Key Takeaway
Missing your EUO can destroy your insurance claim. Learn the serious consequences of EUO no-shows in NY and how to protect your rights. Call 516-750-0595.
Understanding EUO No-Show Consequences in New York Insurance Claims
The recent case of Ultimate Health Prods., Inc. v Travelers Ins. Co., 2019 NY Slip Op 51620(U)(App. Term 2d Dept. 2019) serves as a stark reminder of the serious consequences that can result from failing to appear for a scheduled Examination Under Oath (EUO). This decision affirmed the dismissal of a no-fault insurance claim based on the plaintiff’s failure to appear for their EUO—a consequence that could have been easily avoided with proper legal guidance.
The court emphasized the broad review power available in such cases, stating: “In reviewing a determination made after a nonjury trial, the power of this court is as broad as that of the trial court, and this court may render the judgment it finds warranted by the facts, bearing in mind that the determination of a trier of fact as to issues of credibility is given substantial deference.”
What is an Examination Under Oath (EUO)?
An Examination Under Oath is a formal proceeding where an insurance company has the right to question a claimant under oath about the circumstances of their accident and the claimed damages. This examination is a powerful tool available to insurance companies under New York law to investigate potential fraud and verify the legitimacy of claims.
Legal Authority for EUOs in New York
Insurance companies derive their authority to demand EUOs from both statutory law and the terms of insurance policies. Under New York Insurance Law and standard no-fault insurance policy provisions, insurers can require claimants to submit to an EUO as a condition of coverage.
When Can Insurance Companies Demand an EUO?
Insurance companies typically request EUOs when they suspect:
- Fraudulent or exaggerated claims
- Questions about the legitimacy of medical treatment
- Discrepancies in accident reports or medical records
- Suspicions about pre-existing conditions
- Concerns about the relationship between providers and patients
- Unusual billing patterns or treatment protocols
The Serious Consequences of EUO No-Shows
Failing to appear for a scheduled EUO can have devastating consequences for your insurance claim. The Ultimate Health Products case demonstrates that courts will not hesitate to dismiss claims when claimants fail to comply with EUO requirements.
Immediate Consequences of Missing an EUO
When you fail to appear for your EUO, the insurance company can:
- Immediately deny your entire claim
- Discontinue all benefit payments
- Refuse to authorize future medical treatment
- Terminate coverage under the no-fault policy
Long-term Legal Ramifications
The consequences extend far beyond immediate claim denial:
- Claim Dismissal: Courts routinely dismiss lawsuits when plaintiffs fail to appear for EUOs
- Loss of Benefits: All no-fault benefits may be permanently forfeited
- Legal Precedent: The denial becomes part of your insurance history
- Provider Impact: Medical providers may also lose their right to reimbursement
Understanding Your Rights and Obligations During an EUO
While EUOs are powerful tools for insurance companies, claimants have important rights that must be respected during the examination process.
Your Rights During an EUO
As a claimant, you have the right to:
- Be accompanied by your attorney
- Receive reasonable notice of the examination
- Have the examination conducted at a reasonable time and place
- Object to improper or irrelevant questions
- Take breaks when necessary
- Receive a copy of the transcript
Your Obligations During an EUO
Claimants must:
- Appear at the scheduled time and place
- Answer questions truthfully under oath
- Bring requested documents and records
- Submit to the examination in good faith
- Provide complete and accurate information
Common Reasons People Miss EUOs (And Why They’re Not Valid Excuses)
Understanding why people miss EUOs can help prevent these costly mistakes:
Fear and Anxiety
Many claimants are intimidated by the formal nature of an EUO and choose to avoid it rather than face questioning. However, this fear often stems from misunderstanding the process and their rights during the examination.
Lack of Legal Representation
Claimants without attorneys may not understand the serious consequences of missing an EUO or may feel unprepared to handle the examination alone.
Poor Communication
Sometimes notices are not properly received, or claimants misunderstand the requirements. However, courts generally hold claimants responsible for maintaining current contact information.
Medical Issues
While legitimate medical emergencies may provide grounds for rescheduling, chronic conditions or routine medical appointments are typically not accepted as valid excuses for missing an EUO.
Strategies for EUO Preparation and Success
Proper preparation is key to successfully navigating an EUO without jeopardizing your claim.
