EUO & IME no show

Compas Med., P.C. v Praetorian Ins. Co., 2015 NY Slip Op 51467(U)(App. Term 2d Dept. 2015)

“The Civil Court denied plaintiff’s motion, granted the branch of defendant’s cross motion seeking summary judgment dismissing plaintiff’s third cause of action as premature because plaintiff had failed to provide requested verification, and granted the branches of defendant’s cross motion seeking summary judgment dismissing the remaining causes of action due to the failure of plaintiff’s assignor to appear for independent medical examinations (IMEs) and examinations under oath (EUOs).

In support of the branch of defendant’s cross motion seeking summary judgment dismissing plaintiff’s third cause of action, defendant submitted an affidavit by its claims examiner which established that defendant had timely mailed its verification request and follow-up verification request (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 ; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 ). Defendant demonstrated prima facie that it had not received the requested verification and thus that plaintiff’s third cause of action is premature (see 11 NYCRR 65-3.8 ; Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492 ). As plaintiff failed to raise a triable issue of fact, the Civil Court properly granted the branch of defendant’s cross motion seeking summary judgment dismissing this cause of action.”

My case.  Thank you.  On this one, there was no affidavit attempting to explain the verification compliance.

Legal Significance: Layered Compliance Defenses

The Compas Medical decision illustrates a critical strategic reality in no-fault litigation: carriers need prevail on only one defense to defeat a provider’s claim. Praetorian Insurance asserted three separate defenses—verification non-compliance, IME no-shows, and EUO no-shows. The court addressed the verification defense first, finding it dispositive of one cause of action, then addressed the examination no-shows separately for remaining causes of action.

This layered defense strategy creates significant challenges for providers. Even if a provider could overcome the verification defense, it still must defeat both the IME and EUO no-show defenses. Each defense requires different proof and raises distinct legal issues. Verification involves documentary evidence of what was requested and what was provided. IME no-shows require proof of proper notice, reasonably convenient scheduling, and actual non-appearance. EUO no-shows similarly demand evidence of proper notice and non-appearance. For providers to prevail, they must successfully refute every procedural defense the carrier asserts. One failure dooms the entire case. This asymmetry favors insurers, who can assert multiple defenses knowing that success on any single defense achieves their litigation objective.

Practical Implications for Healthcare Providers

The Compas Medical decision underscores the importance of meticulous compliance with all no-fault procedural requirements. Providers cannot afford to ignore verification requests while focusing on examination appearances, or vice versa. Every procedural demand from the carrier must be addressed comprehensively and documented carefully. When providers receive verification requests, they should respond completely and retain proof of their responses. When examination notices arrive, providers must ensure claimants appear or have documented excuses for non-appearance. The failure to comply with any single requirement can result in dismissal regardless of how strong the provider’s substantive case may be. This case also demonstrates why carriers often prefer multiple procedural defenses over substantive medical necessity challenges. Procedural defenses are often easier to prove, requiring only evidence of requests and non-compliance rather than expert medical testimony about treatment appropriateness.

Related Articles

• Additional verification not produced is probative of nothing
• Triable issue of fact as to non-appearance?
• EUO no-show and verification non-receipt
• No-show failed the Alrof test
• New York No-Fault Insurance Law

Legal Update (February 2026): Since this 2015 post, 11 NYCRR 65-3 has undergone several amendments affecting verification requirements, EUO procedures, and IME scheduling protocols. Practitioners should verify current provisions regarding notice requirements, timeframes for compliance, and procedural safeguards, as regulatory changes may have modified the standards applied in no-show determinations.