Key Takeaway
Court incorrectly rules IME findings aren't conclusive for post-IME treatments in no-fault insurance case, contradicting established precedent.
Huntington Med. Plaza, P.C. v Travelers Indem. Co., 2011 NY Slip Op 21471 (App. Term 2d Dept. 2011)
Facts:
Case #1: IME performed and all post IME services denied on the basis that they lack medical necessity. After trial, Defendant wins.
Case #2: Services performed after those performed in Case #1. Same IME.
Defendant in Case #2 moves in essence for summary judgment on the basis that the services lack medical necessity because of the finding after trial in Case #1. Civil Court denies the motion, and says the following:
“There is no case law of which this court is aware that makes an IME’s finding conclusive as to all post-IME treatment, that is, on the basis of a previous finding that there is no medical necessity for any other post-IME treatments not previously litigated. Obviously, insurers would be content with such a ruling (and there does exist a certain logic to it on public policy grounds) but, barring action by the state legislature, the Insurance Department or a higher court, it is left for the trial court to decide on a case by case basis.”
I think the court is wrong. Barnett v. Ives, 265 A.D.2d 865 (4th Dept. 1999). See, Martin v Geico Direct Ins., 31 A.D.3d 505 (2d Dept. 2006). C.f.???
Related Articles
- Understanding IME No-Shows in New York No-Fault Insurance: Rights, Consequences, and Strategic Considerations
- Understanding CPLR 3212(a): Critical Timing Rules for Summary Judgment Motions in New York
- The CPLR 3212(g) paradigm
- Reasonable excuse satisfied despite claim of lack of personal jurisdiction
- New York No-Fault Insurance Law
Legal Update (February 2026): Since this 2012 post discussing IME findings and medical necessity determinations, New York’s no-fault regulations have undergone several amendments, particularly regarding IME procedures, scheduling requirements, and the preclusive effect of medical necessity findings. The Department of Financial Services has also issued updated guidance on claim handling practices that may affect how courts approach the conclusiveness of IME determinations across related cases. Practitioners should verify current regulatory provisions and recent appellate decisions when advising on the preclusive effect of prior IME findings.
Common Questions
Frequently Asked Questions
What is New York's no-fault insurance system?
New York's no-fault insurance system requires all drivers to carry Personal Injury Protection (PIP) coverage. This pays for medical expenses and lost wages regardless of who caused the accident, up to policy limits. However, you can only sue for additional damages if you meet the 'serious injury' threshold.
