Key Takeaway
Ameriprise's appeal backfires as court rules late EUO scheduling letters are nullified, showing how insurers' procedural mistakes can benefit healthcare providers in no-fault claims.
This case demonstrates how insurance companies’ procedural missteps can work in favor of healthcare providers pursuing New York No-Fault Insurance Law claims. Ameriprise Insurance found itself in hot water when the Appellate Term ruled against them for failing to follow proper timing requirements for Examinations Under Oath (EUO). The decision highlights a critical aspect of no-fault law: insurers must strictly adhere to regulatory deadlines, or risk losing their ability to deny claims altogether.
The case involved A.C. Medical, P.C. seeking payment from Ameriprise for medical services. What makes this particularly noteworthy is how the court applied the “nullity” doctrine - essentially voiding Ameriprise’s EUO scheduling letters because they were sent too late. This creates an interesting strategic question about whether EUO no-shows might sometimes benefit claimants when insurers fail to follow proper procedures.
Jason Tenenbaum’s Analysis:
A.C. Med., P.C. v Ameriprise Ins. Co., 2016 NY Slip Op 51787(U) (App. Term 2d Dept. 2016)
“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 prescribed verification forms” (11 NYCRR 65-3.5 ). Since defendant received the claim in the amount of $403.58 on August 28, 2012 and mailed an EUO scheduling letter to plaintiff on September 26, 2012, defendant’s time to pay or deny that claim was reduced by the number of days that the EUO request was late (see 11 NYCRR 65-3.8 ). However, defendant did not timely deny that claim after plaintiff had failed to appear for the second scheduled EUO (see 11 NYCRR 65-3.8 ). With respect to the remaining claims, because defendant did not mail its first EUO scheduling letter to plaintiff within 30 calendar days of receiving those claims, the scheduling letter was rendered a nullity by its untimeliness”
I almost ask myself – are you sometimes better off not showing up for the EUO?
Key Takeaway
This decision reinforces that insurers cannot escape the consequences of their own procedural failures. When EUO scheduling letters are sent late, they become legally meaningless, and subsequent no-shows by providers cannot be used as grounds for claim denial. The strict timing requirements exist to protect healthcare providers and ensure prompt claim resolution.
Legal Update (February 2026): The EUO timing requirements and procedural standards discussed in this 2016 analysis may have been modified through subsequent amendments to 11 NYCRR 65-3, particularly sections 65-3.5 and 65-3.8 governing verification requests and examination procedures. Practitioners should verify current regulatory provisions and recent appellate decisions, as no-fault procedural requirements have undergone periodic revisions since this post’s publication.
