Key Takeaway
Recent NY court rulings clarify insurers don't need objective reasons to request EUOs when proving no-show defense, though proper objections can change this dynamic.
Understanding EUO No-Show Defenses in New York No-Fault Cases
Examinations Under Oath (EUOs) are a critical tool in New York No-Fault Insurance Law that allow insurers to investigate claims. When medical providers or injured parties fail to appear for these scheduled examinations, insurers often use this “no-show” as grounds to deny claims entirely.
Recent appellate court decisions have clarified an important aspect of EUO no-show defenses: insurers don’t need to provide objective reasons for requesting the examination in the first place. This represents a significant advantage for insurance companies defending against no-fault claims, as it removes one potential avenue of challenge that providers might raise.
However, the legal landscape isn’t entirely one-sided. The timing and nature of objections can dramatically alter the outcome of these cases, making it crucial for healthcare providers to understand when and how to properly challenge EUO requests.
Jason Tenenbaum’s Analysis:
Gentlecare Ambulatory Anesthesia Services; Lyonel F. Paul, M.D. v GEICO Ins. Co., 2018 NY Slip Op 51653(U)(App. Term 2d Dept. 2018)
“Furthermore, defendant was not required to set forth objective reasons for requesting EUOs in order to establish its prima facie entitlement to summary judgment (see Gentlecare Ambulatory Anesthesia Servs. v GEICO Ins. Co., 59 Misc 3d 152, 2018 NY Slip Op 50864 ).”
One need to forget this lesson. That said, a proper and timely objection changes the calculus.
LMS Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co., 2018 NY Slip Op 51655(U)(App. Term 2d Dept. 2018)
Furthermore, defendant was not required to set forth objective reasons for requesting the 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 twice failed to appear, and that the issued a timely denial of the claim[]“
Key Takeaway
While insurers don’t need objective reasons to request EUOs when establishing no-show defenses, healthcare providers shouldn’t assume defeat. EUO objections may be futile in some circumstances, but proper and timely objections can still change the legal analysis and potentially save claims from denial.
