Key Takeaway
Court rules EUO denial valid despite not specifying examination dates, rejecting plaintiff's argument that omission made denial vague or conclusory under New York no-fault law.
Court Upholds EUO Denial Despite Missing Examination Dates
Insurance carriers often deny no-fault claims when assignors fail to appear for scheduled examinations under oath (EUOs). A common challenge from healthcare providers is that denial forms are defective if they don’t include specific details like examination dates. However, a recent Appellate Term decision clarifies that such omissions don’t automatically invalidate an otherwise proper denial.
In the context of New York No-Fault Insurance Law, EUO requirements serve as crucial tools for carriers to investigate claims. When assignors fail to appear for these examinations, carriers can legitimately deny coverage. The question often becomes whether the denial itself meets legal standards for specificity.
This case addresses a frequent dispute in no-fault litigation: how detailed must denial forms be to satisfy legal requirements? While some providers argue that missing dates render denials fatally defective, courts have shown they’re willing to uphold denials that clearly state the reason for denial, even without every specific detail.
Jason Tenenbaum’s Analysis:
Quality Psychological Servs., P.C. v Avis Rent-A-Car Sys., LLC, 2015 NY Slip Op 50378(U)(App. Term 2d Dept. 2015)
“Here, plaintiff has not alleged that it did not receive a denial of claim from defendant. Moreover, the denial of claim form attached to defendant’s motion papers, which plaintiff argues is fatally defective, states that the claim was being denied because plaintiff’s assignor had failed to appear for two properly scheduled examinations under oath. Contrary to plaintiff’s argument, the failure to set forth the dates of the scheduled examinations in the denial of claim form did not render the denial conclusory, vague, or without merit as a matter of law”
The denial was valid despite not setting forth the date on the denials.
Key Takeaway
Courts will uphold EUO-based claim denials even when specific examination dates aren’t listed in the denial form. As long as the denial clearly states that the assignor failed to appear for properly scheduled examinations under oath, the omission of dates doesn’t render the denial legally defective. This ruling provides carriers with flexibility in their denial language while maintaining the substance of their defense. Healthcare providers challenging such denials based solely on missing dates may find their arguments unsuccessful, particularly when dealing with EUO no-show scenarios or multiple examination failures.
