Key Takeaway
Court clarifies that insurers don't need to prove they mailed prescribed forms when seeking summary judgment for provider EUO no-shows in New York no-fault cases.
Understanding EUO No-Show Requirements: What Insurers Must Prove
In New York no-fault insurance law, when healthcare providers fail to appear for scheduled Examinations Under Oath (EUOs), insurers often seek summary judgment to deny claims. A recent appellate court decision clarifies an important procedural point: insurers don’t need to prove they sent “prescribed forms” when establishing their prima facie case for EUO no-shows.
This ruling addresses a common defense argument that attempts to shift the burden back to insurers by claiming they failed to properly notify providers using required regulatory forms. The court’s decision streamlines the summary judgment process for EUO no-show cases by focusing on the core issue — whether the provider appeared as scheduled.
Jason Tenenbaum’s Analysis:
BNE Clinton Med., P.C. v State Farm Mut. Auto Ins. Co., 2021 NY Slip Op 50083(U)(App. Term 2d Dept. 2020)
“Plaintiff’s contention that defendant failed to make a prima facie showing of its entitlement to summary judgment because defendant did not show that it had timely mailed “prescribed forms” upon learning of the accident (see 11 NYCRR 65-3.4) lacks merit, as such a showing is not part of an insurer’s prima facie burden when seeking summary judgment on the ground that a provider or the provider’s assignor failed to appear for duly scheduled EUOs (see Interboro Ins. Co. v Clennon, 113 AD3d 596, 597 ).”
Key Takeaway
When insurers seek summary judgment for EUO no-shows, they don’t need to prove compliance with prescribed form mailing requirements under 11 NYCRR 65-3.4. The court confirmed that demonstrating proper EUO scheduling and the provider’s failure to appear is sufficient for a prima facie case, keeping the focus on attendance rather than administrative paperwork.
