Key Takeaway
Court ruling demonstrates how insurance companies must meet strict procedural requirements when denying no-fault claims based on missed EUOs and IMEs under established legal standards.
No-fault insurance disputes often hinge on procedural technicalities that can make or break a case. When healthcare providers seek payment for treating accident victims, insurance companies frequently attempt to deny claims by citing missed examinations under oath (EUOs) or independent medical examinations (IMEs). However, as demonstrated in Great Health Care Chiropractic, P.C. v Hertz Co., insurers must follow strict procedural requirements to successfully establish these defenses.
The case illustrates a critical principle in New York No-Fault Insurance Law: insurance companies cannot simply assert that a patient failed to appear for required examinations. They must provide concrete proof of proper notice and actual non-appearance. This decision reinforces the “Alrof test,” a legal standard that has become increasingly important in no-fault litigation, particularly regarding procedural requirements for examination scheduling.
The court’s analysis demonstrates how insurers often struggle to meet their burden of proof, especially when scheduling notices may not have been properly mailed or when they lack witnesses with personal knowledge of the alleged no-shows.
Jason Tenenbaum’s Analysis:
Great Health Care Chiropractic, P.C. v Hertz Co., 2014 NY Slip Op 51814(U)(App. Term 2d Dept. 2014)
“However, defendant failed to establish its entitlement to summary judgment dismissing the complaint. Defendant denied the claim at issue based upon plaintiff’s assignor’s failure to appear for examinations under oath (EUOs) and independent medical examinations (IMEs). Defendant failed, among other things, to establish a proper practice and procedure as to the mailing of the IME scheduling notices (see St. Vincent’s Hosp. of Richmond, 50 AD3d 1123; Delta Diagnostic Radiology, P.C., 17 Misc 3d 16) and failed to submit proof by someone with personal knowledge of the nonappearance of plaintiff’s assignor for the EUOs in question (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 ; Bright Med. Supply Co. v IDS Prop. & Cas. Ins. Co., 40 Misc 3d 130, 2013 NY Slip Op 51123 [*2]; Alrof, Inc. v Safeco Natl. Ins. Co., 39 Misc 3d 130, 2013 NY Slip Op 50458 ). As defendant failed to establish either of its defenses as a matter of law, its cross motion was properly denied.”
Key Takeaway
This ruling reinforces that insurance companies must provide substantial proof when denying claims based on missed examinations. Simply alleging non-appearance is insufficient — insurers must demonstrate proper mailing procedures and present testimony from witnesses with personal knowledge of the no-show incidents. The decision strengthens provider protections under no-fault law.
Legal Update (February 2026): The Alrof test and procedural requirements for EUO/IME scheduling referenced in this 2014 post may have been modified through subsequent court decisions or regulatory amendments to 11 NYCRR 65. Additionally, notice requirements and evidentiary standards for proving non-appearance at examinations may have evolved through appellate decisions since this analysis was published. Practitioners should verify current procedural requirements and recent case law developments when handling no-show defenses in no-fault cases.
