Key Takeaway
First Department ruling establishes key standards for proving IME no-shows in no-fault cases, requiring proper notice and competent evidence of nonappearance.
Independent Medical Examinations (IMEs) are a cornerstone of New York’s no-fault insurance system, allowing insurers to verify the medical necessity of ongoing treatment. When patients fail to appear for scheduled IMEs, insurers can use this nonappearance as grounds to deny benefits. However, successfully proving an IME no-show in court requires meeting specific evidentiary standards.
The First Department’s decision in Sunrise Acupuncture demonstrates the precise requirements insurers must satisfy to establish a valid defense based on IME nonappearance. This case is particularly instructive for understanding how courts evaluate the sufficiency of evidence when IME no-show defenses are raised, and what constitutes adequate proof of both proper notice and actual nonappearance.
Jason Tenenbaum’s Analysis:
Sunrise Acupuncture, P.C. v Encompass Auto & Home Ins. Co., 2014 NY Slip Op 51082(U)(App. Term 1st Dept. 2014)
“The defendant-insurer made a prima facie showing of entitlement to summary judgment dismissing the action for first-party no-fault benefits by establishing that it timely and properly mailed the notices for independent medical examinations (IMEs) to plaintiff’s assignor and his counsel, and that the assignor failed to appear (see American Tr. Ins. Co. v Lucas, 111 AD3d 423 ; American Tr. Ins. Co. v Solorzano, 108 AD3d 449 ). With respect to the appearance issue, defendant presented competent evidence of the assignor’s nonappearance in the form of the sworn affidavits of the scheduled examining physician and an employee of the defendant’s third-party biller attesting to the affiants’ “personal knowledge of the office procedures when a failed to appear for a medical exam” (American Tr. Ins. Co. v Lucas, 111 AD3d at 424).”
Key Takeaway
This decision establishes that insurers must prove two elements for successful IME no-show defenses: (1) proper and timely mailing of IME notices, and (2) competent evidence of nonappearance through sworn affidavits from individuals with personal knowledge of office procedures. The court’s emphasis on “personal knowledge” highlights the importance of detailed, first-hand testimony rather than conclusory statements when substantiating no-show claims.
Legal Update (February 2026): Since this 2014 decision, New York’s no-fault insurance regulations have undergone multiple amendments, including updates to IME scheduling procedures, notice requirements, and documentation standards under 11 NYCRR 65. Additionally, subsequent appellate decisions may have refined the evidentiary standards for proving IME non-appearance and the sufficiency of mailing documentation. Practitioners should verify current regulatory provisions and recent case law when handling IME no-show defenses.
