Key Takeaway
Court ruling establishes that late follow-up EUO scheduling letters void claim denials, creating split with other decisions on no-fault insurance timing requirements.
New York’s no-fault insurance regulations contain strict timing requirements that insurers must follow when requesting examinations under oath (EUOs) from healthcare providers. When insurers fail to meet these deadlines, the consequences can be severe — including the invalidation of their claim denials. A recent Appellate Term decision highlights a critical distinction between initial and follow-up EUO requests that has created disagreement among courts.
The case involves the regulatory framework governing additional verification procedures in no-fault insurance claims. Under New York’s insurance regulations, insurers must adhere to specific timeframes when scheduling EUOs, but the rules differ depending on whether it’s an initial request or a follow-up. This distinction has become increasingly important as courts grapple with EUO objections and their consequences for both insurers and healthcare providers.
Jason Tenenbaum’s Analysis:
Acupuncture Healthcare Plaza I, P.C. v Allstate Ins. Co., 2017 NY Slip Op 50939(U)(App. Term 2d Dept. 2018)
I think I failed to specifically comment on this case. In light of Atlantic Radiology, we now have a difference of opinion between the courts.
“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 Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123, 857 N.Y.S.2d 211 ; 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
Key Takeaway
This decision establishes that the safety valve provision in 11 NYCRR 65-3.8 does not protect insurers from the consequences of untimely follow-up EUO scheduling letters. Unlike initial EUO requests, follow-up requests must strictly comply with timing requirements, and failure to do so renders subsequent claim denials untimely and invalid. This creates a judicial split that practitioners must carefully navigate.
Legal Update (February 2026): The regulatory framework governing EUO timing requirements and additional verification procedures under 11 NYCRR 65-3 may have been subject to amendments since this post’s publication in 2018. Given the evolving nature of no-fault insurance regulations and potential updates to sections 65-3.5, 65-3.6, and 65-3.8, practitioners should verify current timing requirements and procedural mandates before relying on the distinctions between initial and follow-up EUO requests discussed in this analysis.
