Key Takeaway
NY court rules medical providers must prove assignor had counsel and counsel wasn't notified of IME scheduling to challenge no-fault insurance denials.
American Tr. Ins. Co. v Leon, 2013 NY Slip Op 08124 (1st Dept. 2013)
The Law Office of Jason Tenenbaum, P.C., Garden City (Jason
Tenenbaum of counsel), for appellant.
“Order, Supreme Court, New York County (Ellen M. Coin, J.), entered March 26, 2013, which denied plaintiff’s motion for summary judgment, unanimously reversed, on the law, without costs, the motion granted, and it is declared that plaintiff insurance company has no obligation to pay defendant Stand-Up MRI’s claims.
Plaintiff demonstrated its entitlement to judgment as a matter of law by submitting competent evidence that it mailed the notices scheduling the injured defendant’s independent medical examinations (IMEs) and that he failed to appear for the examinations (see American Transit Ins. Co. v. Lucas, __ AD3d __, 2013 NY Slip Op 07273 ; American Tr. Ins. Co. v Solorzano, 108 AD3d 449, 449 ). Defendant provider’s contention that plaintiff failed to prove the mailing of IME notices to the assignor’s attorney, absent competent proof in the record establishing that the assignor was represented by counsel with regard to the subject no-fault claim, is unavailing (see Center for Orthopedic Surgery, LLP v New York Cent. Mut. Fire Ins., 31 Misc 3d 128, 2011 N.Y. Slip Op. 50473 ).
Attendance at a medical examination is a condition of coverage. Accordingly, there is no[*2]requirement that the claim denial be timely made (see American Transit Ins. Co. v. Lucas, __ AD3d __, 2013 NY Slip Op 07273; Unitrin Advantage Ins. Co. v Bayshore Physical Therapy, PLLC, 82 AD3d 559, 560 , lv denied 17 NY3d 705 ).”
By the way, this case now effectively overrules Infinity Health Prods., Ltd. v Redland Ins. Co., 2013 NY Slip Op 50751(U)(App. Term 2d Dept. 2013)(“ Furthermore, there is nothing in the record to suggest that plaintiff’s assignor was represented by the attorney to whom the IME scheduling letters were also sent. Consequently, defendant failed to demonstrate that the IMEs had been properly scheduled.”)
Related Articles
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- Court of Appeals precedent supports voiding coverage for IME non-attendance
- Unshakable affidavits establish proper IME scheduling and no-show
- New York No-Fault Insurance Law
Legal Update (February 2026): The procedural requirements for IME scheduling notifications and proof standards discussed in this 2013 decision may have been modified by subsequent regulatory amendments or court rule changes. Practitioners should verify current notification requirements under 11 NYCRR 65, particularly regarding counsel notification procedures and evidentiary standards for establishing representation, as these provisions have been subject to periodic updates since this case was decided.
