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The first pure Unitrin Appellate Term holding
IME issues

The first pure Unitrin Appellate Term holding

By Jason Tenenbaum 2 min read

Key Takeaway

Harmonic granted insurer summary judgment on IME no-show proof. Jason's 2011 note asks why the opinion did not mention a denial.

This article is part of our ongoing ime issues coverage, with 149 published articles analyzing ime issues issues across New York State. Attorney Jason Tenenbaum brings 24+ years of hands-on experience to this analysis, drawing from his work on more than 1,000 appeals, over 100,000 no-fault cases, and recovery of over $100 million for clients throughout Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx. For personalized legal advice about how these principles apply to your specific situation, contact our Long Island office at (516) 750-0595 for a free consultation.

Last reviewed: September 2026.

Historical note: Harmonic’s silence about a denial is narrower than an express holding on disclaimer; Gaines (2025, First Department) later stated that timely disclaimer was unnecessary on its properly noticed IME record.

The insurer won Harmonic Physical Therapy on appeal after proving that it mailed the IME notices and that the assignor missed the examinations. Jason’s question about the absence of any mention of a denial records what caught his attention in August 2011.

Jason’s original note

Harmonic Physical Therapy, P.C. v Praetorian Ins. Co., 2011 NY Slip Op 51597(U)(App. Term 1st Dept. 2011)

“In this action to recover assigned first-party no-fault benefits, defendant’s documentary submissions established prima facie that it mailed the notices of the independent medical examinations (IME) to the assignor and that the assignor failed to appear (see Unitrin Advantage Ins. Co. v Bayshore Physical Therapy, PLLC, 82 AD3d 559, 560 ; Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720, 721 ; Apollo Chiropractic Care, P.C. v Praetorian Ins. Co., 27 Misc 3d 139, 2010 NY Slip Op 50911 ).”

Is a denial mentioned anywhere?

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What the short opinion leaves unsaid

Harmonic v Praetorian, decided August 24, 2011, also found that the provider had raised no triable issue about attendance or the reasonableness of the requests. Those parts of the ruling matter alongside the original excerpt.

The opinion cites Unitrin. That First Department decision treated failure to attend properly requested IMEs as a coverage issue outside the ordinary preclusion rule for an untimely denial.

Harmonic does not discuss a denial; that silence does not establish that no denial existed. The clearer later statement is Gaines (2025), where the First Department expressly held that the insurer did not have to establish timely disclaimer. Gaines still required proof of properly noticed examinations and nonattendance.

Compare the four Second Department decisions later collected in October 2011: those opinions expressly accepted timely-denial evidence. The difference is worth keeping visible when reading the two sets of decisions.

Connect to the Encyclopedia

Start with the IME no-show case directory.

For review of a particular no-fault dispute, contact the firm with the scheduling letters, claim chronology and motion papers.

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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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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Jason Tenenbaum is a personal injury attorney serving Long Island, Nassau & Suffolk Counties, and New York City. Admitted to practice in NY, NJ, FL, TX, GA, MI, and Federal courts, Jason is one of the few attorneys who writes his own appeals and tries his own cases. Since 2002, he has authored over 2,353 articles on no-fault insurance law, personal injury, and employment law — a resource other attorneys rely on to stay current on New York appellate decisions.

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Discussion

Comments (26)

Archived from the original blog discussion.

