Key Takeaway
Court ruling shows insurance companies can't use IME no-shows as defense if they failed to timely deny claims, highlighting procedural requirements in no-fault cases.
Understanding IME Defense Limitations in No-Fault Insurance Cases
In New York No-Fault Insurance Law, insurance companies often rely on Independent Medical Examinations (IMEs) as a tool to challenge claims. However, a recent Appellate Term decision demonstrates that insurers cannot simply invoke an IME no-show defense without first meeting their own procedural obligations. This case illustrates a critical principle: when insurance companies fail to timely deny claims, their ability to use certain defenses becomes severely limited.
The ruling highlights the importance of proper timing in no-fault insurance disputes. Insurance companies must follow strict procedural requirements when handling claims, and failure to do so can result in the preclusion of otherwise valid defenses. This creates a strategic advantage for healthcare providers and their attorneys who understand these procedural nuances.
Jason Tenenbaum’s Analysis:
Clinton Place Med., P.C. v New York Cent. Mut. Fire Ins. Co, 2014 NY Slip Op 50413(U)(App. Term 2d Dept. 2014)
“With respect to the claims at issue in plaintiff’s third, fourth, sixth and seventh causes action, defendant failed to show that it had denied the underlying claims or to otherwise raise a triable issue of fact. To the extent that defendant argues that it is nevertheless entitled to summary judgment upon these claims, defendant is mistaken, as defendant’s defense, based upon the assignor’s failure to appear for IMEs, is subject to preclusion if defendant failed to timely deny these claims”
If the Appellate Division Second Department does the right thing, then we can tell the Court that it is mistaken.
Key Takeaway
This decision reinforces that insurance companies cannot use IME no-show defenses if they failed to properly and timely deny the underlying claims. The court’s clear statement that the defendant is “mistaken” emphasizes that procedural compliance is mandatory, not optional, in no-fault insurance cases.
Legal Update (February 2026): Since this 2014 post, New York no-fault insurance regulations have undergone several amendments affecting IME procedures and claim denial timelines. Practitioners should verify current provisions in 11 NYCRR 65 regarding procedural requirements for IME scheduling, notification periods, and the specific timeframes for denial of claims, as these regulatory standards may have been updated.
