IME no-show substantiated again

Independent Medical Examinations (IMEs) are a critical component of New York’s no-fault insurance system, allowing insurance carriers to verify the medical necessity and extent of claimed injuries. However, disputes frequently arise over the technical requirements for IME scheduling letters, particularly regarding what constitutes proper notice to claimants. The formatting and language of these letters can determine whether an insurance company can successfully deny benefits for a claimant’s failure to appear.

In this case, the Civil Court initially found fault with the insurance carrier’s scheduling letters because they required claimants to call within 48 hours to cancel or reschedule appointments. This ruling reflects the ongoing tension between carriers seeking to streamline the IME process and courts ensuring claimants receive adequate notice and flexibility. The Appellate Term’s reversal demonstrates how IME no-show cases can hinge on seemingly minor procedural details.

Jason Tenenbaum’s Analysis:

AP Orthopedic & Rehabilitation, P.C. v Mercury Cas. Co., 2014 NY Slip Op 51794(U)(App. Term 2d Dept. 2014)

“The Civil Court denied defendant’s motion and plaintiff’s cross motion and held that the only remaining issue for trial was the propriety of defendant’s IME scheduling letters. Defendant argues on appeal that its motion for summary judgment dismissing the complaint should have been granted.

Contrary to the determination of the Civil Court, we find that defendant’s IME scheduling letters comply with the No-Fault Regulations (see 11 NYCRR 65-3.5 ).”

The objection to the letters in this case was that the letters advised the Claimant that they should call within 48 hours if they wished to cancel or reschedule their appointment. The Civil Court found this reasoning persuasive; the Appellate Term felt otherwise, reversed and granted Defendant summary judgment.

Legal Significance

The AP Orthopedic & Rehabilitation decision addresses the tension between regulatory compliance and practical administrative efficiency in the no-fault insurance system. The Civil Court’s initial ruling appeared to favor claimant flexibility, viewing the 48-hour cancellation requirement as potentially burdensome or restrictive. However, the Appellate Term’s reversal recognizes that insurance carriers have legitimate interests in managing their IME scheduling processes efficiently.

The court’s analysis focused on whether the scheduling letters complied with 11 NYCRR 65-3.5, which sets forth the requirements for IME notices. Notably, the regulations require that scheduling letters provide reasonable notice and opportunity for the claimant to appear, but they do not prohibit carriers from establishing reasonable cancellation or rescheduling procedures. The Appellate Term’s holding implicitly recognizes that a 48-hour advance notice requirement for cancellations represents a reasonable balance between claimant flexibility and carrier administrative needs.

This decision also reflects broader judicial recognition of the operational realities facing insurance companies conducting IMEs. When claimants cancel appointments without adequate advance notice, carriers must still compensate the examining physicians for blocked appointment times, incur administrative costs for rescheduling, and experience delays in claims processing. The 48-hour requirement provides carriers with sufficient time to reschedule or adjust physician calendars while still allowing claimants meaningful flexibility.

Practical Implications

For insurance carriers, this decision validates the inclusion of reasonable cancellation notice requirements in IME scheduling letters. Carriers can confidently include 48-hour (or potentially even 72-hour) advance cancellation provisions without fear that such language will invalidate their scheduling letters or prevent them from pursuing no-show defenses. This administrative certainty allows for more efficient IME scheduling and resource management.

Healthcare providers and their counsel should recognize that IME scheduling letters containing advance cancellation notice requirements will generally withstand challenge. Rather than attacking the letters themselves, providers should focus on whether their assignors actually received proper notice, whether the letters specified appropriate examination locations and times, or whether legitimate excuses existed for non-appearance.

The decision also counsels claimants and assignors to read IME scheduling letters carefully and comply with any stated cancellation procedures. If circumstances prevent attendance, contacting the insurance carrier more than 48 hours in advance can preserve the right to reschedule and avoid potential claim denials based on non-appearance.

Key Takeaway

The Appellate Term’s decision reinforces that IME scheduling letters containing 48-hour cancellation notice requirements are legally sufficient under New York’s No-Fault Regulations. This ruling provides clarity for insurance carriers regarding acceptable scheduling language and demonstrates that courts will not invalidate IME procedures based on reasonable administrative requirements designed to facilitate proper examination scheduling.

Legal Update (February 2026): Since this 2014 post, 11 NYCRR 65-3 regulations governing IME procedures may have been amended, particularly regarding scheduling notice requirements, cancellation timeframes, and standardized letter formatting. Practitioners should verify current provisions of section 65-3.5 and related subsections, as regulatory updates could affect the enforceability of IME scheduling requirements and no-show determinations.

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