Sacks and Howard III Secure Favorable Decision Regarding Insurer’s Denial

January 9, 2018 | Insurance Fraud

Andrea Sacks and Floyd Howard III secured a favorable decision on a motion for summary judgment involving GEICO’s verification process and a medical provider’s failure to appear at examinations under oath (EUOs).  Relying on the court’s historical position that an insurer’s follow-up request for an EUO must be mailed within 10 calendar days after a medical provider’s failure to appear at an EUO, the Plaintiff argued that GEICO’s issuance of the letter 13 days after the initial non-appearance negated the validity of GEICO’s denial.

On cross-motion for summary judgment and at subsequent oral argument, Howard and Sacks convinced the court that the mailing of the second EUO scheduling letter 13 days after the initial EUO date in no way prejudiced the medical provider and still acted to toll the time to pay or deny the claim and therefore, was not fatal to GEICO’s defense.

This decision represents the recent shift in the No-Fault landscape as to what qualifies as non-substantive “defects” related to an insurer’s request for EUOs and the denial-of-claim process.

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