A court in Nassau has applied Unitrin through a front door and back door channel

Understanding Unitrin’s Impact on Nassau County No-Fault IME Cases

For legal practitioners and medical providers throughout Long Island and the greater New York metropolitan area, understanding the evolving landscape of no-fault insurance law represents a critical component of successful case management. A recent Nassau County court decision has applied the principles established in Unitrin v. Bayshore through both direct and indirect legal channels, creating important precedent for IME no-show cases across Suffolk County, Queens, Brooklyn, and Manhattan.

This analysis examines how Nassau County courts are interpreting the intersection between the Court of Appeals decision in New York Presbyterian Hospital v. Countrywide and the established precedent in Unitrin v. Bayshore, providing crucial insight for legal professionals practicing in the New York area’s complex no-fault insurance environment.

The Legal Framework: Unitrin v. Bayshore Precedent

As I indicated at one point prior, there is an issue as to whether NYP v. Countrywide has aligned the Court of Appeals with Unitrin v. Bayshore. One Court seems to have agreed with my proposition. “American Transit v. Mayo“, index # 1573/11 (Sup. Ct. Nassau. Co. 2012 )

I have copied the “.pdf” I received in the mail onto this blog.

Case Analysis: American Transit Insurance Company v. Mayo

Court Details and Procedural History

SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF NASSAU
———————————————————————————————————-X
AMERICAN TRANSIT INSURANCE COMPANY,
-against-
ANDREW MAYO,
BARON LEA, INC.,
BEST TOUCH, P.T., P.C.
Plaintiff,
BRAND MEDICAL SUPPLY, INC.,
D&H REHABILITATION MEDICAL, P.c.
DOVPHIL ANESTHESIOLOGY GROUP, PLLC.,
DYNAMIC MEDICAL IMAGING, P.C.
ENJOY REHAB, P.T., P.C.
FREEDOM CHIROPRACTIC, P.C.
KKM MEDICAL DIAGNOSTICS, P.C.
MIDWOOD TOTAL REHABILITATION MEDICAL, P.C.
MIRA ACUPUNCTURE, P.C.
PARK RADIOLOGY, P.C.
PARK SLOPE ADVANCED MEDICAL, PLLC.
SAS MEDICAL, P.C.
TARNOFF CHIROPRACTIC, P.c.
BIO REFERENCE LABS
BRUCEC. BROMBERG, D.C.
DAVID HERSHKOWITZ, D.C.
Defendants.
———————————————————————————————————-X
Papers Read on this Motion:
Plaintiff’s Notice of Motion 01
MICHELE M. WOODARD
J.S.C.
TRIAL/IAS Part 8
Index No.: 11573/11
Motion Seq. No.: 01

Motion for Default and Summary Judgment

Upon the foregoing papers, this unopposed motion by the plaintiff, AMERICAN TRANSIT INSURANCE COMPANY, for leave to enter a default judgment against defendants: ANDREW MAYO, BARON LEA, INC., BEST TOUCH, P.T., P.C., D&H REHABILITATION MEDICAL, P.C.; DOVPHIL ANESTHESIOLOGY GROUP, PLLC., DYNAMIC MEDICAL IMAGING, P.C.; ENJOY REHAB, P.T., P.C.; FREEDOM CHIROPRACTIC, P.C.; KKM MEDICAL DIAGNOSTICS, P.C’! MIDWOOD TOTAL REHABILITATION MEDICAL, P.C.; MIRA ACUPUNCTURE,P.C.; PARK RADIOLOGY, P.C.; PARK SLOPE ADVANCED MEDICAL, PLLC.; SAS MEDICAL, P.C.; TARNOFF CHIROPRACTIC; P.C.; BIO REFERENCE LABS; BRUCE C. BROMBERG, D.C.; DAVID HERSHKOWITZ, D.C. (hereinafter “defaulting defendants”), ordering, adjudging and decreeing that the above defendants are not entitled to no-fault coverage for a motor vehicle accident that occurred on September 7, 2010 is granted.

Similarly, this unopposed motion for summary judgment against BRAND MEDICAL SUPPLY,INC., (“appearing defendants”) ordering, adjudging and decreeing that the above defendant is not entitled to no-fault coverage for a motor vehicle accident that occurred on September 7, 2010 is granted.

Factual Background and IME Requirements

The September 7, 2010 Motor Vehicle Accident

According to the proofs submitted on this motion, a policy of insurance under BY Al 02536 was issued and in effect on September 7, 2010, when Defendant ANDREW MAYO (an eligible injured person) was involved in a motor vehicle accident. An Independent Medical Examination (hereinafter “IME”) scheduling letter, with proper proof of mailing was sent to ANDREW MAYO on November 19,2010, requesting his appearance for an IME on December 2, 2010. Defendant ANDREW MAYO failed to attend this IME, as is evidenced through the affidavits of the IME vendor and the healthcare professionals who were supposed to conduct the IME.

