Why Trust This Analysis
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.
Understanding EUO Requirements: No Need for Objective Justification
When insurance companies request Examinations Under Oath (EUOs) in no-fault insurance cases, a common misconception persists that they must provide objective, specific reasons for making such requests. A 2018 appellate decision clarifies this misunderstanding and reinforces the established legal standard.
Key Takeaways
- An insurer does not need to articulate objective reasons for requesting an EUO to win summary judgment on a no-show defense.
- Under Interboro Ins. Co. v Clennon, the carrier’s prima facie burden is mechanical: two duly made demands, two failures to appear, and a timely denial.
- The Appellate Term in Gentlecare v GEICO applied this rule and rejected the objective-basis argument outright.
- Providers attacking an EUO no-show defense should focus on mailing proof, scheduling timeliness, and denial timeliness — not the insurer’s motives.
In New York No-Fault Insurance Law, EUOs serve as a crucial tool for insurers to investigate potentially fraudulent or questionable claims. The examination allows insurance companies to question claimants under oath about the circumstances surrounding their claims. However, the procedural requirements for requesting and enforcing EUOs have been the subject of ongoing litigation.
The legal landscape surrounding EUO no-shows and discovery waivers demonstrates how courts consistently prioritize procedural compliance over subjective reasoning. This approach reflects the court system’s emphasis on clear, mechanical standards rather than case-by-case evaluations of an insurer’s motivations.
The Decision
Jason Tenenbaum’s Analysis:
Gentlecare Ambulatory Anesthesia Servs.; Lyonel F. Paul, M.D. v GEICO Ins. Co., 2018 NY Slip Op 51773(U)(App. Term 2d Dept. 2018)
“Furthermore, defendant was not required to set forth objective reasons for requesting EUOs in order to establish its prima facie entitlement to summary judgment, as an insurer need only demonstrate “as a matter of law that it twice duly demanded an from the … that the twice failed to appear, and that the issued a timely denial of the claim[]” (Interboro Ins. Co. v Clennon, [*2]113 AD3d 596, 597 ”
Objective reasons? Non-sense.
The Legal Framework
The EUO is a creature of the no-fault regulation, 11 NYCRR 65, and the mandatory personal injury protection endorsement, which makes an eligible injured person’s (or assignee’s) appearance at a duly demanded examination under oath a condition precedent to coverage. When a claimant or provider twice fails to appear for properly scheduled EUOs, the carrier may deny all claims under the policy arising from that breach.
The objective-basis argument has an honest pedigree: the no-fault claims regulation directs carriers to have standards for when verification examinations are requested, and DFS opinion letters reference objective standards. Providers seized on this language to argue that a carrier must justify each EUO request in litigation. The Appellate Term’s answer, repeated in Gentlecare and the cases collected below, is that whatever internal standards a carrier maintains, proof of those standards is not part of the prima facie case. The provider cannot put the insurer’s reasons on trial in opposition to summary judgment when the demand, the no-shows, and the denial are established.
Why This Matters for Carriers and Providers
For carriers, the rule keeps the EUO no-show defense streamlined. The summary judgment package is the familiar trio: affidavits establishing the mailing of two EUO scheduling letters, proof (usually from counsel who appeared to conduct the examination) that the claimant failed to appear on both dates, and a timely denial on EUO no-show grounds. Nothing about claim-specific suspicion needs to be pleaded or proven.
For medical providers, the lesson is to stop litigating motive and start litigating mechanics. The vulnerable links in the chain are the same ones that decide IME no-show cases: defective mailing affidavits, scheduling letters sent to the wrong address, untimely denials, and follow-up requests that miss regulatory deadlines. An objection that the carrier “had no reason” to demand the EUO, by contrast, may well be futile.
Practice Pointers
- Carriers: keep the prima facie package tight — two demand letters with mailing proof, a no-show affirmation from the attorney assigned to take the EUO for each date, and a denial issued within 30 days of the second no-show.
- Carriers: maintain internal objective standards for EUO selection anyway; the regulation contemplates them, and discovery fights over them are easier when they exist.
- Providers: demand the scheduling letters and denial in discovery and check every date against the regulatory timeframes.
- Providers: if the EUO demand issue matters to your case, preserve it precisely — but recognize that the Appellate Term has repeatedly refused to add an objective-basis element to the carrier’s burden.
Frequently Asked Questions
Does a no-fault insurer have to give a reason for requesting an EUO?
Not to win summary judgment. Under Interboro Ins. Co. v Clennon and its progeny, the carrier need only prove that it twice duly demanded the EUO, that the claimant twice failed to appear, and that it issued a timely denial. The insurer’s underlying reasons are not an element of the defense.
What happens if a claimant skips two scheduled EUOs?
Appearance at a duly demanded EUO is a condition precedent to no-fault coverage. Two failures to appear constitute a breach that, when properly proven and timely denied, defeats the claims — regardless of whether the medical services themselves were legitimate.
How can a provider defeat an EUO no-show defense?
By attacking the mechanics: insufficient proof that the scheduling letters were mailed, letters sent to the wrong address, demands or follow-ups that missed regulatory deadlines, inadequate proof of non-appearance, or an untimely denial. Arguments about the insurer’s motives for demanding the EUO have consistently failed.
Related Resources
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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An ALROF citing
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Jul 6, 2014Frequently Asked Questions
Common Questions About This Topic
3 answers from the firm's New York personal-injury and employment-law practice. Click any question to expand.
Does a no-fault insurer have to give a reason for requesting an EUO?
Not to win summary judgment. Under *Interboro Ins. Co. v Clennon* and its progeny, the carrier need only prove that it twice duly demanded the EUO, that the claimant twice failed to appear, and that it issued a timely denial. The insurer's underlying reasons are not an element of the defense.
What happens if a claimant skips two scheduled EUOs?
Appearance at a duly demanded EUO is a condition precedent to no-fault coverage. Two failures to appear constitute a breach that, when properly proven and timely denied, defeats the claims — regardless of whether the medical services themselves were legitimate.
How can a provider defeat an EUO no-show defense?
By attacking the mechanics: insufficient proof that the scheduling letters were mailed, letters sent to the wrong address, demands or follow-ups that missed regulatory deadlines, inadequate proof of non-appearance, or an untimely denial. Arguments about the insurer's motives for demanding the EUO have consistently failed.
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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.
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