Key Takeaway
New York no-fault insurers must wait for verification responses before disclaiming claims based on EUO failures, as established in Alleviation Med. Services v Citiwide Auto Leasing.
Understanding the Timing Requirements for No-Fault Insurance Disclaimers
In New York’s no-fault insurance system, timing is everything. Insurance companies must follow specific procedural requirements when seeking to disclaim coverage, particularly when dealing with examinations under oath (EUOs) and verification requests. The Appellate Term’s decision in Alleviation Medical Services v Citiwide Auto Leasing provides crucial guidance on the proper sequence insurers must follow when pursuing both verification materials and EUO compliance.
This case illustrates a fundamental principle: insurers cannot simply rush to disclaim coverage based on EUO non-appearance without first completing their verification procedures. The decision reinforces that proper no-fault claim handling requires methodical adherence to statutory requirements, with each step completed before moving to the next phase of the disclaimer process.
Jason Tenenbaum’s Analysis:
Alleviation Med. Servs., P.C. v Citiwide Auto Leasing, 2015 NY Slip Op 51709(U)(App. Term 2d Dept. 2015)
“Contrary to plaintiff’s contention, defendant established that verification requests and EUO scheduling letters had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 ); that, upon receipt of the requested verification, defendant had timely denied (see St. Vincent’s Hosp. of Richmond, 50 AD3d 1123) the claim on the ground that plaintiff’s assignor had failed to appear for duly scheduled EUOs; and that plaintiff’s assignor had, in fact, failed to appear for the duly scheduled EUO”
Key Takeaway
The court’s analysis demonstrates that successful disclaimer defenses require proof of proper procedural compliance at each stage. Insurers must show they timely mailed both verification requests and EUO scheduling letters, waited for verification responses, and only then proceeded with EUO-based disclaimers when claimants failed to appear for scheduled examinations.
