Key Takeaway
New York court ruling clarifies that insurers don't need objective reasons to request EUOs, only proper notice and documentation of provider's failure to appear.
When Insurers Request EUOs: No Objective Reasons Required
Under New York No-Fault Insurance Law, insurance companies frequently request Examinations Under Oath (EUOs) from healthcare providers seeking reimbursement. A common question arises: must insurers provide objective, specific reasons for demanding these examinations?
A recent Appellate Term decision provides clarity on this issue, establishing that insurers have broad discretion in requesting EUOs without needing to justify their reasons upfront. This ruling has significant implications for both insurance companies defending claims and healthcare providers navigating the no-fault system.
The case demonstrates how the legal framework differs depending on whether a provider simply fails to appear versus actively objecting to the EUO request. Understanding these distinctions is crucial for providers who want to avoid having their discovery rights waived due to procedural missteps.
Jason Tenenbaum’s Analysis:
Parisien v Metlife Auto & Home, 2017 NY Slip Op 50208(U)(App. Term 2d Dept, 2017)
“Contrary to plaintiff’s contention, defendant was not required to set forth objective reasons for requesting EUOs in order to establish its prima facie entitlement to summary judgment, as an insurer need only demonstrate “as a matter of law that it twice duly demanded an from the … that the provider failed to appear and that the issued a timely denial of the claims” (Interboro Ins. Co. v Clennon, 113 AD3d 596, 597 ; see Barakat Med. Care, P.C. v Nationwide Ins. Co., 49 Misc 3d 147, 2015 NY Slip Op 51677 ).”
Compare this to the more common scenario where the plaintiff objects or requests a reason for the EUO. c.f American Transit Ins. Co. v. Jaga Med. Servics, P.C.
Key Takeaway
The Parisien decision establishes that insurers don’t need to provide objective justifications when requesting EUOs. They must only prove proper notice was given, the provider failed to appear, and claims were timely denied. However, when providers actively object to EUO requests rather than simply not showing up, different legal standards may apply, creating strategic considerations for both sides.
