Key Takeaway
Restoration Chiropractic v 21st Century: a follow-up EUO scheduling letter mailed more than 10 days after a no-show is untimely under NY no-fault rules.
This article is part of our ongoing additional verification coverage, with 92 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.
In New York’s no-fault insurance system, insurance companies frequently request Examinations Under Oath (EUOs) as part of their verification process when investigating claims. These examinations allow insurers to question claimants or healthcare providers under oath about the circumstances surrounding an accident and treatment. However, the scheduling of these examinations is governed by strict regulatory timelines that insurers must follow precisely — and a follow-up scheduling letter mailed too late can wipe out the entire defense.
The Decision: Restoration Chiropractic v 21st Century
Restoration Chiropractic, P.C. v 21st Century Ins. Co., 2019 NY Slip Op 51961(U) (App. Term 2d Dept, 2019)
” The record establishes that defendant’s follow-up scheduling letter was mailed more than 10 days after plaintiff’s assignor had failed to appear for the first scheduled EUO. As a result, this follow-up scheduling letter was untimely (see 11 NYCRR 65-3.5 ). Consequently, defendant’s motion should have been denied”
The Regulatory Framework: EUOs as Verification
An EUO is a creature of the no-fault regulation, 11 NYCRR 65. When a carrier receives a claim — typically from a medical provider holding an assignment of benefits from the injured person (the “assignor”) — it may demand additional verification before paying or denying, and an EUO is one recognized form of that verification. The examination is conducted under oath, transcribed, and functions much like a deposition limited to the claim: the accident, the treatment, the billing, and the provider’s eligibility.
But the verification process is not open-ended. The regulation builds in a tight choreography of deadlines designed to keep claims moving. The carrier must request verification promptly after receiving the claim, and — critically here — when requested verification is not received, the regulation requires a follow-up. For appearance-based verification like an EUO or an independent medical examination (IME), the case law applies the same discipline to rescheduling: when the claimant or assignor fails to appear at the first scheduled examination, the carrier must mail its second scheduling letter within 10 calendar days of the no-show.
Miss that window and the second letter is untimely. An untimely second letter means the carrier never properly completed its verification demand, which in turn means it cannot establish the failure-to-appear defense — the defense that the claimant breached a condition precedent to coverage by skipping two duly scheduled examinations.
Why the Carrier’s Motion Failed
In Restoration Chiropractic, the carrier moved for summary judgment on the strength of the assignor’s two non-appearances. The record showed, however, that the follow-up scheduling letter went out more than 10 days after the first missed EUO. The Appellate Term held the follow-up letter untimely under the regulation and ruled that the carrier’s motion “should have been denied.”
Note what the court did not say: it did not question that the assignor failed to appear, and it did not reach the merits of the underlying claim. The defense collapsed purely on calendar math. That is the defining feature of no-fault verification litigation — timeliness is examined before substance, and a carrier that cannot prove every mailing date in the chain loses the defense regardless of what the EUO might have revealed.
Why This Matters
For carriers and defense counsel: the 10-day follow-up window must be treated as a hard operational deadline, tracked from the date of the missed appearance, with proof of mailing maintained for both scheduling letters. Summary judgment motions on EUO and IME no-show defenses live or die on the documentary timeline, so the moving papers must establish the mailing dates of the initial letter, the date of the first no-show, and a follow-up letter mailed within 10 days.
For medical providers and their counsel: the decision is a checklist for opposing these motions. Before engaging with the substance of a no-show defense, audit the dates. If the second scheduling letter was mailed more than 10 days after the first missed examination, the defense is vulnerable no matter how clean the carrier’s affidavits otherwise appear.
For injured claimants: the case illustrates that the no-fault system’s procedural rules cut both ways. The same regulation that imposes cooperation duties on claimants imposes strict timeliness duties on insurers, and courts enforce both sides of the bargain.
Practical Takeaways
- Calendar the follow-up EUO letter immediately upon a no-show; the 10-day clock runs from the missed appearance date.
- Build motion papers around the complete mailing chain — initial letter, no-show date, timely second letter, second no-show, and denial.
- When opposing a no-show defense, scrutinize the gap between the first missed examination and the second letter before anything else.
Related Resources
- EUO requirements in New York no-fault insurance cases — the firm’s cluster hub on examination under oath law
- The firm’s Legal Encyclopedia — plain-language explainers on New York no-fault doctrine
- No-fault insurance defense practice
- An EUO defense that was precluded
- The application of the 10-day follow up period to send EUO requests
- Timely EUO letters
- Verification non-receipt issues
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.
92 published articles in Additional Verification
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Jan 19, 2018Frequently Asked Questions
Common Questions About This Topic
4 answers from the firm's New York personal-injury and employment-law practice. Click any question to expand.
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.
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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.