Key Takeaway
Learn why EUO no-shows occur when insurers fail to provide required justification. Court rules insurers must give specific objective reasons for EUO requests.
Avalon Radiology, PC. v Ameriprise Ins. Co., 2016 NY Slip Op 26182 (Dis. Ct. Suffolk Co. 2016)
“Avalon responded to the first EUO request with a letter dated April 3, 2014, requesting the good faith, objective reason for defendant’s request for an EUO pertaining to Avalon’s incorporation and licensure, as well as the basis for suspecting it had engaged in fraudulent behavior (Exhibit K). In response to Avalon’s letter of April 3, 2014, defendant sent a second letter dated April 14, 2014, stating that it was not required to provide the specific objective justification for its EUO request and rescheduling the EUO for May 1, 2014 (Exhibit L), as well as a third letter dated April 18, 2014, also setting forth the May 1, 2014 EUO date (Exhibit H). The claims were denied following Avalon’s failure to appear for the May 1, 2014 EUO (Exhibits R, S and T).”
“The insurer’s response in this case to the effect that it was not obligated to do so is plainly wrong. The insurer clearly had an obligation to comply with No-Fault regulation 65-3.5(e)and supply the requesting party, in this case the provider, with the “specific objective justification supporting the use of such examination.” The regulations do not allow the insurer to use an EUO as a fishing expedition. There must be a specific objective reason for the request. See American Transit v Jaga Medical Services, P.C., 128 AD3d 441 (1st Dep’t 2015); American Transit v Curry, 45 Misc 3d 171 (Sup.Ct. NY Co. 2013). If the Court were to conclude otherwise, the cited language of the applicable regulation would be rendered meaningless.”
I have to agree with the District Court on this one. To dictate letters to providers demanding a provider’s appearances at EUOs without giving a reason when asked to provide a reason is improper. That is plain and simple. When taken to the mat as to why an EUO is necessary, the carrier must respond. The Court got this one right. Hopefully EUO counsel has learned from their mistakes.
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- Understanding EUO Requirements in New York No-Fault Insurance Cases
- EUO No-Show Consequences: What Happens When You Skip Your Examination Under Oath in New York
- Validity of EUO, Appellate Term, 2d Dept: Take two
- New York No-Fault Insurance Law
Legal Update (February 2026): Since this 2016 post was published, No-Fault Regulation 65-3.5 governing examination under oath procedures may have been amended, including potential changes to disclosure requirements for EUO justifications and procedural timelines. Additionally, subsequent court decisions may have further clarified insurers’ obligations to provide specific objective reasons for EUO requests. Practitioners should verify current regulatory provisions and recent case law developments when advising on EUO compliance issues.
