Key Takeaway
Court rules insurance company failed to prove assignor's EUO non-appearance with personal knowledge testimony, highlighting burden of proof requirements in no-fault cases.
Proving Non-Appearance at Examinations Under Oath: The Personal Knowledge Requirement
In New York’s no-fault insurance system, Examinations Under Oath (EUOs) serve as a critical tool for insurance companies to investigate claims and prevent fraud. When an assignor fails to appear for a scheduled EUO, insurers often attempt to deny coverage based on this non-cooperation. However, as demonstrated in a recent Appellate Term decision, insurance companies must meet specific evidentiary standards when claiming non-appearance occurred.
The burden of proof falls squarely on the insurance company to demonstrate that the assignor actually failed to appear for the EUO. This isn’t simply a matter of stating that someone didn’t show up – the law requires testimony from someone with personal knowledge of the alleged non-appearance. This evidentiary requirement protects healthcare providers and ensures that New York no-fault insurance law operates fairly.
The personal knowledge standard serves an important purpose in the legal system. It prevents hearsay evidence and ensures that only witnesses who actually observed or have direct knowledge of events can testify about them. In the context of EUO proceedings, this typically means the person who was present at the scheduled examination location, such as a court reporter, insurance representative, or office staff member, must provide testimony about the assignor’s failure to appear.
This case demonstrates how procedural requirements can significantly impact the outcome of no-fault insurance disputes, similar to issues we’ve seen in other EUO objection cases where technical compliance matters greatly.
Jason Tenenbaum’s Analysis:
Active Care Med. Supply Corp. v Metlife Auto & Home, 2018 NY Slip Op 50772(U)(App. Term 2d Dept. 2018)
“Plaintiff correctly argues on appeal that defendant failed to submit proof by someone with personal knowledge of plaintiff’s assignor’s nonappearance at an initial and follow-up EUO “
Key Takeaway
Insurance companies cannot simply assert that an assignor failed to appear for an EUO without proper evidentiary support. The court must have testimony from someone who was actually present and can provide personal knowledge of the non-appearance. This ruling reinforces the importance of proper documentation and witness testimony in no-fault insurance disputes. Healthcare providers should be aware that EUO no-show scenarios require careful attention to procedural requirements, and insurers who fail to meet the personal knowledge standard may find their denial defenses unsuccessful, as we’ve observed in various Allstate EUO cases where similar evidentiary issues arose.
