Key Takeaway
New York court rules insurers don't need objective justification for EUO requests under No-Fault Regulation 68, emphasizing compliance importance.
Understanding EUO Request Standards in New York No-Fault Insurance
Examinations Under Oath (EUOs) represent a critical component of the New York No-Fault Insurance Law claims process. Insurance companies routinely request these sworn examinations to investigate claims, but healthcare providers often question whether insurers must provide objective justification for such requests.
A recent Appellate Term decision addresses this exact issue, clarifying that insurers are not required to demonstrate objective standards when requesting an EUO. This ruling has significant implications for providers who may be tempted to ignore EUO requests they perceive as unreasonable or lacking proper justification.
The decision reinforces a fundamental principle: compliance with EUO requests is mandatory, regardless of whether the provider believes the request is justified. As we’ve seen in other cases where EUO objections may be futile, challenging the basis for an EUO rarely succeeds and often results in claim denials.
Jason Tenenbaum’s Analysis:
Longevity Med. Supply, Inc. v Praetorian Ins. Co., 2015 NY Slip Op 50685(U)(App. Term 2d Dept. 2015)
“An appearance at an EUO “is a condition precedent to the insurer’s liability on the policy” (Stephen Fogel Psychological, P.C., 35 AD3d at 722). Contrary to the determination of the District Court, no provision of No-Fault Regulation 68 requires an insurer to set forth any objective standards for requesting an EUO (see Flow Chiropractic, P.C. v Travelers Home & Mar. Ins. Co., 44 Misc 3d 132, 2014 NY Slip Op 51142 ). As plaintiff does not allege, let alone establish, that it or its assignor responded in any way to defendant’s EUO requests at issue, plaintiff’s objections regarding the EUO requests [*2]will not now be heard (see Crescent Radiology, PLLC v American Tr. Ins. Co., 31 Misc 3d 134, 2011 NY Slip Op 50622 ).”
This is an open issue as of now.
Key Takeaway
Healthcare providers cannot successfully challenge EUO requests by arguing that insurers lack objective justification. The court established that No-Fault Regulation 68 contains no requirement for insurers to demonstrate objective standards when requesting examinations. Providers who fail to comply with EUO requests—regardless of their perceived merit—risk having their objections dismissed and their claims denied. The focus must be on compliance, not on challenging the insurer’s rationale.