LR
Larry Rogak
No denial is mentioned, but I find it hard to believe that if there were no denials, that issue would have flown under the radar.
ML
mitch lustig
Jeff Siegel in my office believes that is good for the defense that no denials were mentioned. In his opinion, the Court is treating the faiure to appear for an IME as breach of a condition precedent that voids the policy in which case you do not need any denials. But I have a questions? Under a liability policy, the insured is required to give notice. Notice is a condition precedent to coverage such that the failure to comply voids the policy. However, the insurer is still required to disclaim coverage in a timely manner. Why is a breach of condition precedent in no-fault different wherein the insurer does not have to issue a denial. Any comments
J
JT Author
I discussed that one awhile back. It is funny that nobody addressed that query. Jeff’s observation is quite astute.
ML
mitchell lustig
I agree that Jeff’s observation is astutue. But what about the answer to my inquiry regarding why no denial is needed under no-fault for a breach of a condition precedent to coverage while a timely disclaimer is needed under a liability policy for late notice and other conditions precedent to coverage. Basically I am questioning the validity of Unitrin and why a no-fault defense predicated on a breach of a condition precedent to coverage falls into the category of a lack of coverage defense where no denial or disclaimner is needed.
J
JT Author
Keep questioning, and good luck finding an answer. I tried to find one, but to no avail.
KL
Kurt LunDGREN
Mitch, your analysis is astute. As for Jeff, he is equally astute – but you are more equally astute than he. You did answer your own question. Under any other insurance policy there must be some form of a disclaimer. For instance, in UM or SUM, the carrier must do something to disclaim coverage. The same for general liability. However, there seems to be special rules of disclaimer applies in no-fault. It doesnt matter that it is a prompt pay statute, that there exists a 30 day rule, or that the NF regs must be strictly applied. Unitrin is just a bad decision. It makes no sense in terms of insurance law. That is the answer.
RZ
Raymond Zuppa
If anyone calls me astute I will be very upset
N
nycoolbreez
the decision does not say anything about the timing of the requests either…. Does the timing of the IME demand really matter if the failure to attend “voids the policy”? Does it matter that the NO SHOW is by the person who pays the premium or a 3d party beneficiary? and lastly do partners in no fault defense firms really want this kind of ruling given how slim the margins for outside counsel are starting to get?
J
JT Author
If the margins are slim, then beef up the Information Technology budget so you can do more with less. That way, you can (1) put out a more precise product at a fraction of the cost and can; (2) thrive off “reduced margins” and (3) prove that you are most cost efficient and better than in-house counsel.
ML
mitch lustig
JT, if we constantly continue to do more with less, many no-fault attorneys will find themselves unemployed. You can only reduce margins by so much. Too much cost efficiency is not such a good thing. I also agree with Coolbreeze that for the continued viability of defense counsel, the courts must strike a balance in thier decisions between medical providers and insurers. Finally, as to the timing of IME requests, often ignored by counsel is the fact that Court in Unitrin specifically stated that the insurers IME requests were timely demanded as per the no-fault regs.
J
JT Author
Mitch, I agree with paragraph #2; kind of agree with paragraph #3; and have no empathy towards those who find themselves in paragraph #1. I would say that people who go to law school need to understand the risks of the employment market before they undertake such financial risks. On the good side, I think a portion of the 2005 let’s hurt the consumer Bankruptcy Reform Act will be amended soon to allow the dischargability in bankruptcy of private education loans. This will help law students who cannot find work. In light of what I have been through, I am not too sympathetic towards the person in paragraph #1. The fact that efficiency might cost people jobs should only motivate them even more to find acceptable employment. When there is a will, there is a way. Been there, done that.
RZ
Raymond Zuppa
I graduated from Law School in 96. I had a job by March 96 and a number of offers. I never knew that No Fault existed. For the past 6 years it appears that No Fault has generated the largest segment of new employment of graduating attorneys. It has given them jobs but very little useful experience. Now the practice of law as degenerated to the string cite and a number of other external factors that I have been critical of. So No Fault lawyers could probably cut it in other areas. But you better know what you are doing in front of a jury. I don’t see much hope for the No Fault practitioner there. So I would not celebrate the pendulum swing to the defense side. Best for all would be no slant on the part of the judiciary. Provider attorneys cannot survive without denials and there will be less denials if the providers always win in court. Remember the commentator named cave man. He lost his job. I heard he’s working at a bait shop down in Sandy Hook.
KI
Keep it simple
This decision is from my company. The brief was submitted before Unitrin existed, I believe. The AT threw Unitrin in there with the kitchen sink. We would have won the appeal even if Unitrin didn’t exist. The IME requests were timely and proper, as were the additional verification requests and denials. I know a lot of carriers are demonized in these blogs. However, our policy is simple. If we don’t do something right, you get paid; and if we find something wrong with our defense, we settle. We have no interest in litigating cases that lack a proper defense. And while we’re a small company, this is why you see so many appeals in our name.
