Key Takeaway
Court clarifies that EUO scheduling letters must be sent within 30 days of claim receipt, reinforcing timing requirements under New York no-fault insurance law.
In New York no-fault insurance law, timing is everything. Insurance companies must follow strict deadlines when processing claims, including when they schedule Examinations Under Oath (EUOs). The 30-day rule for claim denials has been well-established, but what about EUO scheduling letters? A recent appellate court decision provides important clarity on this timing requirement.
The case of Fontanella v Allstate Ins. Co. addresses a critical procedural issue that affects both healthcare providers and patients seeking no-fault benefits. When insurers delay in scheduling EUOs, they may forfeit their right to deny claims based on those examinations. This decision reinforces existing precedent while explicitly stating what many practitioners have long understood about timing requirements in no-fault insurance disputes.
Jason Tenenbaum’s Analysis:
Fontanella v Allstate Ins. Co., 2016 NY Slip Op 51679(U)(App. Term 2d Dept. 2016)
“As to the remaining claims, defendant failed to establish that the denials were timely. The EUO scheduling letters were not sent within 30 days of the insurer’s receipt of each of the claims (see O & M Med., P.C. v Travelers Indem. Co., 47 Misc 3d 134, 2015 NY Slip Op [*2]50476 ), and we note that delay letters, which request no verification, do not toll the 30-day statutory time period within which a claim must be paid or denied”
Beating a dead horse. I think this may be the first time I saw a direction that said “EUO scheduling letters needed to be sent within 30-days of receipt of the claim.” This has been implied in light of 65-3.5(b); 3.5(l); 3.8 and Ins Law 5106 and the Neptune-Ameriprise case.
I actually get shutters when I see “Ameriprise” or “Allstate” listed in a no-fault appeal, because I know my life has just gotten that much more difficult than the night before.
Key Takeaway
This decision explicitly confirms that EUO scheduling letters must be sent within 30 days of claim receipt, just like denial letters. Delay letters cannot extend this statutory deadline. The ruling reinforces timing requirements that have been implied by various regulations and prior cases, particularly involving Allstate EUO cases, and provides clearer guidance for future disputes over procedural compliance in no-fault insurance claims.
Legal Update (February 2026): Since this 2016 post, New York no-fault regulations may have been amended regarding EUO scheduling deadlines and procedural requirements under Insurance Law Section 5106 and related regulatory provisions. Practitioners should verify current timing requirements for EUO scheduling letters and any updates to the 30-day rule, as regulatory changes and subsequent case law may have modified these procedural standards.
