Failure to attend IMEs voids coverage – with citation to Court of Appeals precedent

American Transit v Lucas is a November 2013 First Department decision about two no-fault coverage actions. The insurer won the relief at issue against Sky Acupuncture. The court accepted the physician and employee affidavits and applied the IME no-show coverage rule. The published opinion names Jason Tenenbaum as counsel for American Transit.

Historical note — Last reviewed: September 2026. Lucas applied the First Department’s IME no-show rule to identified affidavits; Gaines (2025) later cited it when distinguishing pre-claim notices and disclaimer timing, while the IME directory explains contrasting proof records.

The two appeals and the relief granted

In American Transit Insurance Co. v Lucas, 111 AD3d 423, decided November 7, 2013, the First Department reversed the orders insofar as challenged and granted the insurer’s motions against Sky Acupuncture. It declared that American Transit owed that provider no no-fault coverage obligation for the two injured claimants.

This was not an award of personal-injury damages or a medical-necessity trial. The appeal concerned the insurer’s declaratory relief based on failure to attend examinations.

The opinion’s counsel line identifies the Law Office of Jason Tenenbaum, P.C., with Jason of counsel, for the appellant. That is a documented connection between the firm’s historical writing and its appellate work. It does not establish a later result, a recovery amount or involvement in every case cited here.

What the affidavits established

The court accepted evidence from the scheduled examining physician and his employee. The affidavits established mailing and nonappearance, explained the employee’s role in the physician’s no-fault department, and supplied the physician’s knowledge of the office procedures used when a claimant missed an examination.

The opinion also recognized two ways to establish a mailing presumption: proof of the actual mailing or a sufficiently established standard office practice designed to ensure proper addressing and mailing. It did not insist on a witness who remembered physically posting each individual letter.

That is why Radiology Today’s medical-professional proof should not be paraphrased as a doctor-only rule. Lucas’s discussion identifies why these witnesses’ evidence was competent, rather than accepting their professional titles as substitutes for a foundation.

What the Court of Appeals citation does—and does not—mean

The historical title refers to Lucas’s citation to New York & Presbyterian Hospital v Country-Wide, 17 NY3d 586 (2011). That Court of Appeals case addressed a different question: whether a hospital’s timely proof of claim could cure missing timely notice of the accident. It did not itself decide the Lucas claimants’ IME nonappearances.

Lucas relied on that higher-court authority in its coverage discussion. The immediate IME precedent was Unitrin Advantage v Bayshore Physical Therapy, 82 AD3d 559 (1st Dept 2011). The distinction matters: saying Lucas “cites Court of Appeals precedent” is not the same as saying the Court of Appeals decided this IME case or expressly adopted every formulation in Unitrin.

A reader following the authorities should therefore keep the original accident-notice case, the First Department IME rule, and the Lucas proof record separate. Collapsing the chain would make the article sound more conclusive than the cited decisions support.

A missed examination still requires a properly established defense

Lucas rejected a timely-disclaimer requirement for the IME no-show defense it found established. That does not mean the insurer may dispense with proper scheduling, mailing or proof of absence.

American Transit v Acosta is the important contrast. The 2022 majority continued to cite Unitrin but denied summary judgment because the record did not show compliance with the relevant request and examination time frames. A strong coverage characterization cannot cure an unproved prerequisite.

The reasonableness note addresses another boundary. An insurer’s right to request examinations is not a right to demand anything under any circumstances. A court’s rejection of a particular objection does not erase the issue for a different record.

For the same reason, Lucas should not be used as a suggestion to ignore appointment notices. A current dispute requires timely, case-specific review of the demand, the evidence and the law applicable in the forum.

Follow the later citation to Gaines

Nationwide General v Gaines (2025) cited Lucas when granting relief after properly noticed examinations were missed. Its chronology was important: the notices preceded the claims. The court also rejected the argument that the insurers had to establish a timely disclaimer.

Gaines supplies a later connection for this historical note. It does not turn all post-claim requests into pre-claim notices or supply missing evidence in an unrelated matter. Comparing it with Acosta is more useful than collecting favorable outcomes without the timing facts that distinguish them.

Read the archive by issue, not just by winner

Solorzano is a nearby 2013 decision in which Jason also appears as counsel. There, competent IME evidence supported summary relief, but a separate default-notice problem prevented the requested default relief. That is a particularly useful companion because it shows success on the no-show question coexisting with a procedural failure.

East 75th Street supplies a Nassau County example of accepted scheduling, attendance and denial proof. The 2026 GC Chiropractic discussion concerns a later EUO affirmation and helps isolate the different question of elapsed time.

These connections preserve what makes Lucas worth reading: the actual witnesses, the distinct appellate issue, the firm’s documented role and the way later cases use the opinion. They are not a substitute for reading the affidavit or policy involved in a new file.

Connect to the Encyclopedia

The IME no-show case directory connects notice, attendance, timing and procedural decisions:

• Radiology Today: who supplied the mailing and nonappearance evidence
• East 75th Street: the Nassau County examination-notice record
• Acosta: timing proof and the separate Unitrin concurrence
• Center for Orthopedic Surgery: reasonableness and proof of representation
• Solorzano: summary judgment and default relief were different requests
• GC Chiropractic (2025): a later EUO affirmation and the time-lapse objection

For review of a particular no-fault claim or motion record, contact the Law Office of Jason Tenenbaum, P.C. and read about our no-fault defense practice.