J
JT Author
What is funny is that Praetorian’s appeals have picked up where the Mercury appeals left off. I have seen Praetorian’s papers, and they tend to be pretty solid. The denials, verification requests and IME letters are mailed using a mailing ledger and the affidavits are clean. So whoever you are Mr. simple, you are doing something right. I am proud to say that you will be seeing more Interboro and Mercury appeals soon. I just filed Mercury v. Encare, which will be heard in November before the Appellate Division, First Department, unless it gets bumped to the December term. A win in Encare will be a great way to neutralize the mess that we were left with in Fair Price. I will also feel that I have done something worthwhile since Fogel, Pan Chiro and to a lesser extent, Cornell.
RZ
Raymond Zuppa
Oh God … this mushy mush love fest is making me sick and I long for real uncompromising men like Rogak. Praetorian. You know what that is. Why the very name means this company will fight to keep their policyholder’s money to the death. Look what they did to Russell Crowe’s family in Gladiator.
RZ
Raymond Zuppa
Kurt I know you didn’t mean that. You know me to well to call me astute. Prolix Ray. Verbose Ray. Tedious Ray. As the Court in Nassau County just called me. That’s Ray. Great line from the Movie Angels and Demons. Near the end of the movie — the last 45 minutes. The paid killer (I would have cast me in the role) has killed everyone. He informs Hanks and the femme fatale that they have been unharmed because 1) he is not being paid to kill them; 2) they have been unarmed. He warns that if they follow him then it will be different. He offers Hanks a word of advise. “Be cautious. These are men of religion.” Could have just as easily been: “Be cautious. These are people of justice.”
KL
Kurt LunDGREN
Oh Ray, you know that I know, that you are a voice crying out in the wilderness. You are the Ralph Nader of no-fault. Call it a man crush. I would love to be a fly on the wall to see JT and Ray go at it in Court. As I know both, I would say that whatever the result, the real fight would be over who paid for lunch. JT, let him buy! Ray is bigger.
J
JT Author
Did I ever tell any of you about the witness I had in a Family Offense proceeding who testified under oath that he (1) Consulted with private attorney generals; (2) Has been arrested and served time in Nassau County but did not know why; and (3) Might as well have said he was abducted by aliens? This was my star witness. I am not going to disclose how I got stuck trying this one, but I think going at it with Ray would probably be a more productive use of my time. And so the comment readers know, I have two appeals with Sun at the App. Term 1st Dept and one at the App. Term 2d Dept. He knows of one but does not know of the other two, because I haven’t sent the record to the printer. Without my disclosing the issues, does anyone want to place a wager on the outcome? By the way, happy labor day. Is anyone else besides me at the office? Kurt, Ray is going to be hosting a no-fault dinner outing, he just does not know it yet. All of us no-fault junkies will be coming out of the closet and will be in one room. He will pick a date, time and be paying for all of us who will be in attendance. All are welcome. Let the suggestions begin.
RZ
raymond zuppa
I’m up for it. I’ll do it. But I want full participation from those of us who meet here at the Defender.
RZ
raymond zuppa
Hey J.T. how is that proposed Law Review Article: What Does Unitrin Mean? — How is that going. I know you’ve written it but has any school expressed even the slightest interest in publishing it.
J
JT Author
There was an interesting article in this month’s Florida Bar Journal discussing Paper IME’s… I will scan it and throw it on here this week. I am sure those of you who foam at the mouth when there is even a thought about rolling back Presbyterian preclusion will have a heart attack when you read this thriller.
LR
Larry Rogak
JT wrote: “If the margins are slim, then beef up the Information Technology budget so you can do more with less. That way, you can (1) put out a more precise product at a fraction of the cost and can; (2) thrive off ‘reduced margins’ and (3) prove that you are most cost efficient and better than in-house counsel.” With all due respect, I hope you don’t choose your own personal physicians using these criteria, my friend.
RZ
raymond zuppa
I must say that no one has been tougher on Larry then me. But he got you J.T. Good one Larry. I expect you at the dinner. Also at the Dinner. A special treat. I am serious. Jimmy Hand and I do our presentation: “To Live and Die in Bethpage” It is all about our stint at the RPC.
LR
Larry Rogak
I hope my prior post was not misinterpreted. The point I was trying to make is that saving money through information technology should not be an end in itself. Cost efficiency is a good concept in the abstract, but there is a wide spectrum: at one end of that spectrum, there are lavish offices at fancy addresses with high overhead items that do nothing to enhance value to the client. At the opposite end of that spectrum, valuable personnel are being sacrificed so that documents can be produced by lawyers on the other side of the globe for a pittance. At the risk of sounding like a Luddite, I think that the overuse of IT in the legal field may take a valuable human element out of the practice and reduce insurance defense lawyers to little more than messengers who present documents to the court with a little allocution. Now I shall retire to my rocking chair on the front porch and smoke my pipe.
K
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