Key Takeaway
Court reverses order in IME no-show case, establishing key precedent for no-fault insurance claims when proper notice procedures are followed and examinations missed.
Independent Medical Examinations (IMEs) play a crucial role in New York No-Fault Insurance Law, serving as a mechanism for insurance carriers to verify the medical necessity and extent of injuries claimed by accident victims. When an Eligible Injured Person (EIP) fails to appear for a scheduled IME, insurance companies can deny ongoing benefits—but only if they follow proper procedural requirements.
The case of VE Med. Care, P.C. v NY Cent. Mut. Fire Ins. Co. highlights the fundamental elements required for a successful IME no-show denial. This appellate decision demonstrates how courts evaluate whether insurance carriers have met their burden of proof when denying claims based on a patient’s failure to attend an independent medical examination.
Unlike cases where IME letters do not need to be sent to provider, this situation involved direct communication with the patient. The procedural requirements for IME scheduling and the consequences of non-attendance have been refined through numerous court decisions, creating a framework that protects both insurers and injured parties. This case contributes to the body of law surrounding medical necessity determinations and proper notice procedures.
Understanding these requirements is essential for medical providers, insurance companies, and injured parties navigating the no-fault system. The court’s decision reinforces that when proper procedures are followed, insurance carriers have legitimate grounds to deny benefits based on IME non-attendance.
Jason Tenenbaum’s Analysis:
VE Med. Care, P.C. v NY Cent. Mut. Fire Ins. Co., 2012 NY Slip Op 51074(U)(App. Term 2d Dept. 2012)
(1) Letters were mailed; (2) The EIPs did not show; and (3) The denial was timely. Order reversed.
Key Takeaway
This decision establishes a clear three-part test for successful IME no-show denials in New York no-fault cases. Insurance carriers must demonstrate they properly mailed examination notices, that the eligible injured persons failed to appear, and that any resulting benefit denials were issued within statutory timeframes. The appellate court’s reversal indicates that when these procedural requirements are met, lower courts should uphold the insurance carrier’s right to deny benefits. This outcome differs from situations where IME scheduling was not properly documented, reinforcing the importance of maintaining detailed records of all communications and procedural compliance in no-fault insurance administration.
Legal Update (February 2026): Since this 2012 post, New York’s IME procedures and notice requirements may have been modified through regulatory amendments, updated insurance department guidelines, or subsequent court decisions affecting no-show denial protocols. Practitioners should verify current IME scheduling requirements, notice provisions, and procedural standards under the most recent New York No-Fault regulations and case law.
