Key Takeaway
Court clarifies delay letter requirements under 11 NYCRR 65-3.6(b), ruling insurers only must notify attorneys when seeking verification from third parties, not plaintiffs.
Understanding delay letter requirements in no-fault insurance litigation is crucial for healthcare providers pursuing reimbursement claims. The regulation 11 NYCRR 65-3.6(b) establishes specific notification protocols when insurers seek additional verification, but confusion often arises about when these requirements apply. The Appellate Term’s decision in Recover Med. Servs., P.C. v Ameriprise Ins. Co. provides important clarification on this procedural requirement.
This case addresses a common misconception in New York No-Fault Insurance Law practice regarding when insurers must send delay letters to attorneys. The ruling distinguishes between verification requests made to plaintiffs directly versus those made to third parties, establishing clear boundaries for compliance obligations.
Jason Tenenbaum’s Analysis:
Recover Med. Servs., P.C. v Ameriprise Ins. Co., 2017 NY Slip Op 51892(U)(App. Term 2d Dept. 2017)
Upon review of my blog, I failed to note this case.
“With respect to the remaining three bills, there is no merit to plaintiff’s argument that, pursuant to 11 NYCRR 65-3.6 (b), defendant was required to send plaintiff’s attorney a delay letter upon sending the follow-up EUO scheduling letter to plaintiff. The requirement to send a delay letter arises only where the verification is sought from a person or entity other than the plaintiff (see Advantage Radiology, P.C. v Nationwide Mut. Ins. Co., 55 Misc 3d 91, 53 N.Y.S.3d 452 ; see also GNK Med. Supply, Inc. v Tri-State Consumer Ins. Co., 37 Misc 3d 138, 964 N.Y.S.2d 59, 2012 NY Slip Op 52195 ). Here, where defendant sought plaintiff’s EUO, there was no such requirement.”
This case is just an off shoot of Advantage Radiology.
Key Takeaway
When insurers schedule examinations under oath (EUOs) directly with plaintiffs, they are not required to send delay letters to attorneys under 11 NYCRR 65-3.6(b). The delay letter requirement only applies when verification is sought from third parties, not from the plaintiff healthcare provider itself. This distinction helps clarify procedural obligations in EUO-related disputes.
Legal Update (February 2026): The delay letter requirements under 11 NYCRR 65-3.6(b) may have been subject to regulatory amendments or clarifying guidance since 2018. Additionally, appellate decisions interpreting when notification obligations apply to third-party verification requests versus direct plaintiff communications may have evolved. Practitioners should verify current regulatory provisions and recent case law developments affecting delay letter compliance protocols.
