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Insurance Company Can’t Force “Examination Under Oath”

taking-oathCar insurance companies in Massachusetts constantly search for new and unique ways to deny or reduce medical bills related to treatment for people hurt in car accidents. Part of the Massachusetts Automobile Insurance Policy requires insureds and their injured passengers to cooperate with insurance companies in their investigations of car accidents. While “cooperation” isn’t defined in the insurance policy, insurance companies can require their insureds and injured people in the insured vehicle to attend an “Examination Under Oath.” An Examination Under Oath, or EUO, is essentially a deposition or inquiry conducted by an attorney hired by the insurance company to investigate the circumstances of the accident and the medical treatment. Historically, if an insured or the injured passenger didn’t show up for the EUO, the insurance company would deny the claim as a result of “non-cooperation.”

Over the last few years, insurance companies have stretched the boundaries of the demand for cooperation. They have requested that medical professionals who are providing treatment to the insured or their passengers appear for these EUO’s. Some medical professionals have done so, others have refused. Certain Massachusetts insurance companies have used that refusal on the part of the medical professional to appear for an EUO as a reason to deny payment of medical bills.

In a recent decision out of one of the Massachusetts District Courts, VIP Physical Therapy, Inc. v. GEICO, Judge William Hadley disagreed with GEICO in its denial of medical bills owed to an insured. GEICO used the fact that the physical therapist didn’t attend an EUO as a reason to deny bills.

Robert E. Mazow of Mazow & McCullough, PC in Salem represents medical providers in PIP cases. While not involved in VIP Physical Therapy, he called the ruling an “important reminder” to auto insurers that the primary purpose of the PIP statute is to provide those injured in car accidents with a quick and efficient method for payment of related medical bills.

“Requiring that medical providers jump through hoops and attend what are essentially depositions without boundaries puts an unfair burden on providers and their patients and stretches the PIP statute beyond the breaking point,” Mazow said. “Moreover, the PIP statute simply cannot be logically construed so as to extend the duty to provide an EUO beyond insureds and claimants.”

Because Judge Hadley determined that the insurance company has no authority under the law to demand that medical providers attend EUO’s, he ordered that the patient’s medical bills be paid.

While this decision is non-binding on other courts, it certainly sends a strong message to the insurance industry that “cooperation” has its boundaries in the Massachusetts automobile insurance context.

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