Key Takeaway
Court upholds insurer's summary judgment when medical provider's assignor failed to appear for IMEs and EUOs despite proper notice mailing.
No-fault insurance disputes often hinge on whether insurers properly notified claimants of required examinations and whether valid excuses exist for non-appearance. When medical providers seek reimbursement under New York No-Fault Insurance Law, insurers can defend claims by demonstrating that assignors failed to comply with examination requirements.
The Appellate Term’s decision in MDJ Med., P.C. v Praetorian Insurance Co. illustrates how courts evaluate evidence of no-shows for Independent Medical Examinations (IMEs) and Examinations Under Oath (EUOs). This case demonstrates the burden insurers must meet to establish proper notice and actual non-appearance, while highlighting the challenges medical providers face when their assignors fail to cooperate with insurance requirements.
Jason Tenenbaum’s Analysis:
MDJ Med., P.C. v Praetorian Ins. Co., 2014 NY Slip Op 50895(U)(App. Term 1st Dept. 2014)
“The defendant-insurer made a prima facie showing of entitlement to summary judgment dismissing this action for first-party no-fault benefits by submitting competent evidence establishing the proper and timely mailing of the notices scheduling the assignor’s independent medical examinations and examinations under oath, as well as the assignor’s failure to appear (see American Tr. Ins. Co. v Lucas, 111 AD3d 423 ). With respect to the latter, defendant’s moving submission, including the sworn affidavits of the scheduled examining physicians, set forth facts sufficient to demonstrate the affiants’ personal knowledge of the assignor’s repeated failures to appear for the duly scheduled IMEs, and the affiants’ actions, “in the ordinary course of business,” in advising defendants’ third-party biller of such nonappearance. As to defendant’s mailing of the EUO notices, we note that the assignor’s address as listed in the notices was consistent with that appearing on the claim form submitted by the plaintiff medical provider, which, notably, offered no persuasive explanation, either below or on appeal, as to why the notices were returned to defendant as “unclaimed.”
Key Takeaway
This decision reinforces that insurers can successfully defend no-fault claims by providing detailed evidence of proper notice and actual non-appearance. Medical providers must ensure their assignors comply with examination requirements, as failed appearances can result in claim denials even when providers themselves have no control over assignor behavior. The court’s emphasis on physician affidavits and consistent addressing underscores the importance of thorough documentation in EUO proceedings.
Legal Update (February 2026): Since this 2014 post, New York’s no-fault insurance regulations have undergone several revisions that may affect IME and EUO notice requirements, scheduling procedures, and documentation standards for establishing non-appearance. Additionally, appellate decisions since 2014 may have refined the evidentiary standards for proving proper notice and substantiating no-shows. Practitioners should verify current regulatory provisions and recent case law when handling examination compliance disputes.
