Appellate Term, First Department
Oct 1, 2026
2026 NY Slip Op 26160
Insurer prevailed
The provider failed to justify the four-month delay between another insurer's denials and submission of its claims to MVAIC. The parties stipulated that MVAIC timely denied the claims under the 45-day rule and limited trial to reasonable justification under 11 NYCRR 65-3.3 (e). The provider's witness could not recall or document when the referring physician was contacted about other coverage. Cover letters describing prior submission to another insurer did not explain the subsequent delay, and the provider did not respond to MVAIC's invitation to supply justification. General public policy considerations could not displace the filing requirements. The Appellate Term, First Department, reversed the judgment after nonjury trial and directed judgment dismissing the complaint.
Appellate Term, First Department
Sep 22, 2026
2026 NY Slip Op 51528(U)
Insurer prevailed
The provider's failure to attend the initial and follow-up EUOs violated a condition precedent to coverage. The Appellate Term, First Department, reversed the order and granted the insurer's unopposed motion for summary judgment dismissing the no-fault complaint. The insurer established that it timely and properly mailed the EUO scheduling notices and that the provider failed to appear. The provider's challenge to the reasonableness of the EUO requests was raised for the first time on appeal and was therefore unpreserved for review.
Appellate Term, First Department
Sep 22, 2026
2026 NY Slip Op 51527(U)
Insurer prevailed
The insurer established timely mailing of the provider's EUO notices, nonappearance and an objective basis for the EUOs. The Appellate Term, First Department, reversed the order, insofar as appealed from, and granted the insurer's motion for summary judgment dismissing the no-fault complaint. The insurer's attorney described the office's standard mailing practices and procedures and represented under penalty of perjury, with personal knowledge, that those procedures were followed. This adequately proved mailing of the scheduling letters, and the provider failed to appear at the initial and follow-up EUOs. The provider raised no factual issue, and the insurer supplied a specific objective justification under 11 NYCRR 65-3.5 (e).
Appellate Term, First Department
Nov 24, 2025
2025 NY Slip Op 51853(U)
Insurer prevailed
The insurer established mailing of EUO scheduling letters and the provider's failure to appear at properly scheduled EUOs. The Appellate Term, First Department, reversed the order, denied the provider's cross-motion for summary judgment, and granted the insurer's motion dismissing the no-fault complaint. The insurer's attorney sufficiently described the office's standard mailing practices and procedures and represented under penalty of perjury, based on personal knowledge, that they were followed in this matter. That proof adequately established mailing to the provider; the court reached no other issue.
Appellate Term, First Department
Nov 21, 2025
2025 NY Slip Op 51848(U)
Insurer prevailed
The insurer established mailing of EUO scheduling letters and the provider's failure to appear at properly scheduled EUOs. The Appellate Term, First Department, reversed the order denying the insurer's unopposed summary judgment motion, granted the motion, and dismissed the provider's no-fault complaint. The insurer's attorney described the office's standard mailing practices and procedures and represented under penalty of perjury, based on personal knowledge, that those procedures were followed in this matter. That showing adequately proved mailing to the provider.
Appellate Term, First Department
Nov 13, 2025
2025 NY Slip Op 51784(U)
Insurer prevailed
The insurer's EUO request, sent one day after the 15-day deadline but before the 30-day denial window expired, remained valid. The Appellate Term, First Department, reversed the order denying the insurer's unopposed summary judgment motion, granted the motion, and dismissed the provider's no-fault complaint. The insurer made a prima facie showing that the provider failed to appear at properly scheduled EUOs. Contrary to the lower court's conclusion, the verification request's one-day delay beyond the period in 11 NYCRR 65-3.5 (b) did not invalidate the request; it merely reduced the insurer's 30-day period to pay or deny the claim.