A follow-up IME scheduling letter, with proper proof of mailing was sent to Defendant ANDREW MAYO on December 6, 2010, scheduling an WE for December 15, 2010. Defendant ANDREW MAYO failed to attend this IME, as is evidenced through the affidavits of the IME vendor and the healthcare professionals who were supposed to conduct the IME. On December 23, 2010, the claim was denied on the basis inter alia that Defendant ANDREW MAYO failed to appear for his IME appointments.

Legal Analysis and Discussion

IME as Condition Precedent to Coverage

An appearance at an IME is a condition precedent to coverage under the no-fault policy of insurance, which all insurance policies are construed to contain. Ins. Law § 5106(a). See Apollo Chiropractic Care, P.C. v Praetorian Ins. Co., 2010 NY Slip Op 50911(U), 27 Misc 3d 139(A)(App. Term 1st Dept. 2010). An IME is also a verification request.

The law requires that “ requests be made in compliance with the time limits set forth in the verification procedures.” Inwood Hill Medical. v. Allstate Ins. Co., 15 Misc. 3d 143(A)(App. Term 1st Dept. 2007) citing 11 NYCRR65- 3.5(b); 11 NYCRR 65- 3.6(b); Bronx Med. Servs. P.C. v Windsor Ins. Co. 2003 NY Slip Op 50885(U)(App. Term. 1st Dept. 2003).

Proof Requirements for IME Scheduling

An insurance carrier must also prove that the IME letters were mailed (St. Vincent’s Hasp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 ) and that the injured person failed to attend the.IME’s. Stephen Fogel Psychological, P. e. v Progressive Cas. Ins. Co., 35 AD3d 720 (2d Dept. 2006). See Celtic Med. P.e. v New York Cent. Mut. Fire Ins. Co., 15 Misc.3d 13 (App. Term 2d Dept. 2007).

The Unitrin Advantage Decision and Its Application

Appellate Division Holding

The Appellate Division also held that: “The failure to appear for IMEs requested by the insurer when, and as often as, it may reasonably require (Insurance Department Regulations § 65-1.1) is a breach of a condition precedent to coverage under the no-fault policy, and therefore fits squarely within the exception to the preclusion doctrine, as set forth in Central Gen. Hosp. v Chubb Group of Ins. Cos. (90 NY2d 195 ). Accordingly, when defendants’ assignors failed to appear for the requested IMEs, plaintiff had the right to deny all claims retroactively to the date of loss, regardless of whether the denials were timely issued. Unitrin Advantage Ins. Co. v Bayshore Physical Therapy, PLLC, 82 AD3d 559, 560 (1st Dept 2011).

Court of Appeals Analysis in NYP v. Countrywide

The Court of Appeals in New York & Presbyt. Hasp. v Country-Wide Ins. Co., 17 NY3d 586 (2011), in a similar matter observed that where there “as a failure to fully comply with the terms of the no-fault policy … which is a condition precedent to insurer liability … the assignment effectively became worthless … you cannot assign your right to benefits if your right to those benefits has not been triggered, or if you had no right to those benefits in the first place.”

Timing Requirements and Proof Standards

30-Day Denial Requirements

Similarly there was ample proof that the claim was denied within 30-days from the last IME no-show. Westchester Med. Ctr. v Lincoln Gen. Ins. Co., 60 AD3d 1045 (2d Dept 2009); Interboro Ins. Co. v Bennet, 2011 WL 5006424 (Sup. Ct. Nassau Co. 2011). C.f. New York & Presbyt. Hosp. v Country-Wide Ins. Co., 17 NY3d 586 at 592-593.

Default Judgment Standards

The CPLR allows a default judgment to be entered when the requisite time period has elapsed. Where Defendants have not appeared or answered and proof of the facts of the loss is supplied through affidavit or a properly verified pleading. See CPLR § 3215(f). In Mercury Cas. Co. v Surgical Center at Milburn, LLC, 65 AD3d 1102 (2d Dept. 2009), the Appellate Division held that: “the plaintiff demonstrated its entitlement to a default judgment against the defendant by submitting proof of service of the summons and complaint, proof of the facts constituting its claim, and proof of the defendant’s default in answering or appearing.”

Summary Judgment Requirements

Similarly, the proponent of a summary judgment motion must make a prima facie showing of entitlement to judgment as a matter of law, tendering sufficient evidence to demonstrate the absence of any material issues of fact. See CPLR § 3212(b); Muscaella v City of New York, 215 AD2d 463 (2d Dept. 1995).

In the Court’s opinion, Plaintiff has presented sufficient proof to demonstrate that defendants breached a condition precedent to coverage through failing to attend their IME’ s.