Pre-EUO Preparation Steps
Before your EUO, you should:
- Hire experienced legal counsel – An attorney familiar with EUO procedures is essential
- Review all relevant documents – Refresh your memory about accident details and medical treatment
- Organize medical records – Ensure all treatment records are complete and available
- Prepare for common questions – Practice answering questions about the accident and your injuries
- Understand the scope – Know what topics will be covered and what documents to bring
During the EUO: Best Practices
During your examination:
- Listen carefully to each question before answering
- Answer only what is asked – don’t volunteer additional information
- Tell the truth – lying under oath is perjury
- Say “I don’t know” if you genuinely don’t remember
- Let your attorney object to improper questions
- Take your time – there’s no need to rush your answers
What to Do If You’ve Already Missed an EUO
If you’ve already missed your EUO, immediate action is required to minimize the damage to your claim.
Immediate Steps to Take
Contact an experienced attorney immediately to:
- Assess whether the EUO notice was proper
- Determine if you have valid grounds for rescheduling
- Negotiate with the insurance company for a second chance
- Explore legal options for challenging the claim denial
Potential Defenses to EUO No-Show Claims
In some circumstances, you may have valid defenses:
- Improper or insufficient notice
- Medical emergency or hospitalization
- Unreasonable scheduling or location requirements
- Insurance company bad faith
- Procedural violations by the insurer
The Role of Medical Providers in EUO Cases
The Ultimate Health Products case involved a medical provider, highlighting how EUO no-shows affect not just individual claimants but also healthcare providers seeking reimbursement.
Provider Responsibilities
Medical providers must understand that:
- Patient EUO compliance can affect provider reimbursement
- Providers may be subject to their own EUO requirements
- Documentation quality becomes crucial when EUO issues arise
- Provider-patient relationships may be scrutinized during EUOs
Frequently Asked Questions About EUO No-Shows
Can I reschedule my EUO if I have a conflict?
Yes, legitimate conflicts can often be accommodated if you contact the insurance company or their attorney promptly. However, you should work with your attorney to ensure proper procedures are followed and that the request is reasonable.
What happens if I ‘m sick on the day of my EUO?
If you have a legitimate medical emergency or sudden illness, contact your attorney immediately. Medical documentation may be required to support a rescheduling request. However, chronic conditions or routine appointments typically won’t excuse an absence.
Can the insurance company deny my claim if I miss the EUO by accident?
Unfortunately, yes. Insurance companies can deny claims for EUO no-shows regardless of whether the absence was intentional. This is why it’s crucial to maintain current contact information and work with an attorney who can help ensure proper notice.
Is there any way to reverse a claim denial for missing an EUO?
In limited circumstances, denials may be challengeable if there were procedural problems with the EUO notice or if you had valid grounds for missing the examination. However, these cases are difficult and require immediate legal intervention.
How long do I have to appear for an EUO after receiving notice?
The insurance company must provide reasonable notice, typically at least 10 days. However, the specific requirements can vary depending on the circumstances and policy language. Your attorney can review the notice to ensure it meets legal requirements.
The Importance of Experienced Legal Representation
The Ultimate Health Products decision underscores why having experienced legal counsel is essential when dealing with EUO requirements. An attorney can help you understand your rights, prepare for the examination, and avoid the costly mistakes that can derail your entire claim.
At the Law Office of Jason Tenenbaum, we have extensive experience guiding clients through the EUO process. We understand the tactics used by insurance companies and know how to protect your rights while ensuring compliance with all legal requirements.
Conclusion
The consequences of missing an EUO are severe and often permanent. As demonstrated in Ultimate Health Products v. Travelers, courts will not hesitate to dismiss claims when claimants fail to appear for scheduled examinations. The phrase “well, this is not surprising” from the original case commentary reflects the legal community’s understanding that EUO no-shows almost always result in claim denials.
Don’t let fear or confusion about the EUO process cost you your entire claim. With proper preparation and experienced legal guidance, you can successfully navigate an EUO while protecting your rights and preserving your claim for benefits.
If you’ve been scheduled for an EUO or have already missed one, don’t wait—call 516-750-0595 for a free consultation. Our experienced team can help you understand your rights, prepare for your examination, and protect your claim from denial. Time is critical in EUO cases, so contact us today.
