Key Takeaway
Court ruling clarifies timing requirements for IME no-show denials when verification is requested after the missed appointment in New York no-fault insurance cases.
Understanding IME No-Show Denials and Verification Timing
In New York no-fault insurance law, insurance carriers must follow strict procedural requirements when denying claims based on Independent Medical Examination (IME) no-shows. A critical issue that frequently arises involves the timing of denials when carriers request additional verification after a claimant fails to appear for a scheduled IME.
The timing requirements become particularly complex when an insurance carrier requests additional verification after an IME no-show occurs. Courts have established specific jurisprudence regarding whether denials remain timely when verification is requested post-no-show, creating important precedents for both insurance carriers and healthcare providers navigating the no-fault system.
This case represents the second decision under the Appellate Term’s established framework addressing situations where IME no-show defaults occur before verification materials are received. Understanding these timing requirements is essential for practitioners handling no-fault insurance disputes, as improper timing can invalidate an otherwise valid denial.
Jason Tenenbaum’s Analysis:
Village Med. Supply, Inc. v NY Cent. Mut. Fire Ins. Co., 2014 NY Slip Op 50631(U)(App. Term 2d Dept. 2014)
This is the second case under the Appellate Term’s Westchester/Lincoln jurisprudence which addressed the case where the IME no-show default occurs before the verification is received.
“Defendant alleged that it had denied one of these claims within 30 days of its receipt and that it had requested verification on the other claim and then denied that claim within 30 days of its receipt of the requested verification”
Key Takeaway
This decision reinforces that insurance carriers can maintain timely denial rights even when verification is requested after an IME no-show, provided the denial occurs within 30 days of receiving the requested verification. This ruling provides important guidance for carriers managing IME procedural requirements and helps clarify the interaction between verification requests and no-show defaults in no-fault insurance cases.
Legal Update (February 2026): Since this 2014 analysis of IME no-show denial timing requirements, New York’s no-fault regulations may have been subject to amendments affecting verification procedures and denial timeframes. Practitioners should verify current provisions in 11 NYCRR Part 65 and recent appellate decisions, as both procedural requirements and judicial interpretations of IME-related denials may have evolved over the past decade.
