Key Takeaway
New York court reaffirms established EUO timing rules in First Class Med. v Ameriprise, confirming that proper EUO requests toll insurer payment deadlines under existing Arco precedent.
Understanding Provider EUO Request Timing Under New York No-Fault Law
Examination Under Oath (EUO) requests remain a critical tool for insurance companies investigating potentially fraudulent or questionable no-fault insurance claims. A recent decision from New York’s Appellate Term reinforces the established legal framework governing when these requests properly toll an insurer’s obligation to pay or deny claims.
The case of First Class Med., P.C. v Ameriprise Insurance Co. provides healthcare providers and insurers with a clear restatement of existing law regarding EUO timing and consequences. While this decision doesn’t break new legal ground, it serves as an important reminder of how courts continue to apply the foundational Arco precedent that governs New York No-Fault Insurance Law.
Understanding these timing rules is crucial for medical providers who may face EUO requests, as failing to appear can have serious consequences for pending and future claims related to the same patient and accident.
Jason Tenenbaum’s Analysis:
First Class Med., P.C. v Ameriprise Ins. Co., 2019 NY Slip Op 50477(U)(App. Term 2d Dept. 2019)
“The initial EUO scheduling letter resulted in a toll of defendant’s time to pay or deny plaintiff’s claims as to each claim form which had been submitted by the same plaintiff for the same assignor and accident prior to the EUO request, as long as the request had been timely with respect to such claim, and to any claim form received subsequent to that request, but before plaintiff breached a policy condition by failing to appear for two properly scheduled EUOs ”
This is just a restatement of the Arco law. No new ground is covered in this case.
Key Takeaway
The First Class Med. decision confirms that properly timed EUO requests toll payment deadlines for all related claims from the same provider, assignor, and accident - both those submitted before the EUO request and those received afterward, until the provider fails to appear for properly scheduled examinations. This reinforces existing precedent without establishing new legal standards.
