Key Takeaway
Appeals court confirms that failing to specifically deny a patient's IME no-show in opposition papers proves fatal to a medical provider's no-fault insurance claim.
No-fault insurance disputes often hinge on procedural requirements, and one of the most critical involves Independent Medical Examinations (IMEs). When insurance companies schedule IMEs and patients fail to appear, the burden shifts dramatically in subsequent litigation. This 2012 Appellate Term decision from Continental Medical demonstrates a fundamental principle: medical providers must address IME no-show allegations head-on or risk losing their claims entirely.
The case illustrates how New York No-Fault Insurance Law creates specific procedural hurdles that can make or break a provider’s ability to recover benefits. Understanding these requirements is crucial for both medical providers seeking reimbursement and insurers defending against claims.
Jason Tenenbaum’s Analysis:
Continental Med., P.C. v New York Cent. Mut. Fire Ins. Co., 2012 NY Slip Op 50844(U)(App. Term 1st Dept. 2012)
“The defendant-insurer made a prima facie showing of entitlement to summary judgment dismissing the action for first-party no-fault benefits by establishing that it timely and properly mailed the notices for independent medical examinations (IMEs) to plaintiff’s assignor, and that the assignor failed to appear (see Unitrin Advantage Ins. Co. v Bayshore Physical Therapy, PLLC, 82 AD3d 559, 560 , lv denied 17 NY3d 705 ; cf. Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720, 721 ). In opposition, plaintiff did not specifically deny the assignor’s nonappearance or otherwise raise a triable issue with respect thereto (see Unitrin at 560).”
Key Takeaway
When an insurance company establishes proper IME notice and claims a patient failed to appear, medical providers cannot simply ignore these allegations in their opposition papers. The failure to specifically deny the no-show allegation, as seen in cases like Unitrin, creates a fatal procedural defect that allows insurers to obtain summary judgment dismissing the entire claim.
Legal Update (February 2026): Since this 2012 decision, New York’s no-fault insurance regulations have undergone several amendments that may affect IME procedures, notice requirements, and the burden of proof standards for establishing non-appearance defenses. Additionally, appellate courts have continued to refine the procedural requirements for both scheduling IMEs and responding to non-appearance allegations. Practitioners should verify current regulatory provisions under 11 NYCRR Part 65 and recent case law developments when handling IME-related disputes.
