Key Takeaway
New York court rules that incarceration creates triable issues for excusable no-show at examination under oath, requiring case-by-case analysis of circumstances.
Understanding Excusable Absence for No-Fault Examinations Under Oath
In New York’s no-fault insurance system, healthcare providers seeking payment for medical services must sometimes comply with insurance company requests for examinations under oath (EUOs). When an assignor fails to appear for a scheduled EUO, insurance companies often use this as grounds to deny claims. However, courts recognize that certain circumstances may constitute valid excuses for non-appearance.
A recent Appellate Term decision in Omega Diagnostic Imaging, P.C. v Praetorian Ins. Co. highlights an unusual but important scenario where an assignor’s incarceration was considered a potentially excusable reason for missing an EUO. This case demonstrates that courts will examine the specific circumstances surrounding a no-show situation rather than automatically ruling against the provider.
Jason Tenenbaum’s Analysis:
Omega Diagnostic Imaging, P.C. v Praetorian Ins. Co., 2016 NY Slip Op 50762(U)(App. Term 1st Dept. 2016)
“he limited record so far developed presents triable issues as to whether the assignor’s failure to appear was excusable” (see IDS Prop. Cas. Ins. Co. v. Stracar Med. Servs., P.C., 116 AD3d 1005, 1007 ). In this regard, defendant’s moving submission, which contains letters from its no-fault examiner and no-fault supervisor acknowledging the assignor’s incarceration, creates rather than eliminates genuine triable issues.”
The EUO should have taken place – if anywhere – at the prison or jail. For what its worth, if someone is incarcerated, they are probably not treating and billing no-fault.
Key Takeaway
Courts will not automatically excuse a no-show EUO, but incarceration presents a compelling circumstance that creates triable issues requiring further examination. Insurance companies acknowledging an assignor’s incarceration in their own documentation may inadvertently strengthen the provider’s position. When dealing with notification issues, proper documentation and circumstances matter significantly in determining whether an absence is excusable.
