Key Takeaway
Appeals court confirms insurance companies can retroactively deny all no-fault claims when patients fail to appear for required IMEs, regardless of timing.
Independent Medical Examinations (IMEs) are a critical component of New York’s no-fault insurance system. When an insurance company requests an IME, the patient’s attendance isn’t optional—it’s a mandatory condition for maintaining coverage. The consequences of failing to appear can be severe and far-reaching.
This particular case from the Appellate Term highlights a fundamental principle in no-fault law: when patients don’t show up for scheduled IMEs, insurance companies gain powerful rights to deny claims. The court’s reference to the Unitrin decision underscores established precedent that gives insurers broad authority in these situations.
The case also touches on important procedural aspects of IME scheduling and notification requirements. While IME letters don’t necessarily need to be sent to healthcare providers directly, proper notice to the patient remains crucial. Issues around whether IME notices were properly mailed frequently arise in these disputes.
Understanding these IME requirements is essential for both patients and healthcare providers navigating the no-fault system.
Jason Tenenbaum’s Analysis:
MDJ Med., P.C. v New York Cent. Mut. Ins. Co., 2013 NY Slip Op 51797(U)(App. Term 1st Dept. 2013)
There was nothing out of the ordinary about this case, except the quote from Unitrin: “We note that “when assignor[] failed to appear for the requested IMEs, had the right to deny all claims retroactively to the date of loss, regardless of whether the denials were timely issued” (id.).”
I am assuming that Civil Court found that preclusion applied to IME no-shows, hence the “we note” language in the opinion.
Key Takeaway
This decision reinforces that IME no-shows carry serious consequences in New York no-fault cases. Insurance companies can retroactively deny all claims back to the original date of loss when patients fail to appear for required medical examinations, even if the denial notices weren’t issued within typical timeframes. The Unitrin precedent continues to provide insurers with significant leverage in these situations.
Legal Update (February 2026): Since this 2013 post, New York’s IME regulations and procedures may have been subject to amendments through Insurance Department regulatory updates, fee schedule revisions, or changes to notification and scheduling requirements. Practitioners should verify current IME provisions under 11 NYCRR Part 65 and recent appellate decisions interpreting no-show consequences and procedural compliance standards.
