Key Takeaway
Learn about objective standards for no-fault insurance examinations under oath on Long Island. Expert legal analysis from Jason Tenenbaum. Call 516-750-0595.
This article is part of our ongoing no-fault coverage, with 271 published articles analyzing no-fault 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.
Understanding Objective Standards for No-Fault Insurance Examinations Under Oath
In a recent decision that has significant implications for no-fault insurance claims on Long Island, the Appellate Term addressed whether insurance companies need objective reasons to request Examinations Under Oath (EUOs) from healthcare providers. The case, MUA Chiropractic Healthcare, PLLC v Nationwide Mut. Ins. Co., 2022 NY Slip Op 51384(U)(App. Term 2d Dept. 2023), raises important questions about the balance of power between insurers and medical providers in no-fault disputes.
What Are Examinations Under Oath in No-Fault Cases?
An Examination Under Oath (EUO) is a formal proceeding where an insurance company can compel an injured person or medical provider to answer questions under oath about a claim. Think of it as a sworn statement, similar to a deposition, but conducted by the insurance company as part of their investigation process.
For injured parties, EUOs typically focus on:
- The circumstances of the accident
- The extent and nature of injuries
- Treatment received and its necessity
- Previous medical history
- Employment and lost wage claims
For healthcare providers, EUOs usually examine:
- The medical treatment provided
- Billing practices and procedures
- Patient records and documentation
- The provider’s relationship with the patient
- Compliance with no-fault regulations
The Legal Issue: Objective Standards for Provider EUOs
The central question in the MUA Chiropractic Healthcare case was whether insurance companies must demonstrate objective reasons before requesting an EUO from a medical provider. This is a critical distinction that affects the rights of both providers and patients in the personal injury and no-fault insurance system.
The Court’s Ruling
The court stated: “Plaintiff does not argue that defendant did not demonstrate its prima facie entitlement to summary judgment. Rather, plaintiff argues that defendant did not have an objective basis for requesting the EUOs. However, contrary to plaintiff’s contention, defendant was not required to set forth objective reasons for requesting EUOs in order to establish its prima facie entitlement to summary judgment.”
The court cited several cases supporting this position, including Interboro Ins. Co. v Clennon, NY Wellness Med., P.C. v Nationwide Mut. Ins. Co., and others. However, as our analysis reveals, this ruling may not reflect the complete legal landscape.
A Critical Analysis of the Decision
Attorney Jason Tenenbaum notes a significant issue with the court’s reasoning: “The Court cites to Clennon, but Clennon never decided the issue of objective standards.” This observation highlights a potential flaw in the court’s legal analysis and suggests that the precedent may not be as clear-cut as the decision implies.
The distinction between injured persons and medical providers is crucial here. While it may be reasonable for insurance companies to examine injured parties about their claims and treatment—especially when there’s significant treatment involved—the standards for compelling provider EUOs should arguably be higher.
What This Means for You
If You’re an Injured Party
Understanding your rights regarding EUOs is essential if you’ve been injured in a motor vehicle accident on Long Island. Insurance companies generally have broad authority to examine you under oath, particularly when:
- You’ve received extensive medical treatment
- There are questions about the accident circumstances
- You’re claiming significant lost wages
- There are discrepancies in your medical records
However, these examinations must be conducted fairly and within legal bounds. You have the right to legal representation during an EUO, and your attorney can object to improper questions or procedures.
If You’re a Medical Provider
The MUA Chiropractic Healthcare decision suggests that insurance companies may not need to demonstrate objective reasons before requesting your EUO. However, this area of law remains complex, and the standards may vary depending on the jurisdiction and specific circumstances.
Traditional grounds for provider EUOs include:
- Discrepancies between the patient’s testimony and treatment records
- Evidence suggesting potential fraud or abuse
- Questions about the necessity or appropriateness of treatment
- Billing irregularities or patterns
The Broader Legal Landscape
Jurisdictional Differences
Attorney Tenenbaum observes: “I think the Second Department if forced to confront the issue would probably side with the First Department on the objective basis issue.” This suggests that different appellate courts may have varying approaches to the objective standard requirement, creating potential inconsistencies in how these cases are handled across New York State.
This jurisdictional variation means that the outcome of your case may depend significantly on where it’s filed and which court ultimately decides the matter. This underscores the importance of having experienced legal representation familiar with local court practices and precedents.
The Mallela Defense
One commonly accepted ground for requesting provider EUOs is when there’s evidence supporting a Mallela defense. This refers to situations where the insurance company believes the provider may have engaged in fraudulent billing practices or provided unnecessary treatment. When a “bona fide investigation shows a Mallela defense,” courts have generally found this to constitute sufficient objective grounds for an EUO.
Protecting Your Rights in No-Fault Disputes
Whether you’re an injured party dealing with insurance company demands or a medical provider facing an EUO request, understanding your rights is crucial. The evolving legal landscape around objective standards makes it essential to have knowledgeable legal representation.
Key steps to protect yourself include:
- Respond promptly to insurance company requests
- Maintain detailed records of all communications
- Seek legal advice before agreeing to an EUO
- Understand your rights and obligations under no-fault law
- Don’t face the insurance company alone
Frequently Asked Questions About EUOs
Can I refuse to attend an Examination Under Oath?
