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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 ).”
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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.
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Legal Context
Why This Matters for Your Case
New York law is among the most complex and nuanced in the country, with distinct procedural rules, substantive doctrines, and court systems that differ significantly from other jurisdictions. The Civil Practice Law and Rules (CPLR) governs every stage of civil litigation, from service of process through trial and appeal. The Appellate Division, Appellate Term, and Court of Appeals create a rich and ever-evolving body of case law that practitioners must follow.
Attorney Jason Tenenbaum has practiced across these areas for over 24 years, writing more than 1,000 appellate briefs and publishing over 2,353 legal articles that attorneys and clients rely on for guidance. The analysis in this article reflects real courtroom experience — from motion practice in Civil Court and Supreme Court to oral arguments before the Appellate Division — and a deep understanding of how New York courts actually apply the law in practice.
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Apr 13, 2011Was this article helpful?
Disclaimer: This article is published by the Law Office of Jason Tenenbaum, P.C. for informational and educational purposes only. It does not constitute legal advice, and no attorney-client relationship is formed by reading this content. The legal principles discussed may not apply to your specific situation, and the law may have changed since this article was last updated.
New York law varies by jurisdiction — court decisions in one Appellate Division department may not be followed in another, and local court rules in Nassau County Supreme Court differ from those in Suffolk County Supreme Court, Kings County Civil Court, or Queens County Supreme Court. The Appellate Division, Second Department (which covers Long Island, Brooklyn, Queens, and Staten Island) and the Appellate Term (which hears appeals from lower courts) each have distinct procedural requirements and precedents that affect litigation strategy.
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