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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)
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” 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.
Legal Significance
The Appellate Term’s holding establishes a clear framework for what insurers must prove to obtain summary judgment based on EUO non-compliance. This framework differs significantly from standards that some lower courts had attempted to impose. By confirming that insurers need not demonstrate objective reasons for requesting EUOs, the court recognizes the broad contractual and regulatory authority insurance companies possess to investigate claims through examination under oath procedures.
The decision reflects policy considerations inherent in no-fault insurance regulation. Insurance companies face substantial fraud risks in processing medical claims, particularly when dealing with assigned benefits where the actual patient may be difficult to locate or interview. EUOs serve as a critical investigative tool for detecting fraudulent billing patterns, staged accidents, and other improper claims. Requiring objective justification for each EUO request would substantially undermine this investigative authority.
However, the court’s decision leaves unresolved a significant question that practitioners continue to grapple with: what happens when providers or assignors object to EUO requests rather than simply failing to appear? The distinction between non-objection and objection may prove critical in future cases, potentially creating different procedural pathways and evidentiary standards.
Practical Implications
For insurance companies, this decision streamlines the process of establishing EUO-based defenses on summary judgment motions. Insurers need not expend resources developing justifications for why they requested an EUO. The focus remains on procedural compliance: properly scheduling the EUO, sending timely follow-up requests after no-shows, and issuing denials within regulatory timeframes. These mechanical requirements are far easier to document than subjective assessments of whether objective reasons existed for the examination.
Medical providers and their counsel must recognize that challenging the substantive basis for EUO requests will not succeed when the insurer has followed proper procedures. Instead, providers should focus on procedural defects such as improper addressing, unreasonable scheduling, insufficient notice periods, or failure to send required follow-up requests. These procedural challenges can defeat EUO-based denials even when insurers had legitimate reasons for seeking the examination.
The unanswered question about objections to EUO requests creates strategic opportunities for providers. When an EUO request appears overbroad, burdensome, or seeks information beyond the scope of proper investigation, providers should consider lodging formal objections rather than simply failing to appear. While this decision does not address how courts will handle such objections, the alternative approach of simply not appearing provides insurers with a clear path to claim denial based on non-compliance.
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.
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Legal Context
Why This Matters for Your Case
New York law is among the most complex and nuanced in the country, with distinct procedural rules, substantive doctrines, and court systems that differ significantly from other jurisdictions. The Civil Practice Law and Rules (CPLR) governs every stage of civil litigation, from service of process through trial and appeal. The Appellate Division, Appellate Term, and Court of Appeals create a rich and ever-evolving body of case law that practitioners must follow.
Attorney Jason Tenenbaum has practiced across these areas for over 24 years, writing more than 1,000 appellate briefs and publishing over 2,353 legal articles that attorneys and clients rely on for guidance. The analysis in this article reflects real courtroom experience — from motion practice in Civil Court and Supreme Court to oral arguments before the Appellate Division — and a deep understanding of how New York courts actually apply the law in practice.
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Disclaimer: This article is published by the Law Office of Jason Tenenbaum, P.C. for informational and educational purposes only. It does not constitute legal advice, and no attorney-client relationship is formed by reading this content. The legal principles discussed may not apply to your specific situation, and the law may have changed since this article was last updated.
New York law varies by jurisdiction — court decisions in one Appellate Division department may not be followed in another, and local court rules in Nassau County Supreme Court differ from those in Suffolk County Supreme Court, Kings County Civil Court, or Queens County Supreme Court. The Appellate Division, Second Department (which covers Long Island, Brooklyn, Queens, and Staten Island) and the Appellate Term (which hears appeals from lower courts) each have distinct procedural requirements and precedents that affect litigation strategy.
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