Key Takeaway
Court ruling shows insurance companies must prove IME notices were properly mailed and patients failed to appear to deny no-fault benefits claims.
When insurance companies attempt to deny no-fault medical benefits based on a patient’s failure to appear for an Independent Medical Examination (IME), they must meet strict evidentiary standards. The burden of proof lies squarely on the insurer to demonstrate both proper notice and actual non-attendance. This 2011 appellate decision illustrates a common pitfall where insurance companies fail to establish these fundamental requirements, resulting in denied summary judgment motions and continued litigation.
Under New York No-Fault Insurance Law, IME no-shows can be legitimate grounds for benefit denials, but only when the insurance company can prove its case. The procedural requirements are not merely technicalities—they protect patients’ rights to receive proper notice and healthcare providers’ rights to payment for legitimate services.
Jason Tenenbaum’s Analysis:
Excel Radiology Serv., PC v Utica Mut. Ins. Co., 2011 NY Slip Op 50751(U)(App. Term 1st Dept. 2011)
“In this action to recover first-party no-fault medical benefits, defendant’s motion for summary judgment was properly denied since it failed to establish, prima facie, that the notices of the independent medical examinations (IMEs) were properly mailed to the assignor and that he failed to appear for the IMEs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720, 721 ; Marina v Praetorian Ins. Co., 28 Misc 3d 132, 2010 NY Slip Op 51292 ; cf. Inwood Hill Med., P.C. v General Assur. Co., 10 Misc 3d 18, 19-20 ).”
How bad was the vendor affidavit? Was there an affidavit from a healthcare professional attesting to the assignor’s failure to attend the IME?
Key Takeaway
This case demonstrates that insurance companies cannot simply assert an IME no-show defense without proper documentation. Courts require concrete proof of both proper mailing procedures and actual non-attendance. As seen in similar cases involving IME mailing failures, inadequate vendor affidavits and missing healthcare professional attestations often doom these defenses, leaving insurers liable for the disputed benefits.
Legal Update (February 2026): Since this 2011 decision, New York’s no-fault insurance regulations have undergone multiple revisions, including amendments to IME notice requirements, procedural standards for proving non-attendance, and evidentiary burden standards. Additionally, subsequent appellate decisions may have refined or modified the legal framework governing IME no-show defenses. Practitioners should verify current regulatory provisions and recent case law developments when handling IME-related benefit denials.
