Key Takeaway
Court of Appeals precedent confirms failure to attend IMEs voids no-fault insurance coverage. American Transit v. Lucas case analysis and implications.
American Transit Ins. Co. v. Lucas, 2013 NY Slip Op 07273 (1st Dept. 2013)
| American Tr. Ins. Co. v Lucas |
| 2013 NY Slip Op 07273 |
| Decided on November 7, 2013 |
| Appellate Division, First Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| This opinion is uncorrected and subject to revision before publication in the Official Reports. |
Decided on November 7, 2013
Mazzarelli, J.P., Acosta, Saxe, Richter, Feinman, JJ. 10975-
152409/12 10976 152413/12
****[*1]American Transit Insurance Company, Plaintiff-Appellant,****vKeyana Lucas, et al., Defendants, Sky Acupuncture, P.C., Defendant-Respondent. American Transit Insurance Company, Plaintiff-Appellant, Tashuana Lucas, et al., Defendants, Sky Acupuncture, P.C., Defendant-Respondent.
The Law Office of Jason Tenenbaum, P.C., Garden City (Jason
Tenenbaum of counsel), for appellant.
Law Offices of Melissa Betancourt, P.C., Brooklyn (Sam Lewis
of counsel), for respondent.
Orders, Supreme Court, New York County (Ellen M. Coin, J.), entered on or about February 26 and 28, 2013, which, to the extent appealed from as limited by the briefs, in the respective actions regarding the injured claimants Keyana Lucas and Tashuana Lucas, denied plaintiff’s motions for summary judgment seeking declarations of noncoverage for no-fault benefits as against defendant-respondent Sky Acupuncture, P.C., unanimously reversed, on the law, without costs, the motions granted, and it is declared that plaintiff owes no coverage obligation to Sky Acupuncture, P.C. for no-fault benefits for the injured claimants.
The failure to attend duly scheduled medical exams voids the policy ab initio (see Unitrin Advantage Ins. Co. v Bayshore Physical Therapy, PLLC, 82 AD3d 559, 560 , lv denied 17 NY3d 705 ). Accordingly, when defendants’ assignors failed to appear for the requested medical exams, plaintiff had the right to deny all claims retroactively to the date of loss, regardless of whether the denials were timely issued (see Insurance Department Regulations § 65-3.8; Unitrin, 82 AD3d at 560). [*2]
” properly executed affidavit of service raises a presumption that a proper mailing occurred, and a mere denial of receipt is not enough to rebut this presumption’” (Matter of Ariel Servs., Inc. v New York City Envtl. Control Bd., 89 AD3d 415, 415 ). “The presumption may be created by either proof of actual mailing or proof of a standard office practice or procedure designed to ensure that items are properly addressed and mailed” (Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679, 680 ).
Plaintiff submitted competent evidence that the notices scheduling the claimant’s medical examinations were mailed, as well as the failure to appear, based on the sworn affidavits of the scheduled examining physician and his employee (see American Tr. Ins. Co. v Solorzano, 108 AD3d 449, 449 ). Contrary to defendants’ contention, the affidavits were not conclusory, as they established personal knowledge, the employee’s role in the physician’s no-fault department, and the physician’s personal knowledge of the office procedures when a claimant failed to appear for a medical exam (cf. First Help Acupuncture, P.C. v Lumbermens Mut. Ins. Co., 9 Misc 3d 1127, *3 , affd 14 Misc 3d 142 ).
There is no requirement to demonstrate that the claims were timely disclaimed since the failure to attend medical exams was an absolute coverage defense (see New York & Presbyt. Hosp. v Country-Wide Ins. Co., 17 NY3d 586, 593 ; Unitrin Advantage Ins. Co., 82 AD3d at 560).
THIS CONSTITUTES THE DECISION AND ORDER
OF THE SUPREME COURT, APPELLATE DIVISION, FIRST DEPARTMENT.
ENTERED: NOVEMBER 7, 2013
CLERK
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Legal Update (February 2026): Since this 2013 post, New York’s no-fault insurance regulations under Part 65 have undergone multiple revisions, including amendments to procedural requirements for independent medical examinations and notification protocols. Additionally, subsequent appellate decisions may have refined the standards for IME non-attendance and coverage voidance. Practitioners should verify current provisions under the most recent version of Part 65 and review recent case law developments regarding IME compliance requirements.