Court’s Final Order and Judgment

Accordingly, it is hereby,

ORDERED that Plaintiffs motion for leave to enter a default judgment against the defaulting Defendants is granted; and it is further

ORDERED that Plaintiffs motion for summary judgment against the appearing Defendant is granted; and it is further

ORDERED, ADJUDGED and DECREED that Defendants ANDREW MAYO, BARON LEA, INC., BEST TOUCH, P.T., P.C. BRAND MEDICAL SUPPLY, INC., D&H REHABILITATION MEDICAL, P.C. DOVPHILANESTHESIOLOGY GROUP, PLLC.; DYNAMIC MEDICAL IMAGING, P.C ENJOY REHAB, P.T., P.C.; FREEDOM CHIROPRACTIC, P.C.; KKM MEDICAL DIAGNOSTICS, P.C.; MIDWOOD TOTAL REHABILITATION MEDICAL, P.C.; MIRA ACUPUNCTURE, P.C.; PARK RADIOLOGY, P.C.; PARK SLOPE ADVANCED MEDICAL, PLLC.; SAS MEDICAL, P.c.; TARNOFF CHIROPRACTIC, P.C.; BIO REFERENCE LABS; BRUCE C. BROMBERG, D.C.; DAVID HERSHKOWITZ, D.C., are not entitled to no-fault coverage or fist-party coverage, as a result of a motor vehicle accident that occurred on September 7, 2010.

This constitutes the Decision and Order of the Court.

DATED:

February 3, 2012

Mineola, N.Y. 11501

ENTER:

HON. MICHELE M. WOODARD
J.S.C.

Strategic Implications for Long Island Legal Practice

Front Door and Back Door Channels

The Nassau County court’s application of Unitrin through both “front door and back door channels” represents a significant development for legal practitioners throughout the Long Island and New York City area. This approach demonstrates how courts are finding multiple pathways to apply established precedent, even when higher court decisions might appear to create tension between different legal principles.

Impact on Medical Provider Litigation

For medical providers throughout Nassau and Suffolk Counties, this decision reinforces the importance of understanding IME compliance requirements and the severe consequences of patient non-appearance. The case demonstrates how IME no-shows can result in complete denial of coverage, affecting not just individual claims but entire provider relationships with insurance carriers.

Frequently Asked Questions

Q: What does “front door and back door channel” mean in this legal context?

A: This refers to the court finding multiple legal pathways to apply the Unitrin v. Bayshore precedent, both directly through established doctrine and indirectly through related legal principles, ensuring consistent application of IME no-show consequences.

Q: How does this Nassau County decision affect medical providers on Long Island?

A: It reinforces that IME no-shows by patients can result in complete denial of no-fault coverage, potentially affecting all claims related to that incident and impacting provider relationships with insurance carriers throughout Nassau and Suffolk Counties.

Q: What proof requirements must insurance companies meet for IME scheduling?

A: Insurance carriers must prove that IME letters were properly mailed, that they complied with timing requirements, and that the injured person actually failed to attend the scheduled examinations.

Q: Can medical providers challenge these IME no-show denials?

A: While the decision creates strong precedent for insurance carriers, providers may still have grounds to challenge denials based on procedural defects in IME scheduling or insufficient proof of non-attendance.

Q: How does this decision align with Court of Appeals precedent?

A: The Nassau County court found that this approach aligns the Court of Appeals decision in NYP v. Countrywide with the established Unitrin v. Bayshore precedent, creating consistency in no-fault IME law.

Get Expert Legal Guidance for No-Fault IME Issues

Navigating the complex intersection of no-fault insurance law, IME requirements, and evolving court precedents requires sophisticated legal expertise. Whether you’re a medical provider dealing with claim denials, an attorney representing clients in no-fault disputes, or an insurance professional seeking to understand current legal standards, having experienced counsel makes all the difference.

Our legal team understands the nuances of New York no-fault law, IME procedural requirements, and the strategic implications of recent court decisions throughout Nassau County, Suffolk County, and the greater New York metropolitan area.

Don’t let complex IME issues and evolving legal precedents impact your practice or case outcomes. Contact us today at 516-750-0595 for expert guidance on no-fault insurance law, IME compliance, and protecting your interests in this challenging legal environment.

Related Articles

• Understanding IME No-Shows in New York No-Fault Insurance Cases
• IME no-show victory
• IME No Show: Understanding Confusing Court Interpretations of Duplicate Mailing Requirements
• IME Notification Requirements in New York No-Fault Cases: Address Matching Rules
• New York No-Fault Insurance Law

Legal Update (February 2026): The regulations cited in this post, particularly Insurance Department Regulations § 65 and the underlying fee schedules, have been subject to multiple amendments since 2012. Additionally, New York’s no-fault insurance regulatory framework has undergone significant changes, including updates to IME procedures and denial practices. Practitioners should verify current provisions under the relevant Insurance Law sections and updated departmental regulations before relying on the precedential analysis discussed in this older post.