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IME no show – complied with Neptune, AT v. Vance and 3.5(b); 3.6(b)September 29, 2016

“Defendant also established that the assignor had failed to appear for the duly scheduled IMEs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]). Defendant further demonstrated that, upon receipt of the claims, it had timely mailed initial and follow-up requests for written verification (see 11 NYCRR 65-3.5 [b]; 65-3.8 [l]; St. Vincent’s Hosp. of Richmond, 50 AD3d 1123). Finally, defendant established that, upon receiving the requested verification, it had timely denied the claims at issue based upon the assignor’s failure to appear for IMEs

This is a case where it appears the first IME date was scheduled within 30-days of receipt of the billing.  Also, the billing was delayed pending verification and the carrier properly waited for the verification prior to denying the billing on the policy violation.

 

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