Key Takeaway
New York court clarifies that insurers don't need to provide objective reasons for EUO requests when seeking summary judgment for provider no-shows.
Understanding EUO Requirements: When Objective Standards Don’t Apply
In New York’s no-fault insurance system, Examinations Under Oath (EUOs) serve as a critical investigative tool for insurance companies. When healthcare providers fail to appear for these examinations, insurers often seek to deny claims and pursue summary judgment. A recent appellate decision has clarified an important procedural point: insurers may not need to justify their reasons for requesting EUOs when providers simply fail to show up.
This ruling builds on established precedent regarding EUO no-show situations and reinforces the procedural requirements insurers must meet to successfully defend against provider claims. The decision is particularly significant for understanding how courts evaluate EUO objections and their effectiveness in the litigation process.
Jason Tenenbaum’s Analysis:
New Way Med. Supply Corp. v State Farm Mut. Auto. Ins. Co., 2019 NY Slip Op 51158(U)(App. Term 2d Dept. 2019)
“This court has held on multiple occasions that since the Appellate Division, Second Department, stated that an insurer need only establish as a matter of law that it twice duly demanded an EUO from the provider that the provider twice failed to appear, and that the insurer issued a timely denial of the claims, an insurer does not need to set forth the objective reasons for the requested EUOs as part of its prima facie showing of entitlement to judgment as a matter of law”
Key Takeaway
When healthcare providers fail to appear for properly noticed EUOs, insurance companies can obtain summary judgment without demonstrating objective reasons for requesting the examinations. The court’s focus remains on procedural compliance—proper notice, non-appearance, and timely claim denial—rather than the underlying justification for the EUO request. This streamlined approach reflects the importance courts place on provider cooperation in the no-fault insurance investigation process.
