MUA Chiropractic Healthcare, PLLC v Nationwide Mut. Ins. Co., 2022 NY Slip Op 51384(U)(App. Term 2d Dept. 2023)
“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 (see Interboro Ins. Co. v Clennon, 113 AD3d 596 [2d Dept 2014]; NY Wellness Med., P.C. v Nationwide Mut. Ins. Co., 75 Misc 3d 126[A], 2022 NY Slip Op 50359[U] [App Term, 2d Dept, 9th & 10th Jud Dists 2022]; cf. Kemper Independence Ins. Co. v AB Med. Supply, Inc., 187 AD3d 671 [1st Dept 2020]; American Tr. Ins. Co. v Jaga Med. Servs., P.C., 128 AD3d 441 [1st Dept 2015]).”
The Court cites to Clennon, but Clennon never decided the issue of objective standards. It is one thing to demand that an EIP attend an EUO. I would surmise that if there is significant treatment, the carrier should be entitled to question the injured person on the facts of the claim and the treatment. As to the provider, I was always taught that an objective basis was required to compel this EUO. Common grounds are the EIP’s testimony is at odds with the bill or treatment, or a bona fide investigation shows a Mallela defense.
I think the Second Department if forced to confront the issue would probably side with the First Department on the objective basis issue. But the again, doesn’t the name “MUA Chiropractic Healthcare” make you cringe?
