Key Takeaway
DME provider loses case after failing to respond to EUO letter, with court ruling that non-compliance permits denial of all claims, not just pending ones.
Understanding EUO Non-Compliance: When Silence Leads to Case Dismissal
Examination Under Oath (EUO) requests are a critical component of New York No-Fault Insurance Law, serving as an insurance carrier’s tool to investigate potentially fraudulent claims. When medical providers or their assignors fail to respond to these requests, the consequences can be severe and far-reaching. The recent Appellate Term decision in Leica Supply, Inc. v Encompass Indemnity Co. demonstrates just how costly silence can be in the no-fault insurance context.
This case highlights a common misconception among healthcare providers and durable medical equipment (DME) suppliers: that failing to appear for an EUO only affects pending claims. As the court made clear, the ramifications extend much further, potentially jeopardizing a provider’s ability to recover on any claims related to the underlying treatment.
Jason Tenenbaum’s Analysis:
Leica Supply, Inc. v Encompass Indem. Co., 2012 NY Slip Op 50890(U)(App. Term 2nd Dept. 2012)
Plaintiff’s argument that its assignor’s failure to appear for the duly scheduled EUOs permitted only the denial of pending claims is without merit (see ARCO Med. NY, P.C. v Lancer Ins. Co., 34 Misc 3d 134, 2011 NY Slip Op 52382 ). Moreover, plaintiff does not claim to have responded to the EUO requests; therefore, plaintiff’s objection on appeal regarding those requests will not be heard
The next issue to be tackled: What happens when Plaintiff responds to the EUO demands and still fails to attend the EUO? Do we finally reach a reasonableness analysis? I would say I can hardly wait, but it is the lack of certainty that makes reading these decisions interesting. As each gap gets filled, this sometimes becomes an exercise in who can cite the most principles of law.
Key Takeaway
Complete non-response to EUO requests can result in dismissal of all claims, not just pending ones. The court reinforced that when a provider fails to even respond to an EUO letter, they waive their right to object to the reasonableness of the request. This creates a bright-line rule that distinguishes between cases where providers object but fail to appear and situations involving total non-compliance.
Legal Update (February 2026): Since this 2012 post, New York’s no-fault insurance regulations have undergone several revisions, including amendments to Insurance Regulation 68 and updates to procedural requirements for EUO scheduling and compliance. Practitioners should verify current EUO notification requirements, response timeframes, and the specific grounds for claim denial under the most recent regulatory framework, as procedural standards may have evolved.
