Key Takeaway
New York Court of Appeals clarifies that no-fault insurers don't need objective criteria before requesting an Independent Medical Examination, unlike examinations under oath.
Understanding IME Requirements in New York No-Fault Insurance Cases
New York No-Fault Insurance Law contains specific procedural requirements that insurers must follow when investigating claims. One area that has generated significant litigation involves the standards insurers must meet before requesting different types of examinations. A 2011 Court of Appeals decision provided important clarity on the distinction between Independent Medical Examinations (IMEs) and examinations under oath.
The case highlights a critical procedural difference that affects how no-fault insurers can investigate potentially fraudulent or questionable claims. While examinations under oath require specific objective justification under Insurance Department Regulations, IMEs operate under different standards. This distinction has practical implications for both insurers defending IME no-show cases and healthcare providers challenging examination requests.
Jason Tenenbaum’s Analysis:
All County, LLC v Unitrin Advantage Ins. Co., 2011 NY Slip Op 50621(U)(App. Term 2d Dept. 2011)
“We note that, contrary to the finding of the District Court, while Insurance Department Regulations (11 NYCRR) § 65-3.5 (e) states that a no-fault insurer must base its request for an examination under oath upon “the application of objective standards so that there is specific objective justification supporting the use of such examination,” it does not impose such a standard on a request for an IME.”
When it comes to IME no-show cases, I must tip my hat to Unitrin. They are the Mercury of IME no-show cases.
Key Takeaway
This decision establishes that no-fault insurers have greater flexibility in requesting IMEs compared to examinations under oath. The court clarified that while objective criteria must support requests for examinations under oath, IME requests are not subject to the same stringent justification requirements. This ruling provides insurers with important procedural advantages when investigating claims through medical necessity reviews.
Legal Update (February 2026): Since this 2011 post was published, 11 NYCRR § 65-3.5 and related examination provisions may have been amended through regulatory updates or Insurance Department guidance. Additionally, subsequent appellate decisions may have further refined the standards and procedures governing IME requests versus examinations under oath. Practitioners should verify current regulatory language and recent case law developments when advising on IME procedural requirements.
