The presumption of prejudice can be shattered if the medical provider can present evidence that the insurance company’s investigation was not destroyed.

Many times insurance companies like to make medical providers believe that if the insured fails to appear to an Examination Under Oath (EUO) the medical provider will not get paid any medical bills. It is true that insurance companies have a statutory right to request an Examination Under Oath and most insurance policies set forth procedures specifying how the insurance company is to take an EUO.

What happens when the patient/insured fails to appear to an examination under oath? Is the medical provider’s chances of getting paid doomed? Not always. One thing that is often overlooked is that there must be more than just the insured failing to appear to an EUO for an insurance company to avoid paying medical bills to a medical provider.

When an insured/patient fails to appear to an EUO, there is a presumption that the insurance company is “prejudiced” or hurt, meaning that it cannot investigate the PIP claim. However, this presumption is what the law calls a “bursting bubble” presumption, meaning that the presumption can be shattered and no longer exist if the medical provider can present evidence that the insurance company’s investigation was not destroyed by the insured/patient not appearing to the EUO.

For example, if the insurance company has information already in its investigation arsenal to show that there is no coverage or answers questions the insurance company would have wanted to ask the insured/patient at the EUO, then the presumption of prejudice bubble is burst and no longer exists. This can make the
insurance company’s examination under oath defense becomes invalid.

An experienced attorney should be able to find out if the presumption bubble is burst in an EUO no show case. Once this happens, then the medical provider can get paid its deserved PIP benefits owed to it.