Key Takeaway
Court rejects Allstate's EUO no-show defense due to insufficient proof of nonappearance, highlighting the importance of proper documentation in no-fault insurance disputes.
Allstate’s EUO No-Show Defense Falls Short on Proof Requirements
Examination Under Oath (EUO) proceedings are a critical component of New York No-Fault Insurance Law, allowing insurance companies to investigate claims before making coverage decisions. When medical providers fail to appear for scheduled EUOs, insurers often use this as grounds to deny claims entirely. However, a recent Appellate Term decision demonstrates that insurance companies must provide proper proof of nonappearance to successfully defend on this basis.
The case of New Quality Med., P.C. v Allstate Ins. Co. illustrates common issues that arise when insurers attempt to prove EUO no-shows without adequate documentation. This decision also touches on the ongoing debate regarding Allstate’s mailing procedures and whether their standard affidavits meet the court’s requirements for establishing personal knowledge of nonappearance.
Jason Tenenbaum’s Analysis:
New Quality Med., P.C. v Allstate Ins. Co., 2016 NY Slip Op 50871(U)(App. Term 2d Dept. 2016)
Defendant’s contention that its cross motion for summary judgment should have been granted due to plaintiff’s failure to appear for duly scheduled EUOs lacks merit, as the Civil Court correctly found that defendant had failed to submit proof by someone with personal knowledge of the nonappearance of plaintiff for the EUOs in question (see Bright Med. Supply Co. v IDS Prop. & Cas. Ins. Co., 40 Misc 3d 130, 2013 NY Slip Op 51123 ; Alrof, Inc. v Safeco Natl. Ins. Co., 39 Misc 3d 130, 2013 NY Slip Op 50458 ). Since defendant failed to raise a triable issue of fact as to whether it had timely denied plaintiff’s claims (see 11 NYCRR 65-3.8 ; Westchester Med. Ctr. v Lincoln Gen. Ins. Co., 60 AD3d 1045 ), defendant’s contention that its papers were sufficient, at least, to raise a triable issue of fact as to whether plaintiff had failed to appear for the scheduled EUOs is irrelevant.
I have heard about the split in the courts regarding the Allstate mailing affidavit. Does this represent that?
Key Takeaway
The court’s decision reinforces that insurance companies cannot simply claim an EUO no-show occurred—they must provide testimony from someone with personal knowledge of the nonappearance. This case references the problematic Alrof decision, which continues to create challenges for medical providers in no-fault litigation. The ruling also highlights timing issues with claim denials under regulatory requirements.
Legal Update (February 2026): Since this 2016 post, New York’s no-fault regulations under 11 NYCRR 65-3 have undergone several amendments, including updates to EUO procedural requirements and documentation standards. Additionally, appellate decisions since 2016 may have further refined the proof requirements for establishing EUO non-appearance, and fee schedules referenced in related regulations have been periodically updated. Practitioners should verify current provisions of 11 NYCRR 65-3.8 and review recent case law developments regarding EUO proof standards.
