Key Takeaway
Court reversal highlights how IME timing affects medical necessity determinations in no-fault insurance disputes, with burden of proof shifting to plaintiffs.
Amato v. State Farm Ins. Co., 30 Misc.3d 238 (Dis. Ct. Nassau Co. 2010), rev’d by Amato v State Farm Ins. Co., 2013 NY Slip Op 51113(U)(App. Term 2d Dept. 2013)
“Dr. Aordkian’s examination found the range of motion of Burrell’s cervical and lumbar spine to be essentially normal. The only objective finding he made was decreased sensation along the right leg.”
“Dr. Aordkian testified a trial Burrell’s condition would not improve even if she received additional chiropractic treatment.”
“An IME is a snapshot of the injured parties medical condition as of the date of the IME.”
“Dr. Aordkian testified that he did not review any reports or records relating to the treatment Burrell received after the IME. He was unaware of the reasons Burrell sought and obtained the treatment. He was unaware of the treatment provided. Therefore, the defendant failed to prove either a factual basis or a medical rationale for its determination the chiropractic treatment was unnecessary.”
“For the foregoing reasons, the court finds for the plaintiff.”
REVERSED
“It is undisputed that the IME had been conducted on September 8, 2005 and that the services at issue had been provided from January 3, 2006 to January 30, 2007. Defendant’s IME chiropractor testified that there was a lack of medical necessity for the chiropractic treatment at issue, which had been rendered after the IME, because, at the time of the IME, plaintiff’s assignor had reached “status quo ante.” Contrary to the holding of the District Court, after defendant made such a showing, plaintiff bore the burden of demonstrating, by a preponderance of the credible evidence, that the treatment at issue was medically necessary. Since plaintiff proffered no evidence, a finding that the assignor’s condition had worsened after the IME would be speculative, at best.”
“Accordingly, the judgment is reversed and the matter is remitted to the District Court for the entry of judgment in favor of defendant dismissing the complaint”
Related Articles
- Why conclusory affidavits fail in opposing medical necessity summary judgment motions
- When IME doctors must explain their findings about diminished range of motion
- Understanding prima facie cases in medical necessity disputes
- Insurance carrier expert testimony limitations in medical necessity cases
- New York No-Fault Insurance Law
Legal Update (February 2026): Since this 2013 decision, New York’s no-fault regulations have undergone several amendments, particularly regarding IME procedures, medical necessity standards, and the temporal scope of IME findings in relation to subsequent treatment. Practitioners should verify current provisions in 11 NYCRR 65 and recent appellate decisions when analyzing the evidentiary weight of IME testimony regarding post-examination treatment periods.
