Key Takeaway
Court wrestles with Quality vs Amex theories for proving IME no-shows, highlighting ongoing legal tensions in New York no-fault insurance cases.
Court Grapples with Competing Legal Theories in IME No-Show Case
In New York’s no-fault insurance system, Independent Medical Examinations (IMEs) serve as a crucial tool for insurance carriers to evaluate injury claims. When patients fail to appear for these scheduled examinations, insurers often use this as grounds to deny claims. However, proving that a patient actually received proper notice and deliberately failed to appear has become a contentious legal issue, with courts applying different standards and theories.
The tension centers around two competing approaches: the “Quality” theory, which generally requires less stringent proof of personal knowledge regarding no-shows, and the “Amex” theory, which demands more concrete evidence that the patient had actual knowledge of the examination requirement. This legal battle has significant implications for both healthcare providers seeking reimbursement and insurance companies defending against New York no-fault insurance claims.
The case discussed below illustrates how courts continue to wrestle with these competing frameworks, particularly when determining what level of proof insurers must provide to successfully assert an IME no-show defense.
Jason Tenenbaum’s Analysis:
True-Align Chiropractic Care, P.C. v Country Wide Ins. Co., 2014 NY Slip Op 51821(U)(App. Term 2d Dept. 2014)
“Finally, contrary to plaintiff’s argument with respect to the remaining causes of action, defendant established that plaintiff’s assignor had failed to appear for the scheduled IMEs (see Quality Psychological Servs., P.C. v Interboro Mut. Indem. Ins. Co., 36 Misc 3d 146, 2012 NY Slip Op 51628 ).”
What is interesting is that this Court battles with the Alrof theory and the modified Amex theory regarding the personal knowledge of no-shows.
Key Takeaway
This decision highlights the ongoing judicial struggle between different evidentiary standards for proving IME no-shows. Courts must balance protecting patients’ rights to proper notice against preventing abuse of the examination process. The reference to both Alrof theories and modified Amex approaches demonstrates the unsettled nature of this area of law, creating uncertainty for practitioners on both sides of no-fault insurance disputes.
Legal Update (February 2026): The legal standards governing IME no-show cases and the competing “Quality” versus “Amex” theories discussed in this 2014 post may have evolved through subsequent appellate decisions and regulatory amendments. Practitioners should verify current case law regarding burden of proof requirements for IME notice and the specific evidentiary standards courts now apply when evaluating no-show defenses in no-fault insurance disputes.
