Key Takeaway
Learn what proof is needed to establish an IME no-show defense in New York no-fault insurance cases. Court ruling clarifies simple standard for examining physicians.
Understanding IME No-Show Defense Requirements in New York No-Fault Cases
In New York’s no-fault insurance system, Independent Medical Examinations (IMEs) serve as a crucial tool for insurers to verify the medical necessity and appropriateness of claimed treatments. When a patient fails to appear for a scheduled IME, insurers can use this “no-show” as a defense to deny coverage. However, questions often arise about what level of proof is required to establish that a claimant actually failed to attend the examination.
The burden of proof for IME no-show defenses has been a source of ongoing litigation in New York courts. Insurance companies must demonstrate that they properly scheduled the examination and that the claimant failed to appear, but the specific evidentiary requirements have varied across different cases. This uncertainty has led to disputes over whether additional documentation beyond physician statements is necessary to substantiate a no-show claim.
Understanding the standards for proving IME non-attendance is essential for both healthcare providers pursuing New York no-fault insurance claims and insurers defending against such claims. The Right Aid Diagnostic Medicine case provides important clarification on this procedural issue.
Jason Tenenbaum’s Analysis:
Right Aid Diagnostic Medicine, P.C. v Travelers Ins. Co., 2013 NY Slip Op 51033(U)(App. Term 2d Dept. 2013)
One of the most contentious areas involving the IME no-show defense involves the proof necessary to show that Claimant failed to attend the examination.
“Defendant also submitted an affirmation by its examining physician and affidavits by its examining chiropractor, psychologist and acupuncturist, respectively, each of which stated that plaintiff’s assignor had failed to appear for the scheduled IMEs.”
I think this is all that is necessary on motion. Examining doctor says Claimant did not show. That is it.
Key Takeaway
The Right Aid Diagnostic Medicine decision establishes a straightforward standard for proving IME no-shows: a simple statement from the examining physician that the claimant failed to appear is sufficient evidence. This ruling reduces the evidentiary burden on insurers and provides clarity for practitioners handling IME-related disputes in New York no-fault cases. The decision emphasizes practical efficiency over complex procedural requirements when establishing non-attendance at scheduled medical examinations.
Legal Update (February 2026): Since this 2013 post, New York’s no-fault insurance regulations and IME procedures may have been subject to amendments, including potential changes to evidentiary standards for establishing IME no-shows and updated procedural requirements under 11 NYCRR 65. Practitioners should verify current regulatory provisions and recent case law interpretations regarding quantum of proof requirements for IME non-attendance defenses.
