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Appellate Term upholds denial issued on Pre-Claim EUO no-show defense

Longevity Medical Supply, Inc., as Assignee of Hodge, Kerry, Respondent, v Nationwide Ins., Appellant.

Lower Court Index No. 708551/17

Appellate Term of the Supreme Court – Second Judicial Department

Appellate Term Docket # 2018-2563 KC

HLG’s “Pre-Claim” EUO Request Was Proper – Appellate Term Reverses Lower Court Decision

In this case, the insurer issued EUO requests to the Plaintiff’s Assignor before the Plaintiff ever submitted a claim/bill to Nationwide for reimbursement. Upon receipt of the action, Nationwide then moved for summary judgement. The lower court denied the insurer’s motion and the insurer appealed. On appeal, the Appellate Term concluded that simply because the EUO request of the Assignor (which was timely) was made prior to receipt of the medical provider’s bill, does not make the request a nullity and that the provider is therefore bound by its Assignor’s failure to comply with a condition precedent to coverage. 

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