Generally, no. If properly requested, EUOs are mandatory under no-fault insurance regulations. However, you have the right to legal representation during the examination, and your attorney can challenge improper or abusive EUO requests.
What happens if I don’t cooperate with an EUO?
Failure to cooperate with a properly requested EUO can result in the denial of your no-fault benefits or the dismissal of your provider’s claim for payment. Insurance companies can use non-cooperation as grounds to stop paying benefits.
Do I need a lawyer for an EUO?
While not legally required, having an attorney present during an EUO is highly recommended. Your lawyer can protect your rights, object to improper questions, and ensure the examination stays within proper bounds.
How long does an EUO typically last?
EUOs can last anywhere from one to several hours, depending on the complexity of the case and the issues being examined. Your attorney can help ensure the examination doesn’t become unnecessarily prolonged or abusive.
Can the insurance company ask about my personal medical history?
The scope of questioning in an EUO is generally limited to matters relevant to the claim. While some personal medical history may be relevant, your attorney can object to overly broad or intrusive questions that don’t relate to your current claim.
The Importance of Experienced Legal Representation
The MUA Chiropractic Healthcare decision and the ongoing evolution of objective standards in EUO cases demonstrate why experienced legal representation is essential in no-fault insurance matters. These cases involve complex legal issues that can significantly impact your rights and financial recovery.
At the Law Office of Jason Tenenbaum, we stay current with the latest developments in no-fault law and work tirelessly to protect our clients’ interests. Whether you’re facing an EUO demand or dealing with other no-fault insurance disputes, we have the experience and knowledge to guide you through the process.
Don’t let insurance companies take advantage of unclear legal standards or procedural complexities. Your rights matter, and you deserve representation that understands both the law and the practical realities of no-fault insurance disputes.
If you’re facing an Examination Under Oath or other no-fault insurance issues on Long Island, don’t navigate this complex legal landscape alone. Call 516-750-0595 for a free consultation with an experienced no-fault insurance attorney who will fight for your rights and ensure you receive the benefits you deserve.
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Legal Context
Why This Matters for Your Case
New York's no-fault insurance system, established under Insurance Law Article 51, is one of the most complex insurance frameworks in the country. Every motorist must carry Personal Injury Protection coverage that pays medical expenses and lost wages regardless of fault, up to $50,000 per person.
But insurers routinely deny valid claims using peer reviews, EUO scheduling tactics, fee schedule reductions, and coverage defenses. The Law Office of Jason Tenenbaum has handled over 100,000 no-fault cases since 2002 — from initial claim submissions through arbitration before the American Arbitration Association, trials in Civil Court and Supreme Court, and appeals to the Appellate Term and Appellate Division. Jason Tenenbaum is one of the few attorneys in the state who both writes his own appellate briefs and tries his own cases.
His 2,353+ published legal articles on no-fault practice are cited by attorneys throughout New York. Whether you are dealing with a medical necessity denial, an EUO no-show defense, a fee schedule dispute, or a coverage question, this article provides the kind of detailed case-law analysis that helps practitioners and claimants understand exactly where the law stands.
About This Topic
New York No-Fault Insurance Law
New York's no-fault insurance system requires every driver to carry Personal Injury Protection (PIP) coverage that pays medical expenses and lost wages regardless of who caused the accident. But insurers routinely deny, delay, and underpay valid claims — using peer reviews, IME no-shows, and fee schedule defenses to avoid paying providers and injured claimants. Attorney Jason Tenenbaum has litigated thousands of no-fault arbitrations and court cases since 2002.
271 published articles in No-Fault
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About the Author
Jason Tenenbaum, Esq.
Jason Tenenbaum is the founding attorney of the Law Office of Jason Tenenbaum, P.C., headquartered at 326 Walt Whitman Road, Suite C, Huntington Station, New York 11746. With over 24 years of experience since founding the firm in 2002, Jason has written more than 1,000 appeals, handled over 100,000 no-fault insurance cases, and recovered over $100 million for clients across Long Island, Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, the Bronx, and Staten Island. He is one of the few attorneys in the state who both writes his own appellate briefs and tries his own cases.
Jason is admitted to practice in New York, New Jersey, Florida, Texas, Georgia, and Michigan state courts, as well as multiple federal courts. His 2,353+ published legal articles analyzing New York case law, procedural developments, and litigation strategy make him one of the most prolific legal commentators in the state. He earned his Juris Doctor from Syracuse University College of Law.
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.
If you need legal help with a no-fault matter, contact our office at (516) 750-0595 for a free consultation. We serve clients throughout Long Island (Huntington, Babylon, Islip, Brookhaven, Smithtown, Riverhead, Southampton, East Hampton), Nassau County (Hempstead, Garden City, Mineola, Great Neck, Manhasset, Freeport, Long Beach, Rockville Centre, Valley Stream, Westbury, Hicksville, Massapequa), Suffolk County (Hauppauge, Deer Park, Bay Shore, Central Islip, Patchogue, Brentwood), Queens, Brooklyn, Manhattan, the Bronx, Staten Island, and Westchester County. Prior results do not guarantee a similar outcome.
