It was NOT mailed

In New York no-fault insurance litigation, insurance companies frequently deny claims based on alleged failures to comply with procedural requirements, such as missing examinations under oath (EUOs). However, before an insurer can successfully defend against a claim on these grounds, they must first prove they properly notified the claimant of these requirements.

The burden of proof regarding proper mailing can be more challenging than insurers anticipate. When an insurance company claims they sent required notices — whether for EUOs, independent medical examinations, or claim denials — they must establish every link in the mailing process. This means providing evidence not just that the notice was prepared, but that it was actually placed in the mail and sent to the correct address.

This evidentiary standard protects healthcare providers and patients in the New York no-fault insurance system from having claims wrongfully denied based on procedural defenses when proper notice was never actually provided.

Jason Tenenbaum’s Analysis:

Contemporary Acupuncture, P.C. v Allstate Ins. Co., 2016 NY Slip Op 50464(U)(App. Term 2d Dept. 2016)

“Defendant’s motion for summary judgment dismissing the complaint was based on the alleged failure of plaintiff’s assignor to appear for duly scheduled examinations under oath (EUOs). Upon a review of the record, we find that defendant failed to establish a prima facie showing of its entitlement to summary judgment. Among other things, defendant failed to establish as a matter of law that the EUO notices and the denial of claim forms at issue had been properly and timely mailed (see Progressive Cas. Ins. Co. v Infinite Ortho Prods., Inc., 127 AD3d 1050”

I only cite this case because of its mention to Progressive v. Infinite. That case stood for the proposition that if a link in the mailing chain is missing, then an item cannot not be proven to be mailed.

Key Takeaway

This case reinforces the critical principle that insurance companies cannot simply assert they mailed required notices — they must prove it with complete documentation. If any step in the mailing process lacks proper evidence, the entire procedural defense fails, and the underlying no-fault claim must be evaluated on its merits rather than dismissed on procedural grounds.