Key Takeaway
Allstate's procedural errors in EUO scheduling led to an untimely claim denial in this New York no-fault insurance case, highlighting the importance of strict compliance with regulatory deadlines.
No-fault insurance cases hinge on strict procedural compliance, and even minor timing errors can have significant consequences for insurance carriers. Examinations Under Oath (EUOs) are a critical tool that insurers use to investigate potentially fraudulent claims, but the scheduling and conduct of these examinations must follow precise regulatory requirements under New York law.
The case of Acupuncture Healthcare Plaza I, P.C. v Allstate Ins. Co. demonstrates how seemingly small administrative mistakes can undermine an insurer’s entire defense strategy. While Allstate correctly handled the initial EUO scheduling, their failure to properly time the follow-up scheduling letter created a domino effect that rendered their ultimate claim denial untimely. This type of procedural error is particularly concerning for law firms that specialize in EUO defense work and bill clients on an hourly basis.
The regulatory framework governing EUOs is unforgiving, and courts have consistently held insurers to strict compliance standards. When carriers fail to follow proper procedures, they risk losing their right to deny claims entirely, regardless of the underlying merits.
Jason Tenenbaum’s Analysis:
Acupuncture Healthcare Plaza I, P.C. v Allstate Ins. Co., 2017 NY Slip Op 50939(U)(App. Term 2d Dept. 2017)
“In the papers submitted in support of its motion, defendant admitted receiving plaintiff’s claim form. In an affirmation, defendant’s counsel established that an initial EUO scheduling letter had been timely mailed to plaintiff’s assignor (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 ; 11 NYCRR 65-3.5 ), but further demonstrated that the follow-up EUO scheduling letter had not been timely mailed (see 11 NYCRR 65-3.6 ). Contrary to defendant’s contention, 11 NYCRR 65-3.8 specifically states that it does not apply to follow-up requests for verification. As a result, because defendant’s follow-up EUO scheduling letter was untimely, the NF-10 denial of claim form which defendant eventually sent was untimely. ”
When you are an “EUO firm” and you bill hourly, these are mistakes that make people cringe.
Key Takeaway
This case underscores the critical importance of strict adherence to New York no-fault insurance procedural requirements. Insurance carriers and their counsel must maintain rigorous deadline tracking systems for EUO scheduling, as even follow-up letters are subject to specific timing requirements that can invalidate subsequent claim denials if missed.
Legal Update (February 2026): Since this post’s publication in 2017, New York’s no-fault insurance regulations under 11 NYCRR Part 65 have undergone several amendments, including potential revisions to EUO procedural requirements and timing provisions. The specific regulatory sections cited (65-3.5, 65-3.6, and 65-3.8) may have been modified through subsequent regulatory updates. Practitioners handling EUO matters should verify current provisions in 11 NYCRR 65-3 to ensure compliance with any updated procedural requirements and timing standards.
