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.
This article is part of our ongoing ime issues coverage, with 149 published articles analyzing ime issues issues across New York State. Attorney Jason Tenenbaum brings 24+ years of hands-on experience to this analysis, drawing from his work on more than 1,000 appeals, over 100,000 no-fault cases, and recovery of over $100 million for clients throughout Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx. For personalized legal advice about how these principles apply to your specific situation, contact our Long Island office at (516) 750-0595 for a free consultation.
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.
Related Articles
Legal Context
Why This Matters for Your Case
New York law is among the most complex and nuanced in the country, with distinct procedural rules, substantive doctrines, and court systems that differ significantly from other jurisdictions. The Civil Practice Law and Rules (CPLR) governs every stage of civil litigation, from service of process through trial and appeal. The Appellate Division, Appellate Term, and Court of Appeals create a rich and ever-evolving body of case law that practitioners must follow.
Attorney Jason Tenenbaum has practiced across these areas for over 24 years, writing more than 1,000 appellate briefs and publishing over 2,353 legal articles that attorneys and clients rely on for guidance. The analysis in this article reflects real courtroom experience — from motion practice in Civil Court and Supreme Court to oral arguments before the Appellate Division — and a deep understanding of how New York courts actually apply the law in practice.
Keep Reading
More IME issues Analysis
Simple addition is insufficient
NY court rules simple addition insufficient to prove proper fee schedule calculations in no-fault insurance case, requiring detailed evidence of code utilization.
May 22, 2021NF-3 is the operative document
Court ruling confirms NF-3 forms trigger 15-day IME request deadline, and patient no-shows at two scheduled exams justify insurance coverage disclaimer.
Mar 22, 2021The IME recollection issue
Court rules insurance companies must provide competent proof with adequate recollection when claiming patients failed to appear for Independent Medical Examinations.
Mar 25, 2017IME no-show from the First Department
New York Appellate Term ruling clarifies what evidence insurers need to prove patient no-shows at IMEs, emphasizing physician affidavits over office records.
Jul 21, 2015The IME no-show at trial – the eagle has arisen
Eagle Surgical Supply v GEICO highlights the critical requirement that insurance companies must present witnesses with personal knowledge to prove IME no-shows at trial.
Aug 6, 2013The failure to attend IMEs is now considered a Chubb coverage defense
Landmark 2011 Unitrin case establishes IME no-show as Chubb coverage defense, allowing retroactive claim denials regardless of initial denial reasons in NY no-fault law.
Mar 20, 2011Common Questions
Frequently Asked Questions
What is an Independent Medical Examination (IME)?
An IME is a medical examination conducted by a doctor chosen by the insurance company to evaluate the claimant's injuries and treatment. In no-fault cases, insurers use IMEs to determine whether ongoing treatment is medically necessary, whether the injuries are causally related to the accident, and whether the claimant has reached maximum medical improvement. The results of an IME can form the basis for a claim denial or cut-off of benefits.
Can I refuse to attend an IME?
No. Under New York's no-fault regulations, attending an IME when properly scheduled is a condition precedent to receiving benefits. However, the insurer must follow specific scheduling procedures — including providing reasonable notice and accommodating certain scheduling conflicts. If the insurer fails to properly schedule the IME or you have a legitimate reason for missing it, the resulting denial may be challenged.
How should I prepare for an Independent Medical Examination?
Be honest and thorough when describing your symptoms, limitations, and treatment history. Arrive on time with photo ID and be prepared for a physical examination that may test your range of motion and functional abilities. The IME doctor works for the insurance company and may spend limited time with you, so clearly communicate your ongoing symptoms. Your attorney can advise you on what to expect and review the IME report for accuracy afterward.
What is maximum medical improvement (MMI) in no-fault cases?
Maximum medical improvement (MMI) means the point at which your condition has stabilized and further treatment is unlikely to produce significant improvement. When an IME doctor determines you have reached MMI, the insurer may cut off further no-fault benefits. However, reaching MMI does not necessarily mean you have fully recovered — you may still have permanent limitations. Your treating physician can dispute the MMI finding through a detailed rebuttal affirmation.
Can I challenge an IME doctor's findings in my no-fault case?
Yes. If an IME results in a denial or cut-off of benefits, your treating physician can submit a sworn affirmation rebutting the IME findings point by point. The rebuttal should reference specific clinical findings, objective test results, and range-of-motion measurements that contradict the IME conclusions. At arbitration or trial, the fact-finder weighs both the IME report and the treating physician's opinion. An experienced no-fault attorney can identify weaknesses in the IME report.
Was this article helpful?
About the Author
Jason Tenenbaum, Esq.
Jason Tenenbaum is the founding attorney of the Law Office of Jason Tenenbaum, P.C., headquartered at 326 Walt Whitman Road, Suite C, Huntington Station, New York 11746. With over 24 years of experience since founding the firm in 2002, Jason has written more than 1,000 appeals, handled over 100,000 no-fault insurance cases, and recovered over $100 million for clients across Long Island, Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, the Bronx, and Staten Island. He is one of the few attorneys in the state who both writes his own appellate briefs and tries his own cases.
Jason is admitted to practice in New York, New Jersey, Florida, Texas, Georgia, and Michigan state courts, as well as multiple federal courts. His 2,353+ published legal articles analyzing New York case law, procedural developments, and litigation strategy make him one of the most prolific legal commentators in the state. He earned his Juris Doctor from Syracuse University College of Law.
Disclaimer: This article is published by the Law Office of Jason Tenenbaum, P.C. for informational and educational purposes only. It does not constitute legal advice, and no attorney-client relationship is formed by reading this content. The legal principles discussed may not apply to your specific situation, and the law may have changed since this article was last updated.
New York law varies by jurisdiction — court decisions in one Appellate Division department may not be followed in another, and local court rules in Nassau County Supreme Court differ from those in Suffolk County Supreme Court, Kings County Civil Court, or Queens County Supreme Court. The Appellate Division, Second Department (which covers Long Island, Brooklyn, Queens, and Staten Island) and the Appellate Term (which hears appeals from lower courts) each have distinct procedural requirements and precedents that affect litigation strategy.
If you need legal help with a ime issues matter, contact our office at (516) 750-0595 for a free consultation. We serve clients throughout Long Island (Huntington, Babylon, Islip, Brookhaven, Smithtown, Riverhead, Southampton, East Hampton), Nassau County (Hempstead, Garden City, Mineola, Great Neck, Manhasset, Freeport, Long Beach, Rockville Centre, Valley Stream, Westbury, Hicksville, Massapequa), Suffolk County (Hauppauge, Deer Park, Bay Shore, Central Islip, Patchogue, Brentwood), Queens, Brooklyn, Manhattan, the Bronx, Staten Island, and Westchester County. Prior results do not guarantee a similar outcome.