Key Takeaway
Court ruling clarifies NF-10 denial forms don't need specific EUO dates, highlighting inconsistent First Department decisions in no-fault insurance cases.
Understanding NF-10 Denial Requirements: What Information Must Insurers Include?
The New York no-fault insurance system relies on standardized forms to ensure clear communication between healthcare providers and insurance carriers. One critical document is the NF-10 denial of claim form, which insurers use when rejecting coverage for various reasons, including a healthcare provider’s failure to appear for examinations under oath (EUOs). A recent appellate decision provides important clarity about what specific information these denial forms must contain.
The question of EUO requirements and procedures has been a contentious issue in no-fault litigation, with courts sometimes reaching different conclusions about procedural requirements. This case addresses whether insurance carriers must include specific dates when detailing EUO non-appearances in their denial forms.
Jason Tenenbaum’s Analysis:
Aries Chiropractic, P.C. v Ameriprise Ins. Co., 2019 NY Slip Op 52064(U)(App. Term 1st Dept. 2019)
I bolded the Unitrin case. The First Department has been all over the place lately. For anyone to predict how that Court will rule on anything in the no-fault universe would be engaging in an unwise prediction.
“Contrary to plaintiff’s contention, defendant’s denial of claim form did not need to set forth the dates of the EUOs for which plaintiff had failed to appear. “Had it been the intent of the Department of to require the carrier to set forth in the prescribed denial of claim form (see NYS Form N-F 10; 11 NYCRR 65-3.4 ), it would have so provided” (A.B. Med. Servs., PLLC v Liberty Mut. Ins. Co., 39 AD3d 779, 780 ; A.B. Med. Servs., PLLC v GEICO Cas. Ins. Co., 39 AD3d 778, 779 ; cf. Unitrin Advantage Ins. Co. v All of NY, Inc., 158 AD3d 449 ). “
Key Takeaway
This decision reinforces that NF-10 denial forms need not specify exact dates of missed EUOs. The court applied the principle that if regulators intended to require such specific information, they would have explicitly mandated it in the prescribed form requirements. This ruling may benefit insurance carriers defending against challenges to their denial procedures, though providers should still be aware that EUO non-appearance can still result in valid claim denials.
