Understanding EUO Denial: When Insurance Companies Can Substantiate Coverage Denials

Introduction

When you’re involved in a car accident in New York, navigating the complex world of no-fault insurance can be overwhelming. One critical aspect that policyholders often encounter is the Examination Under Oath (EUO) requirement. Understanding when insurance companies can legitimately deny coverage based on EUO non-compliance is essential for protecting your rights and ensuring you receive the benefits you’re entitled to.

At Jason Tenenbaum Law in Long Island and New York City, we’ve handled countless no-fault insurance cases where EUO requirements play a pivotal role. The recent case of Concourse Chiropractic, PLLC v State Farm Mut. Ins. Co. provides important insights into how courts evaluate EUO-related denials.

The Legal Precedent: Concourse Chiropractic v State Farm

Concourse Chiropractic, PLLC v State Farm Mut. Ins. Co., 2013 NY Slip Op 52225(U)(App. Term 2d Dept. 2013)

“e find that the affidavits submitted by defendant established that the examination under oath (EUO) notices had been timely sent to plaintiff (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 ; Richard Morgan Do, P.C. v State Farm Mut. Auto. Ins. Co., 22 Misc 3d 134, 2009 NY Slip Op 50242 ), and that plaintiff had failed to appear for the EUOs”

“The District Court correctly found that defendant demonstrated that the claims underlying these causes of action had been timely denied (see St. Vincent’s Hosp. of Richmond, 50 AD3d 1123) based on plaintiff’s nonappearance at the EUOs. In light of the foregoing, since plaintiff’s appearance at the EUOs “is a condition precedent to the insurer’s liability on the policy” (Stephen Fogel Psychological, P.C., 35 AD3d at 722; see also Insurance Department Regulations § 65-1.1), the burden shifted to plaintiff to rebut defendant’s prima facie showing. However, as the District Court found, plaintiff did not respond in any way to the EUO scheduling letters sent by defendant. Since the opposing affirmation submitted by plaintiff’s counsel was insufficient to raise a triable issue of fact with respect to the claims denied on the ground that plaintiff had failed to appear at the EUOs“

What is an Examination Under Oath (EUO)?

An Examination Under Oath is a formal proceeding where an insurance company can require a policyholder or claimant to answer questions under oath about their claim. This procedure serves several important functions:

Key Characteristics of EUOs:

– Sworn testimony: All responses are given under penalty of perjury
– Court reporter present: The session is typically recorded by a stenographer
– Attorney representation: You have the right to have your attorney present
– Broad scope: Questions can cover the accident, injuries, treatment, and related matters

When Insurance Companies Can Require EUOs:

– After filing a no-fault insurance claim
– When additional information is needed to evaluate the claim
– If there are questions about the circumstances of the accident
– When investigating potential fraud or misrepresentation

Understanding the Legal Standards in New York

Burden of Proof Requirements

New York courts have established clear standards for when insurance companies can successfully defend EUO-related denials:

Insurance Company Must Prove:

1. Timely Notice: The EUO scheduling letters were sent within required timeframes
2. Proper Service: Notice was delivered according to policy terms and applicable regulations
3. Non-Appearance: The claimant failed to appear for the scheduled EUO
4. Compliance with Regulations: All procedures followed Insurance Department Regulations (11 NYCRR § 65-1.1)

Claimant’s Options for Rebuttal:

– Demonstrate lack of proper notice
– Provide evidence of good cause for non-appearance
– Challenge the timeliness of the EUO request
– Show procedural defects in the insurance company’s process

Long Island and NYC No-Fault Insurance Considerations

Geographic Factors Affecting EUO Cases

In the Long Island and New York City metropolitan area, several factors can impact EUO proceedings:

Transportation and Accessibility:

– EUO locations must be reasonably accessible
– Traffic and commuting challenges in NYC/LI can affect attendance
– Public transportation limitations may constitute good cause for delay

Local Court Practices:

– Nassau, Suffolk, Queens, Kings, and New York County courts may have varying approaches
– Local bar practices and relationships with insurance companies
– Regional preferences for settlement vs. litigation

Common Scenarios in LI/NYC Practice:

– Healthcare providers seeking reimbursement for services
– Individual claimants navigating complex medical networks
– Coordination of benefits issues with multiple insurance carriers
– Language barriers in diverse metropolitan communities

Strategic Considerations for Healthcare Providers

Best Practices for EUO Compliance

Healthcare providers and their legal representatives should implement systematic approaches:

Documentation Protocols:

