Key Takeaway
New York no-fault insurance case where provider lost benefits for failing to appear at EUO. Court ruled insurer met burden for summary judgment dismissal.
Dynamic Balance Acupuncture, P.C. v State Farm Ins., 2019 NY Slip Op 50171(U)(App. Term 2d Dept. 2019)
This continues the line of cases where the Appellate Term, Second Department held that a medical provider must attend duly scheduled EUO at peril of losing its assigned benefits.
“To establish its prima facie entitlement to summary judgment dismissing a complaint on the ground that a provider had failed to appear for an EUO, an insurer must demonstrate, as a matter of law, that it had twice duly demanded an EUO from the provider, that the provider had twice failed to appear, and that the insurer had issued a timely denial of the claims (see Interboro Ins. Co. v Clennon, 113 AD3d 596, 597 ; Integrative Pain Medicine, P.C. v Praetorian Ins. Co., 53 Misc 3d 140, 2016 NY Slip Op 51520 )—all elements that the Civil Court found to have been established pursuant to CPLR 3212 (g).
“Plaintiff does not argue that defendant did not demonstrate its prima facie case. Rather, plaintiff argues that defendant’s EUO requests were unreasonable, in that defendant did not [*2]respond to plaintiff’s letter demanding that defendant provide its good faith reasons for requesting plaintiff’s EUO. However, as plaintiff failed to submit proof that it had mailed such a letter, its argument lacks any basis (see e.g. Professional Health Imaging, P.C. v State Farm Mut. Aut. Ins. Co., 52 Misc 3d 132, 2016 NY Slip Op 50997 ). In any event, defendant would not have been required to provide the reason for its demand in response to an objection from plaintiff (see Flow Chiropractic, P.C. v Travelers Home & Mar. Ins. Co.,44 Misc 3d 132, 2014 NY Slip Op 51142 ).”
Related Articles
- Understanding EUO Requirements in New York No-Fault Insurance Cases
- EUO No-Show Consequences: What Happens When You Skip Your Examination Under Oath in New York
- How to Challenge EUO No-Show Denials: When Improper Notice Can Reverse Insurance Denials in New York
- Personal Knowledge Requirements for EUO Non-Appearances: NY Legal Standards
- New York No-Fault Insurance Law
