Donde esta Unitrin?

Understanding IME No-Show Procedures in No-Fault Cases

In New York’s no-fault insurance system, insurance carriers have the right to require injured claimants to attend Independent Medical Examinations (IMEs) to verify the medical necessity of ongoing treatment. When claimants fail to appear for scheduled IMEs without reasonable excuse, carriers can deny claims based on lack of cooperation. However, insurers must follow strict procedural requirements when scheduling IMEs and denying claims for non-appearance.

The proof requirements for IME no-shows have evolved through extensive case law. Insurance carriers must demonstrate they properly scheduled the examination, provided adequate notice to the claimant, and that the claimant actually failed to appear. Additionally, carriers must show they timely mailed denial forms after the no-show. These evidentiary requirements protect claimants from improper denials while preserving carriers’ legitimate rights to verify medical necessity through examinations.

Case Background: Vincent Medical Services v New York Central Mutual

Jason Tenenbaum’s Analysis:

Vincent Med. Servs., P.C. v New York Cent. Mut. Fire Ins. Co., 2011 NY Slip Op 51718(U)(App. Term 2d Dept. 2011).

In support of its cross motion, defendant submitted an affidavit of an employee of Allegiance which sufficiently established that the IME requests had been timely mailed in accordance with Allegiance’s standard office practices and procedures (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 ; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 ). Defendant also submitted an affidavit of the chiropractor/acupuncturist who was to perform the IMEs, which was sufficient to establish that plaintiff’s assignor had failed to appear for the duly scheduled IMEs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 ). In addition, an affidavit executed by defendant’s litigation examiner demonstrated that the claim denial forms, which denied the claims based on plaintiff’s assignor’s nonappearance at the IMEs, had been timely mailed pursuant to defendant’s standard office practices and procedures”

I like Unitrin.  It saddens me when it does not even earn “but see” treatment.  Note the cite to Westchester v. Lincoln.  I have yet to see a case entitled “Westchester v. Lincoln” or any case that Lincoln appealed to the Appellate Division, Second Department that has helped the defense bar.  I think Lincoln should stop appealing cases to the Second Department.

Legal Significance: The Standard Office Practice Doctrine

The Vincent Medical Services decision demonstrates the application of the “standard office practice” doctrine to IME no-show cases. This evidentiary principle allows witnesses to testify that documents were mailed based on their knowledge of office procedures that invariably result in mailing, even when they didn’t personally witness the specific mailing. The doctrine recognizes the practical reality that large organizations cannot have witnesses personally observe every mailing, yet must still be able to prove service occurred.

However, courts require detailed testimony establishing these standard practices. Affiants must explain what the office procedures are, how they ensure mailings occur, and how they personally know these procedures were followed in the specific instance. Generic statements that “we have standard practices” don’t suffice. The affidavit must describe the process: who prepares documents, who reviews them, how they’re placed in mail, what quality controls exist, and the affiant’s personal knowledge of these procedures through their employment.

The decision also addresses proof of IME non-appearance. The chiropractor/acupuncturist’s affidavit established that the claimant failed to appear for scheduled examinations. Courts require such affidavits to demonstrate the affiant’s basis of knowledge—either personal presence at the examination location or review of records documenting who appeared and who didn’t. When properly done, as in this case, such affidavits provide sufficient foundation for summary judgment on no-show defenses.

Practical Implications: The Unitrin Question

Jason Tenenbaum’s commentary about Unitrin Advantage Ins. Co. v Bayshore Physical Therapy, 82 AD3d 559, reflects ongoing debate about IME scheduling requirements. Unitrin held that carriers must use addresses where claimants actually receive mail, not just addresses in the carrier’s file. The Vincent Medical Services decision’s failure to cite or distinguish Unitrin raises questions about whether subsequent courts are consistently applying that precedent.

This inconsistency creates uncertainty for carriers scheduling IMEs. If Unitrin applies broadly, carriers must verify current addresses before scheduling examinations, potentially through phone contact or correspondence confirming where claimants actually receive mail. If Unitrin has limited application or is being effectively ignored in some cases, carriers can rely on addresses in their files even when claimants may not be receiving mail there. The lack of consistent citation to Unitrin in no-show cases suggests its application remains unsettled.

Related Articles

• A court in Nassau has applied Unitrin through a front door and back door channel
• Understanding IME No-Shows in New York No-Fault Insurance Cases
• IME Notification Requirements in New York No-Fault Cases: Address Matching Rules
• IME No Show: Understanding Confusing Court Interpretations of Duplicate Mailing Requirements
• New York No-Fault Insurance Law

Legal Update (February 2026): Since this 2011 decision, New York’s no-fault insurance regulations have undergone several amendments, including updates to IME scheduling procedures, notice requirements, and claim denial documentation standards. Practitioners should verify current regulatory provisions under 11 NYCRR Part 65 and recent appellate decisions when relying on the procedural requirements and evidentiary standards discussed in this case.