1. Maintain detailed calendars of all EUO notices received
2. Confirm receipt of scheduling letters in writing
3. Request reasonable accommodations when necessary
4. Prepare comprehensively for the examination

Communication Strategies:

– Respond promptly to all EUO scheduling correspondence
– Request clarification of vague or overly broad examination scope
– Coordinate with counsel early in the process
– Maintain professional dialogue with insurance company representatives

The Importance of Timely Response

Consequences of EUO Non-Compliance

The Concourse Chiropractic case demonstrates the serious consequences of failing to respond to EUO notices:

– Coverage denial: Insurance companies can deny ongoing benefits
– Summary judgment: Courts may grant judgment against non-compliant claimants
– Burden shift: Claimants must prove good cause for non-appearance
– Limited remedies: Few options exist once default occurs

Preventive Measures

Working with experienced no-fault insurance attorneys can help prevent EUO-related problems:

– Early intervention: Address issues before they become disputes
– Procedural compliance: Ensure all regulatory requirements are met
– Strategic preparation: Develop comprehensive examination strategies
– Relationship management: Maintain professional interactions with all parties

Frequently Asked Questions About EUO Denials

Q: What happens if I miss my EUO appointment?

A: Missing an EUO appointment can result in denial of your no-fault benefits. However, you may have options if you had good cause for missing the appointment, such as illness, emergency, or lack of proper notice. Contact an attorney immediately to discuss your situation.

Q: How much notice must an insurance company give for an EUO?

A: New York regulations require reasonable notice for EUO scheduling. The specific timeframe can vary, but generally, at least 10-14 days’ notice is expected. The notice must be sent to your last known address and comply with policy terms.

Q: Can I bring my attorney to the EUO?

A: Yes, you have the right to have your attorney present during the EUO. In fact, it’s strongly recommended to have legal representation to protect your rights and ensure the examination stays within proper bounds.

Q: What types of questions can be asked during an EUO?

A: Questions must relate to the claim and can cover the accident circumstances, your injuries, medical treatment, work history, and other relevant matters. However, the scope should be reasonable and related to the insurance coverage dispute.

Q: How long can an EUO take?

A: EUOs typically last between 2-6 hours, depending on the complexity of the claim and the number of issues being investigated. More complex cases involving multiple injuries or providers may require longer examinations.

Q: What should I bring to my EUO?

A: Bring any documents requested in the EUO notice, such as medical records, bills, employment records, tax returns, or other relevant materials. Your attorney can help you determine exactly what’s required.

Moving Forward: Protecting Your Rights

When to Seek Legal Assistance

If you’ve received an EUO notice or your claim has been denied based on EUO non-compliance, time is critical. Consider consulting with a no-fault insurance attorney when:

– You’ve received an EUO scheduling notice
– Your benefits have been denied for EUO non-appearance
– You’re unsure about your rights and obligations
– The insurance company is requesting extensive documentation
– You’re facing complex coordination of benefits issues

The Value of Professional Representation

Experienced no-fault insurance attorneys can provide:

– Regulatory expertise: Knowledge of current Insurance Department regulations
– Procedural guidance: Assistance with proper compliance protocols
– Strategic advocacy: Representation during EUO proceedings
– Appeals assistance: Help with challenging improper denials
– Settlement negotiation: Resolution of disputes without litigation

Contact Jason Tenenbaum Law

Don’t let EUO requirements jeopardize your no-fault insurance benefits. The experienced attorneys at Jason Tenenbaum Law understand the complexities of New York no-fault insurance law and can help protect your rights throughout the EUO process.

Call us today at 516-750-0595 for a consultation about your no-fault insurance claim. We serve clients throughout Long Island and New York City, providing aggressive representation and personalized attention to every case.

Whether you’re a healthcare provider seeking reimbursement or an individual navigating the claims process, we have the experience and dedication necessary to achieve the best possible outcome for your case. Contact us now to schedule your consultation and learn how we can help protect your interests in EUO proceedings and beyond.

Related Articles

• EUO no-show defense requirements and court analysis
• Walking out of an EUO and coverage disclaimer consequences
• Personal knowledge standards for EUO non-appearances
• Summary judgment analysis in EUO no-show cases
• New York No-Fault Insurance Law

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Legal Update (February 2026): Since this 2014 post, New York’s no-fault insurance regulations under § 65-1.1 and related Insurance Department provisions may have been amended, particularly regarding EUO notice requirements, timing standards, and substantiation procedures for coverage denials. Practitioners should verify current regulatory provisions and recent case law developments when advising clients on EUO compliance and denial challenges.