept. 2015)
“Pursuant to the No-Fault Regulations, “any additional verification required by the insurer to establish proof of claim shall be requested within 15 business days of receipt of the ” (11 NYCRR 65-3.5 ). This rule applies to requests for EUOs (see e.g. Longevity Medical Supply, Inc. v IDS Property & Cas. Ins. Co., 44 Misc 3d 137, 2014 NY Slip Op 51244 )” (O & M Med., P.C. v Travelers Indem. Co., 47 Misc 3d 134, 2015 NY Slip Op 50476 ). As defendant’s moving papers reflect that defendant’s first EUO scheduling letter was mailed about 50 days after defendant had received the claim at issue in this action, defendant failed to demonstrate that it had properly denied the claim based upon plaintiff’s failure to comply with a condition precedent to coverage”
It should be noted that the same result would apply in the First Department National Liability v. Tam Medical. An EUO must be scheduled within 30-days of receipt of the claim.
Key Takeaway
The 15-day rule under 11 NYCRR 65-3.5(b) is strictly enforced by New York courts. When insurers fail to request EUOs within this timeframe, they cannot later deny claims based on the insured’s failure to appear for the examination. This creates a procedural bar that effectively results in automatic claim approval, regardless of whether the EUO no-show was substantiated.
Legal Update (February 2026): Since this 2015 post, 11 NYCRR 65-3.5(b) and related EUO timing provisions may have been amended through regulatory updates or interpretive guidance from the New York Department of Financial Services. Additionally, subsequent appellate decisions may have further refined the procedural requirements and timing deadlines for EUO requests. Practitioners should verify current regulatory language and recent case law interpretations when advising on EUO compliance matters.
