Key Takeaway
Appellate Term reinforces that failing to appear for EUO is unconditional bar to coverage, rejecting Civil Court's attempt to allow second chance for medical provider.
Understanding EUO Requirements in No-Fault Insurance Claims
Examination Under Oath (EUO) requirements represent one of the most critical procedural hurdles in New York No-Fault Insurance Law. When medical providers or their assignors fail to appear for scheduled EUOs, insurance companies often move to deny coverage entirely. A recent Appellate Term decision reinforces the harsh reality that missing an EUO typically results in an unconditional denial of benefits, with no opportunity for a “do-over.”
The case of Integrative Pain Medicine, P.C. v Allstate Ins. Co. demonstrates the ongoing tension between lower courts that sometimes show leniency and appellate courts that consistently enforce strict compliance with EUO attendance requirements. This pattern mirrors previous decisions where courts have been unwilling to provide second chances for EUO non-attendance.
Jason Tenenbaum’s Analysis:
Integrative Pain Medicine, P.C. v Allstate Ins. Co., 2016 NY Slip Op 51525(U)
“Appearance at an EUO is a condition precedent to coverage (see 11 NYCRR 65—1.1; Interboro Ins. Co. v Clennon, 113 AD3d 596 ; Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 ). Upon finding that defendant demonstrated that it had timely and properly denied the claims at issue on the ground that plaintiff’s assignor had failed to appear for duly scheduled EUOs, the Civil Court should not have given plaintiff’s assignor an opportunity to cure its failure to act during claims processing (see IDS Prop. Cas. Ins. Co. v Stracar Med. Services, P.C., 116 AD3d 1005 ). Under the circumstances, the court should have granted defendant’s cross motion for summary judgment unconditionally.”
It is interesting that the Civil Court found that the EIP should have another opportunity to attend EUO, which is what happened in IDS. The Appellate Term, similar to the Appellate Division in IDS, said no more chances and dismissed the complaint. Interesting.
Key Takeaway
The Appellate Term’s decision reinforces that EUO attendance is an absolute condition precedent to no-fault coverage. Courts cannot provide second chances to medical providers who fail to appear, even when discovery issues may complicate the process. This creates a strict liability standard that requires careful attention to scheduling and attendance by healthcare providers seeking no-fault benefits.
