An objective basis is not needed (again) to schedule an EUO

The right of insurance companies to require Examinations Under Oath represents one of the most powerful investigative tools available in New York no-fault insurance practice. An EUO allows insurers to question injured persons and healthcare providers under oath about claims, treatments, billing practices, and related matters. The scope of this right and the circumstances under which insurers can demand EUOs continue to generate significant litigation.

A fundamental question that arises repeatedly is whether insurance companies must demonstrate some objective basis or specific justification before scheduling an EUO. Healthcare providers frequently argue that insurers should not be permitted to conduct fishing expeditions or request EUOs without articulable reasons. However, New York’s regulatory framework and case law have consistently rejected these arguments, granting insurers broad discretion to schedule EUOs as a condition precedent to coverage.

Understanding the parameters of this discretion is essential for both providers who receive EUO requests and insurers who seek to enforce compliance. The legal principles governing when and how EUOs may be demanded directly affect claim processing, litigation strategy, and the balance of power between providers and insurers in the no-fault system.

Case Background

Flow Chiropractic, P.C. v Travelers Home & Mar. Ins. Co., 2014 NY Slip Op 51142(U)(App. Term 2d Dept. 2014)

“On appeal, plaintiff argues that defendant lacked justification for its EUO requests and that the document demands contained in the EUO requests were palpably improper.

An appearance at an EUO “is a condition precedent to the insurer’s liability on the policy” (Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720, 722 ). Plaintiff’s contention that defendant was not entitled to summary judgment because defendant had failed to set forth any objective standards for requesting the EUOs lacks merit. No “provision of No-Fault Regulations 68 requires an insurer’s notice of scheduling an EUO to specify the reason(s) why the insurer is requiring the EUOs” (2006 Ops Ins Dept No. 06-12-16 ).”

If an insurance carrier does not need to specify why an EUO is being held, then does the IP or provider have the right to object to being subjected to an EUO? The answer is probably not. Again, objections might be limited to location and time of the EUO. But the basic premise that one must show up to an EUO at the carrier’s whim is probably good law. IDS v. Stracar bears that premise out.

Legal Significance

The Flow Chiropractic decision reaffirms a critical principle in no-fault insurance law: insurance companies enjoy virtually unfettered discretion to schedule Examinations Under Oath without providing justification. This principle stems from the regulatory framework established under 11 NYCRR Part 65, which does not require insurers to articulate specific reasons when scheduling EUOs. The absence of regulatory requirements for stated justifications means that providers cannot successfully challenge EUO requests based on lack of objective basis.

The court’s analysis reinforces that attendance at an EUO functions as a condition precedent to insurance coverage. This characterization is significant because it means that failure to appear at an EUO can result in complete forfeiture of benefits, regardless of the underlying merits of the claim. The condition precedent nature of EUO attendance places substantial leverage in the hands of insurance companies and limits the grounds upon which providers can challenge EUO demands.

This decision effectively forecloses one avenue of defense that providers had attempted to assert. By confirming that no objective justification is required, the court eliminates any basis for arguing that particular EUO requests constitute improper fishing expeditions or lack sufficient foundation. The only viable objections to EUO requests concern procedural issues such as location, timing, and the scope of document demands rather than the fundamental right to demand attendance.

Practical Implications

For healthcare providers and their counsel, this decision establishes clear parameters for responding to EUO requests. Providers cannot simply object to EUO notices on grounds that the insurer has not explained why the examination is necessary or has failed to demonstrate suspicious circumstances warranting investigation. Such objections will be rejected, and failure to appear based on these grounds will support disclaimer of coverage.

The limited scope of permissible objections focuses on practical concerns such as whether the EUO location is reasonably convenient, whether the timing provides adequate notice, and whether document demands are overbroad or seek materials outside the scope of proper inquiry. Providers must appear at properly noticed EUOs even when they believe the examination is unnecessary or constitutes harassment.

For insurance companies, this decision provides strong support for broad EUO practices. Insurers can schedule EUOs based on internal protocols, risk assessment criteria, or general investigative approaches without documenting specific red flags or suspicious circumstances. However, while justification is not required, insurers must still comply with procedural requirements regarding proper notice, reasonable location, and appropriate document requests to ensure that no-show disclaimers will be upheld.

Related Articles

• Understanding EUO Requirements in New York No-Fault Insurance Cases
• New York EUO Requirements: When Examination Under Oath Demands Are Untimely
• Validity of EUO, Appellate Term, 2d Dept: Take two
• Understanding EUO Denial: When Insurance Companies Can Substantiate Coverage Denials
• New York No-Fault Insurance Law

Legal Update (February 2026): Since this 2014 post, New York’s no-fault regulations and related case law may have evolved regarding EUO scheduling requirements and procedural standards. Practitioners should verify current provisions in 11 NYCRR Part 65 and recent appellate decisions, as regulatory amendments or judicial interpretations may have modified the standards for EUO requests and any associated disclosure requirements.