Key Takeaway
A 9th and 10th Judicial District case demonstrates how insurers can successfully defend IME no-show claims through proper documentation of office procedures and physician affidavits.
Understanding IME No-Show Cases: Proper Documentation Makes the Difference
Independent Medical Examinations (IMEs) are a cornerstone of New York No-Fault Insurance Law, allowing insurers to verify medical claims through independent physician evaluations. When claimants fail to appear for scheduled IMEs, insurers can deny claims - but only if they can prove proper notice was given and procedures were followed.
The case East 75th St. Diagnostic Imaging, P.C. v New York Cent. Mut. Fire Ins. Co. from the 9th and 10th Judicial Districts provides a textbook example of how insurers should document IME no-show situations to successfully defend their claim denials.
Jason Tenenbaum’s Analysis:
East 75th St. Diagnostic Imaging, P.C. v New York Cent. Mut. Fire Ins. Co.
35 Misc.3d 126(A)
-
“The affidavit sufficiently established that the IME notices had been sent to plaintiff’s assignor in accordance with NCEI’s standard office practices and procedures”
-
“Defendant also submitted affidavits and an affirmation by the doctors who were to perform the IMEs, which established that the assignor had failed to appear [*2]for the duly scheduled IMEs”
-
“In addition, defendant sufficiently established that the denial of claim forms had been timely mailed in accordance with defendant’s standard office practices and procedures”
Compare this with a typical First Department per curiam construing Unitrin.
Key Takeaway
This case demonstrates that insurers can successfully defend IME no-show claims by providing comprehensive documentation: affidavits establishing standard mailing procedures for notices, physician affirmations confirming non-appearance, and proof of timely denial mailings. This thorough approach contrasts with typical First Department decisions that often apply stricter Unitrin standards for claim denials.
Legal Update (February 2026): Since this 2012 post, New York’s no-fault regulations and IME procedures may have been subject to amendments, including potential changes to notice requirements, documentation standards, and denial procedures. The Insurance Department has periodically updated regulations governing IME scheduling and no-show protocols. Practitioners should verify current regulatory provisions under 11 NYCRR Part 65 and recent case law interpretations when handling IME no-show cases.
