Search Site
Menu
Free Consultation 24/7 516-227-2662
EUO

No-Fault Collection:

Physician/Healthcare Provider EUO

No-fault Regulations provide the no-fault insurer with the right to demand, as a condition to coverage, an examination under oath (“EUO”) of the applicant for benefits. As assignee of a claim, a healthcare provider is subject to the same obligation of responding to a request for an EUO. However, while a demand for an EUO of the assignor (patient) is essentially guaranteed, the EUO of a provider is NOT an automatic right of the insurance company. insurance carriers are required to provide some good faith basis for the EUO. The insurer’s right to demand an EUO does not give it unfettered right to disrupt medical professionals. Rather, the insurer must provide good faith reasons, based on objective standards, that serve as justification for the demand for an EUO. There is developing case law regarding what information insurance companies need to provide prior to a request for an EUO. As such, healthcare providers should consult an attorney upon demand for an EUO. Our no-fault attorneys have the knowledge and experience important to protect your rights.

The EUO is a verification tool used typically on claims being investigated by the insurance company. No-fault insurers use this procedure if they suspect a claim may be fraudulent or to dispute coverage. The insurance company will typically ask questions about your experience and treatment of the patient but may also want to inquire into your billing practices, your finances, your employees, and how your patients are referred to you. Based on the answers given, they can also ask you to produce documents, including tax returns, bank statements, leases, loan agreements and expense documentation. While the questions posed at the EUO may seem inconsequential, there are serious ramifications to the information provided, least of which might be denial of the claim.

EUOs are considered a policy condition to coverage. Failure to submit for an EUO is a “material breach” of an insurance policy that precludes coverage for future claims for that patient, arising out of the same accident. Pending claims may also be denied. If the pending claim is for treatment provided prior to the “EUO no-show”, a denial by the insurer may be found to be ineffective by an arbitrator or judge. A successful denial of claims due to a “no-show” defense does not create a right of recovery for the insurer for any benefits previously paid.

Before submitting to any EUO, it is important to consult with an attorney who knows what laws are in place to protect you. Our experienced no-fault attorneys can help you avoid unjustified requests for EUOs that take you away from time that would otherwise be spent providing health care to patients.

Verdicts & Settlements

Over One Billion in Verdicts, Settlements and Awards for Our Clients

  • $8 Million

    Plaintiff sustained a series of fractures and other injuries to the right shin, heel and foot, requiring nailing of the right tibia with two proximal and two distal locking bolts, ultimately resulting in below-the-knee amputation

  • $3 Million

    Infant plaintiff sustained encephalopathy as result of DPT vaccination administered by NYC Health and Hospitals Corporation.

  • $1.7 Million

    Plaintiff was involved in a car accident resulting in multiple disc herniations requiring percutaneous fluoroscopic-guided epidural treatment and lumbar fusion laminectomy.

  • $1.3 Million

    47 year old male police officer injured as a result of surgical malpractice by an orthopedic surgeon resulting in an inability to work and permanent impairment of gait.

  • $2 Million Dollar

    Wrongful death case settled at the Appellate level, 44-year-old husband and father drowned while swimming in a municipal pool.

  • $899,940.10

    69 year old female with underlying osteoporosis and preexisting spinal degeneration awarded as a result of a motor vehicle accident causing an acute T12 fracture of her spine.

Watch Our Videos
Meet Our Team
  • NYSTLA
    Nasaau County Bar Association
    NYSBA
    Queens County Bar Association
  • ABA
    ATLA
    Martindate Peer Review Rated
    Avvo Live Rating
  • Avvo Live Reviews
    Avvo Clients Choice 2018
    US Union Network
    TNTL Top 100
  • Top Attorneys NY Metro 2019
    Rising Star
    Rising Star
  • Client Champion
    SuperLawyers
    SuperLawyers
  • NYSTLA
  • Nasaau County Bar Association
  • NYSBA
  • Queens County Bar Association
  • ABA
  • ATLA
  • Martindate Peer Review Rated
  • Avvo Live Rating
  • Avvo Live Reviews
  • Avvo Clients Choice 2018
  • National Academy of Continuing Legal Education
  • Client Champion
  • SuperLawyers
  • SuperLawyers
Contact us

Quick Contact Form