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This article is part of our ongoing euo issues coverage, with 197 published articles analyzing euo issues issues across New York State. Attorney Jason Tenenbaum brings 24+ years of hands-on experience to this analysis, drawing from his work on more than 1,000 appeals, over 100,000 no-fault cases, and recovery of over $100 million for clients throughout Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx. For personalized legal advice about how these principles apply to your specific situation, contact our Long Island office at (516) 750-0595 for a free consultation.
When a healthcare provider repeatedly fails to appear for Examinations Under Oath (EUOs) in New York no-fault insurance cases, insurers gain significant leverage to deny claims. A recent appellate decision provides crucial guidance on when the clock starts ticking for insurance companies to make their coverage decisions, particularly in cases involving multiple no-shows.
The timing of EUO compliance has become increasingly important as insurers use these examinations as a primary tool to investigate potentially fraudulent claims. Understanding when a “failure to comply” becomes legally operative can mean the difference between payment and denial for healthcare providers seeking reimbursement under New York’s no-fault system.
This case highlights the complex interplay between procedural requirements and substantive coverage decisions, especially when EUO objections may prove futile and providers face multiple examination requests.
Jason Tenenbaum’s Analysis:
Quality Health Supply Corp. v Nationwide Ins., 2020 NY Slip Op 51226(U)(App. Term 2d Dept. 2020)
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“Where, as here, no other verification request is outstanding (see Alev Med. Supply, Inc. v New York Cent. Mut. Fire Ins. Co., 38 Misc 3d 143, 2013 NY Slip Op 50258 ), the 30-day period for an insurer to pay or deny a claim (see 11 NYCRR 65-3.8 ) based upon a failure to appear for an EUO begins to run on the date of the second EUO nonappearance, when an insurer is permitted to conclude that there was a failure to comply with a condition precedent to coverage”.
This one is interesting because there were three (3) no shows. Assuming the second EUO was a reschedule, we are left to assume the third EUO would have been the “second” no-show. It would appear the movant in this weird situation would have to proffer evidence that the second EUO was somehow excused. Very interestging.
Key Takeaway
The court established that insurers can begin their 30-day decision period after the second EUO no-show, not the first. This creates strategic implications for providers facing multiple examination requests, as they must be prepared to explain why any missed appointment was excused, particularly when dealing with cases involving repeated non-appearances.
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Legal Context
Why This Matters for Your Case
New York law is among the most complex and nuanced in the country, with distinct procedural rules, substantive doctrines, and court systems that differ significantly from other jurisdictions. The Civil Practice Law and Rules (CPLR) governs every stage of civil litigation, from service of process through trial and appeal. The Appellate Division, Appellate Term, and Court of Appeals create a rich and ever-evolving body of case law that practitioners must follow.
Attorney Jason Tenenbaum has practiced across these areas for over 24 years, writing more than 1,000 appellate briefs and publishing over 2,353 legal articles that attorneys and clients rely on for guidance. The analysis in this article reflects real courtroom experience — from motion practice in Civil Court and Supreme Court to oral arguments before the Appellate Division — and a deep understanding of how New York courts actually apply the law in practice.
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Disclaimer: This article is published by the Law Office of Jason Tenenbaum, P.C. for informational and educational purposes only. It does not constitute legal advice, and no attorney-client relationship is formed by reading this content. The legal principles discussed may not apply to your specific situation, and the law may have changed since this article was last updated.
New York law varies by jurisdiction — court decisions in one Appellate Division department may not be followed in another, and local court rules in Nassau County Supreme Court differ from those in Suffolk County Supreme Court, Kings County Civil Court, or Queens County Supreme Court. The Appellate Division, Second Department (which covers Long Island, Brooklyn, Queens, and Staten Island) and the Appellate Term (which hears appeals from lower courts) each have distinct procedural requirements and precedents that affect litigation strategy.
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