Key Takeaway
Three 2016 no-fault insurance cases demonstrate how procedural requirements under 11 NYCRR 65-3.5 can derail declaratory judgment actions seeking coverage denials.
No-fault insurance carriers frequently seek declaratory judgment actions to establish their right to deny claims based on alleged non-compliance with policy conditions. However, these cases must navigate strict procedural requirements under New York’s no-fault regulations, particularly 11 NYCRR 65-3.5, which governs the timing and scheduling of Independent Medical Examinations (IMEs) and Examinations Under Oath (EUOs).
The regulatory framework became more stringent following landmark cases like Longevity and Tam Medical Supply, which established specific factors courts must consider when evaluating whether an insurance carrier has properly scheduled these examinations. Under these precedents, carriers must demonstrate they scheduled IMEs and EUOs promptly upon receiving notice of the loss. Failure to meet these procedural requirements can be fatal to a carrier’s case, even when substantive grounds for denial may exist.
The three cases examined below illustrate a troubling pattern for insurance carriers: even when they believe they have grounds for coverage denial, procedural missteps can result in their motions being struck before reaching the merits.
Jason Tenenbaum’s Analysis:
Country-Wide Ins. Co. v Castro, 2016 NY Slip Op 31505(U)(Sup. Ct. NY CO. 2016)
American Tr. Ins. Co. v Tavarez, 2016 NY Slip Op 31601(U)(Sup. Ct. NY CO. 2016)
American Tr. Ins. Co. v Garcia, 2016 NY Slip Op 31602(U)(Sup. Ct. NY CO. 2016)
All of these no-show default motions were struck by 11 NYCRR 65-3.5(d) or 65-3.5(b), 65-3.6(b). Under the post Longevity and Tam Medical Supply cases, DJs involving IMEs and EUOs that are not scheduled upon receipt of the notice of the loss will rarely achieve the goal that is sought through a DJ, absent perjury.
Key Takeaway
These cases demonstrate that procedural compliance under 11 NYCRR 65-3.5 is crucial for insurance carriers pursuing declaratory judgment actions. The post-Longevity legal landscape requires carriers to schedule IMEs and EUOs immediately upon receiving loss notice. Even when carriers have strong substantive arguments for denial, failure to meet these timing requirements will likely result in unsuccessful declaratory judgment actions, regardless of the quality of their legal papers.
Legal Update (February 2026): The no-fault regulatory framework governing declaratory judgment actions has undergone significant revisions since 2016, including amendments to 11 NYCRR 65-3.5 and 65-3.6 regarding IME and EUO scheduling requirements. Additionally, fee schedules and procedural timelines have been updated multiple times. Practitioners should verify current provisions of Part 65-3 and review recent appellate decisions that may have modified the Longevity and Tam Medical Supply precedents discussed in this analysis.
