The Mandatory Personal Injury Protection Endorsement or PIP Endorsement contained in all New York state-issued automobile policies contains four conditions precedent to eligibility for no-fault benefits. The four conditions precedent are as follows: (1) the eligible injured person must provide written notice of the accident to the insurer within 30 days after the accident; (2) the assignee medical provider must submit the bill for medical services to the insurer within 45 days after the services are rendered to the assignor; (3) the eligible injured person must submit to medical examinations (IMEs) by physicians selected by the insurer and (4) the eligible injured person or that person’s assignee (medical provider) must submit to examinations under oath (EUOs) as the insurer may reasonably require.1

Recently, the issue of conditions precedent to coverage under the PIP endorsement has created great controversy. There is a raging dispute as to whether a claimant’s breach of a condition precedent to coverage is a defense that must be asserted by a no-fault insurer in a timely denial of claim, or is it a “lack of coverage” defense that is exempt from preclusion. The controversy only involves conditions (3) and (4) referenced above. There is general agreement that a no-fault insurer’s denial predicated upon the failure of the claimant to provide written notice of loss within 30 days of the accident or the failure of the medical provider to submit the bill within 45 days after the services are rendered must be asserted in a timely denial of claim.

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