Key Takeaway
Court ruling clarifies insurers don't need objective reasons for EUO requests, but leaves unresolved what happens when medical providers object to examinations under oath.
Understanding EUO Requirements in New York No-Fault Cases
Examinations Under Oath (EUOs) are a critical tool in New York No-Fault Insurance Law disputes. When insurance companies suspect fraudulent claims or need additional information, they can demand that medical providers appear for sworn testimony. However, the legal standards surrounding these demands continue to evolve through court decisions.
A recent Appellate Term ruling provides important clarity on what insurers must prove when seeking summary judgment based on EUO non-compliance. The decision addresses a fundamental question about whether insurance companies need to justify their EUO requests with specific reasons, but it also highlights a significant gap in the current legal framework.
Jason Tenenbaum’s Analysis:
Gentlecare Ambulatory Anesthesia Servs. v Geico Ins. Co., 2017 NY Slip Op 51518(U)(App. Term 2d Dept. 2017)
” Furthermore, 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 Parisien v Metlife Auto & Home, 54 Misc 3d 143, 2017 NY Slip Op 50208 ; Palafox PT, P.C. v State Farm Mut. Auto. Ins. Co., 49 Misc 3d 144, 2015 NY Slip Op 51653 ).”
I am still waiting for this Court to answer the following question: What happens when the medical provider objects to the EUO? No answer on this one yet.
Key Takeaway
This ruling simplifies the burden on insurers seeking summary judgment for EUO non-compliance cases. Insurance companies need only prove they properly demanded the EUO twice and issued timely claim denials—no objective justification required. However, the critical question of how courts should handle provider objections to EUO demands remains unanswered, as discussed in cases involving EUO objections and discovery waiver issues.
