Objective justification not necessary

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.

Case Background

Longevity Medical Supply, Inc. provided medical equipment to an injured patient and submitted claims to Praetorian Insurance Company for payment under New York’s no-fault system. The insurer requested that the plaintiff and its assignor appear for Examinations Under Oath. Rather than complying with these requests, Longevity Medical apparently challenged them, arguing that Praetorian failed to provide objective justification for requesting the EUOs.

The District Court initially sided with the provider, apparently finding that insurers must demonstrate objective bases for EUO requests. Praetorian appealed, contending that no such requirement exists under applicable no-fault regulations. The Appellate Term needed to determine whether No-Fault Regulation 68 imposes an objective justification requirement for EUO requests.

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.

Legal Significance

The Longevity Medical Supply decision definitively establishes that insurers need not provide objective justification when requesting EUOs. This ruling flows logically from the principle that EUO attendance is a condition precedent to coverage. Conditions precedent must be satisfied before insurers owe payment obligations. If claimants could avoid EUOs by challenging insurers’ justifications, the condition precedent would lose its meaning—claimants could selectively refuse to appear whenever they deemed requests unjustified.

The decision also addresses waiver principles. Even if providers had colorable objections to EUO requests, failing to respond “in any way” to those requests waives the objections. Providers cannot simply ignore EUO scheduling letters and then raise procedural objections when insurers deny claims. This “use it or lose it” principle ensures that parties raise objections timely rather than sandbagging carriers and raising issues only after denials occur.

The court’s citation to Crescent Radiology reinforces this waiver doctrine. That case similarly held that parties who fail to object to or seek adjournment of EUOs cannot later challenge those EUOs in litigation. The message is clear: providers must engage with the EUO process as it unfolds, not ignore it and try to challenge it retroactively.

Jason Tenenbaum notes this was an “open issue” at the time, suggesting some courts had been sympathetic to providers’ arguments that insurers needed objective justification. Longevity Medical Supply closes that debate, at least for the Second Department Appellate Term. Providers in that jurisdiction cannot defeat EUO no-show defenses by arguing insurers lacked good reasons for requesting examinations.

Practical Implications

For healthcare providers, Longevity Medical Supply delivers an unequivocal message: comply with EUO requests or risk claim denial. Providers cannot successfully argue that EUO requests were unjustified or lacked objective basis. The regulatory framework does not impose such requirements, and courts will not add them through judicial interpretation.

Providers should also understand waiver principles. If providers believe EUO requests are procedurally defective, they must raise objections promptly—ideally before scheduled examination dates. Simply ignoring EUO requests and hoping to challenge them later after claim denials will fail. Providers need to engage with insurers, request adjournments if necessary, or seek declaratory relief if they believe EUO requests violate regulations.

For insurance carriers, this decision validates broad EUO authority. Carriers need not demonstrate to courts or providers why they want to conduct EUOs. The mere fact that EUOs are authorized under no-fault regulations suffices. This authority should be exercised reasonably—unreasonable or harassing EUO requests might still face judicial scrutiny under other legal theories—but carriers need not justify routine exercise of examination rights.

The decision also counsels carriers about responding to provider objections. When providers object to EUO requests or claim they need more information about why examinations are required, carriers can simply respond that regulations authorize EUOs without requiring objective justification. Carriers need not engage in lengthy explanations or negotiations over whether examination requests are justified.

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.

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