The NF-2 and the letters did not match

In New York no-fault insurance litigation, consistency between documented procedures and actual practice is paramount. Insurance companies routinely request that injured persons attend Independent Medical Examinations to verify injuries and ongoing treatment needs. The mailing of IME scheduling letters must comply with strict procedural requirements, and any deviation between stated practices and actual procedures can prove fatal to an insurer’s defense.

The fundamental principle at stake in these cases is straightforward: when an insurance company establishes a particular office procedure and asserts reliance on that procedure, the company must demonstrate that it actually followed the procedure in the case at hand. Courts scrutinize whether scheduling letters were sent to appropriate addresses and whether the evidence supports the claimed mailing practices.

This requirement protects injured persons and healthcare providers from improperly substantiated no-show defenses where insurance companies claim that examination requests were properly mailed but cannot prove they followed their own stated protocols.

Case Background

SS Med. Care, P.C. v Nationwide Ins., 2013 NY Slip Op 51109(U)(App. Term 2d Dept. 2013)

“With respect to defendant’s request that the assignor attend IMEs, defendant submitted an affidavit of an employee of a company which was contracted to schedule medical examinations on defendant’s behalf. The employee attested that it was her company’s standard practice to mail a scheduling letter to the injured party at the address provided by the insurance carrier, as shown on the NF-2 verification of treatment form. Although the NF-2 form, which defendant annexed as an exhibit to its motion, provided an address in Port Jefferson Station, New York, the employee stated that IME scheduling letters and follow-up letters had, in fact, been mailed to the assignor at two different addresses in the Bronx. As a result, defendant’s submissions were insufficient to establish that the requests for EUOs and IMEs had been properly addressed and mailed”

This case is consistent with the principle that if you assert a procedure, you better make sure you stick with it in the case at issue. The other thought that I have is what happens if you do not stick the NF-2 in your submissions and just state that the letter is mailed to the address on the application for benefits. Have not seen that one arise at the Appellate Term.

By the way – why would you name your medical P.C. “SS…”? A bit odd.

Legal Significance

The SS Med. Care decision reinforces a critical evidentiary principle in no-fault insurance litigation: insurance companies cannot benefit from establishing procedures they did not follow. When an affiant testifies that the company’s standard practice is to use addresses from NF-2 forms, but the evidence shows scheduling letters were sent to different addresses entirely, the insurer fails to meet its burden of proving proper mailing.

This ruling creates a practical problem for insurance companies that rely on third-party vendors to schedule medical examinations. The vendor must not only follow established procedures but also maintain documentation showing that the correct address source was used. Generic testimony about standard practices proves insufficient when the actual evidence contradicts those practices.

The decision also highlights the importance of careful exhibit selection when moving for summary judgment. Insurance companies must ensure that all exhibits referenced in supporting affidavits actually support the factual assertions being made. Including an NF-2 form showing one address while claiming letters were sent to different addresses creates an evidentiary conflict that precludes summary judgment.

Practical Implications for Insurers and Providers

Insurance companies defending IME or EUO no-show claims must ensure absolute consistency between their stated procedures and actual practice. This requires maintaining detailed records about address sources and implementing quality control measures to verify that scheduling vendors follow protocols. When affidavits reference specific forms or documents as address sources, those documents must actually contain the addresses used.

Healthcare providers challenging no-show defenses should carefully review the exhibits attached to insurance company motions, comparing stated procedures with documentary evidence. Inconsistencies between NF-2 forms and actual mailing addresses provide strong grounds for defeating summary judgment motions and creating triable issues of fact regarding proper notice.

Related Articles

• Triable issue of fact as to non-appearance?
• The failure to attend IMEs is now considered a Chubb coverage defense
• No-show failed the Alrof test
• No-show substantiated
• New York No-Fault Insurance Law

Legal Update (February 2026): Since this 2013 decision, New York’s no-fault regulations governing IME scheduling procedures and address verification requirements may have been amended through regulatory updates or clarified by subsequent appellate decisions. Practitioners should verify current provisions regarding proper mailing procedures and documentation requirements for IME scheduling correspondence.