Key Takeaway
When patients miss IME appointments, insurers must issue timely disclaimers to deny claims. These NY appellate cases clarify strict procedural requirements.
When Patients Fail to Appear for Independent Medical Examinations
In New York’s no-fault insurance system, Independent Medical Examinations (IMEs) serve as a critical tool for insurance carriers to evaluate the medical necessity of ongoing treatment. When a patient fails to appear for a scheduled IME, insurers cannot simply assume they have grounds to deny coverage. Instead, they must follow strict procedural requirements, including issuing timely disclaimer notices.
The timing and proper issuance of these disclaimers can make or break an insurance carrier’s defense. A no-show at an IME appointment creates an opportunity for the insurer to disclaim coverage, but only if they act within the statutory timeframes and follow proper notice procedures. The consequences of missing these deadlines are severe—carriers may lose their right to deny otherwise questionable claims.
Understanding these procedural requirements is essential for both healthcare providers submitting claims and insurance carriers defending against them. The following cases demonstrate how courts apply these rules when evaluating medical necessity disputes arising from IME no-shows.
Jason Tenenbaum’s Analysis:
Parkway Imaging & Diagnostic, P.C. v Clarendon Natl. Ins. Co., 2011 NY Slip Op 51853(U)(App. Term 2d Dept. 2011).
Triangle R, Inc. v Clarendon Natl. Ins. Co.,2011 NY Slip Op 51854(U)(App. Term 2d Dept. 2011)
Proscan Imaging Buffalo v Clarendon Natl. Ins. Co., 2011 NY Slip Op 51855(U)(App. Term 2d Dept. 2011)
Padova Physical Rehab. Medicine, P.C. v Praetorian Ins. Co., 2011 NY Slip Op 51862(U)(App. Term 2d Dept. 2011).
Key Takeaway
These Appellate Term decisions reinforce that insurance carriers must act swiftly and follow proper procedures when patients fail to appear for IMEs. The cases likely involved situations where carriers either failed to issue disclaimer notices within the required timeframe or did not properly substantiate the no-show circumstances. For healthcare providers operating under New York no-fault insurance law, these rulings provide important precedent for challenging improper claim denials based on IME non-attendance.
Legal Update (February 2026): Since this 2011 post was published, New York’s no-fault regulations have undergone several amendments affecting IME procedures and disclaimer requirements. Practitioners should verify current provisions regarding timing requirements for IME scheduling, notice procedures for non-appearances, and statutory deadlines for issuing disclaimers, as these procedural requirements may have been modified through regulatory updates or legislative changes.
