Key Takeaway
Court ruling clarifies timing requirements for second EUO scheduling letters in no-fault insurance cases, emphasizing strict compliance with regulatory deadlines.
Understanding EUO Scheduling Requirements in No-Fault Insurance Cases
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.
The timing of EUO scheduling letters is particularly critical when dealing with additional verification requirements. Insurance companies often face challenges when claimants fail to appear for initially scheduled examinations, leading to questions about proper procedures for rescheduling. The regulations governing these processes are designed to prevent insurers from using procedural delays as a means to improperly deny legitimate claims.
When examining verification non-receipt issues, courts consistently emphasize that insurers must strictly comply with regulatory deadlines. This case demonstrates how procedural missteps can significantly impact an insurer’s ability to successfully defend against no-fault claims.
Jason Tenenbaum’s Analysis:
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”
Key Takeaway
This ruling reinforces the importance of strict compliance with regulatory timing requirements in no-fault insurance cases. Insurance companies must mail follow-up EUO scheduling letters within 10 days of a missed examination, or risk having their denial motions rejected by the court. The decision highlights how procedural violations can undermine otherwise valid insurance company defenses.
