Key Takeaway
All Borough Group v. Utica Mutual Insurance provides crucial precedent for New York no-fault insurance IME disputes and medical provider rights.
Understanding IME Disputes in New York No-Fault Insurance Cases
Independent Medical Examinations (IMEs) represent one of the most contentious aspects of New York No-Fault Insurance Law. When insurance carriers dispute the medical necessity of treatment or seek to terminate benefits, they often schedule IMEs to obtain independent medical opinions. However, the process surrounding these examinations is fraught with procedural requirements and potential pitfalls for both insurers and medical providers.
The case of All Borough Group Medical Supply, Inc. v. Utica Mutual Insurance Company highlights critical issues that frequently arise in no-fault insurance disputes. Medical supply companies, healthcare providers, and patients often find themselves navigating complex rules about IME scheduling, notification requirements, and the consequences of examination outcomes.
These disputes typically involve questions about proper notice procedures, whether IME letters need to be sent to specific parties, and what constitutes adequate compliance with statutory requirements. The stakes are high because IME results can determine whether ongoing treatment remains covered under no-fault benefits or if coverage will be discontinued.
For medical providers and patients dealing with similar situations, understanding the legal precedents established in cases like All Borough Group can be crucial for protecting their rights and ensuring proper compliance with no-fault insurance procedures. The decision addresses fundamental questions about medical necessity determinations and the procedural safeguards that must be followed in IME processes.
Jason Tenenbaum’s Analysis:
All Borough Group Medical Supply, Inc. v. Utica Mut. Ins. Co., 2011 N.Y. Slip Op. 50949(U)(App. Term 2d Dept. 2011).
I would seriously read this decision.
Key Takeaway
This case serves as an important precedent for understanding IME-related disputes in New York’s no-fault insurance system. Medical providers and patients should carefully examine this decision as it likely addresses critical procedural requirements or substantive issues that could impact future cases. Whether the dispute involves IME no-show situations, substantiated absences, or other IME-related complications, the principles established in All Borough Group may provide valuable guidance for similar disputes involving insurance carriers’ examination requirements and coverage determinations.
Legal Update (February 2026): Since this 2011 post was published, New York’s no-fault insurance regulations have undergone several revisions, particularly regarding IME notification procedures, scheduling requirements, and timeframes for examination requests. The regulatory framework governing independent medical examinations may have been modified through amendments to 11 NYCRR Part 65, and practitioners should verify current provisions regarding notice requirements and procedural compliance standards.
