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.
This article is part of our ongoing additional verification coverage, with 282 published articles analyzing additional verification issues across New York State. Attorney Jason Tenenbaum brings 24+ years of hands-on experience to this analysis, drawing from his work on more than 1,000 appeals, over 100,000 no-fault cases, and recovery of over $100 million for clients throughout Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx. For personalized legal advice about how these principles apply to your specific situation, contact our Long Island office at (516) 750-0595 for a free consultation.
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.
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Legal Context
Why This Matters for Your Case
New York law is among the most complex and nuanced in the country, with distinct procedural rules, substantive doctrines, and court systems that differ significantly from other jurisdictions. The Civil Practice Law and Rules (CPLR) governs every stage of civil litigation, from service of process through trial and appeal. The Appellate Division, Appellate Term, and Court of Appeals create a rich and ever-evolving body of case law that practitioners must follow.
Attorney Jason Tenenbaum has practiced across these areas for over 24 years, writing more than 1,000 appellate briefs and publishing over 2,353 legal articles that attorneys and clients rely on for guidance. The analysis in this article reflects real courtroom experience — from motion practice in Civil Court and Supreme Court to oral arguments before the Appellate Division — and a deep understanding of how New York courts actually apply the law in practice.
About This Topic
Additional Verification in No-Fault Claims
Under New York's no-fault regulations, insurers may request additional verification of a claim within specified time limits. The timeliness, scope, and reasonableness of verification requests — and the consequences of a claimant's failure to respond — are among the most litigated issues in no-fault practice. These articles examine the regulatory framework for verification requests, court decisions on compliance, and the interplay between verification delays and claim determination deadlines.
282 published articles in Additional Verification
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More Additional Verification Analysis
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Feb 25, 2026No Denial Required When Provider Fails to Respond to Verification Within 120 Days
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Feb 25, 2026EUO no-show defense sustained
Natural Therapy Acupuncture v State Farm: Court sustains EUO no-show defense, reinforcing insurer burden of proof for scheduling letters and attorney presence.
Aug 29, 2014Lack of causation proven prima facie through a biomechanical study
Court grants summary judgment based on biomechanical engineer's conclusion that claimed injuries could not have resulted from the accident, shifting burden to plaintiff.
Mar 2, 2012Understanding Verification Requirements in No-Fault Insurance Claims: When the Denial Can Wait
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Jul 5, 2019EUO no show – discovery is waived when objection not lodged
Court ruling clarifies that healthcare providers who fail to respond to EUO requests cannot later challenge their reasonableness, waiving discovery rights in no-fault litigation.
Jul 13, 2016Common Questions
Frequently Asked Questions
What is additional verification in no-fault insurance?
Additional verification is a request by the insurer for more information to process a no-fault claim, authorized under 11 NYCRR §65-3.5. When the insurer sends a verification request, the 30-day clock for claim processing is tolled (paused) until the requested information is received. This is a common insurer tactic to delay payment — but the verification request must be timely and relevant to be valid.
How long does an insurer have to request additional verification?
Under the no-fault regulations, the insurer must request initial verification within 15 business days of receiving the claim. Follow-up verification requests must be made within 10 business days of receiving a response to the prior request. If the insurer fails to meet these deadlines, the verification request is invalid and cannot be used to toll the claim processing period.
What types of additional verification can a no-fault insurer request?
Under 11 NYCRR §65-3.5, insurers may request medical records, provider licensing documentation, proof of treatment rendered, tax returns or financial records (in certain fraud investigations), authorization for release of medical records, and signed NF-3 verification forms. The verification request must be relevant to the claim and not overly burdensome. Requests for information not reasonably related to claim processing may be challenged as improper.
What happens if I don't respond to a no-fault verification request?
Failure to respond to a timely and proper verification request can result in denial of your no-fault claim. Under 11 NYCRR §65-3.5(o), if the requested verification is not provided within 120 calendar days of the initial request, the claim is deemed denied. The 120-day period runs from the date of the original request. However, if the verification request itself was untimely or improper, the denial based on non-response may be challenged.
What is an Examination Under Oath (EUO) in no-fault insurance?
An EUO is a sworn, recorded interview conducted by the insurance company's attorney to investigate a no-fault claim. The insurer schedules the EUO and asks detailed questions about the accident, injuries, treatment, and the claimant's background. Under 11 NYCRR §65-3.5(e), appearing for the EUO is a condition precedent to receiving no-fault benefits — failure to appear can result in claim denial.
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About the Author
Jason Tenenbaum, Esq.
Jason Tenenbaum is the founding attorney of the Law Office of Jason Tenenbaum, P.C., headquartered at 326 Walt Whitman Road, Suite C, Huntington Station, New York 11746. With over 24 years of experience since founding the firm in 2002, Jason has written more than 1,000 appeals, handled over 100,000 no-fault insurance cases, and recovered over $100 million for clients across Long Island, Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, the Bronx, and Staten Island. He is one of the few attorneys in the state who both writes his own appellate briefs and tries his own cases.
Jason is admitted to practice in New York, New Jersey, Florida, Texas, Georgia, and Michigan state courts, as well as multiple federal courts. His 2,353+ published legal articles analyzing New York case law, procedural developments, and litigation strategy make him one of the most prolific legal commentators in the state. He earned his Juris Doctor from Syracuse University College of Law.
Disclaimer: This article is published by the Law Office of Jason Tenenbaum, P.C. for informational and educational purposes only. It does not constitute legal advice, and no attorney-client relationship is formed by reading this content. The legal principles discussed may not apply to your specific situation, and the law may have changed since this article was last updated.
New York law varies by jurisdiction — court decisions in one Appellate Division department may not be followed in another, and local court rules in Nassau County Supreme Court differ from those in Suffolk County Supreme Court, Kings County Civil Court, or Queens County Supreme Court. The Appellate Division, Second Department (which covers Long Island, Brooklyn, Queens, and Staten Island) and the Appellate Term (which hears appeals from lower courts) each have distinct procedural requirements and precedents that affect litigation strategy.
If you need legal help with a additional verification matter, contact our office at (516) 750-0595 for a free consultation. We serve clients throughout Long Island (Huntington, Babylon, Islip, Brookhaven, Smithtown, Riverhead, Southampton, East Hampton), Nassau County (Hempstead, Garden City, Mineola, Great Neck, Manhasset, Freeport, Long Beach, Rockville Centre, Valley Stream, Westbury, Hicksville, Massapequa), Suffolk County (Hauppauge, Deer Park, Bay Shore, Central Islip, Patchogue, Brentwood), Queens, Brooklyn, Manhattan, the Bronx, Staten Island, and Westchester County. Prior results do not guarantee a similar outcome.