Key Takeaway
Court finds insufficient proof of mailing for IME scheduling letters, highlighting the importance of establishing proper office procedures for no-fault insurance cases.
Independent Medical Examinations (IMEs) are a cornerstone of New York no-fault insurance law, serving as a critical tool for insurers to evaluate the medical necessity and reasonableness of treatments. However, the procedural requirements surrounding IME scheduling can create significant challenges for insurance companies. One fundamental requirement is proving that IME appointment letters were properly mailed to claimants. While most disputes center on whether a patient actually appeared for their scheduled examination, a recent Appellate Term decision highlights a less common but equally important issue: proving the letters were sent in the first place.
The case of Faith Acupuncture, P.C. v Maya Assurance Co. demonstrates how inadequate documentation of mailing procedures can undermine an insurer’s defense, even when no-show issues are typically the focus of litigation.
Jason Tenenbaum’s Analysis:
Faith Acupuncture, P.C. v Maya Assur. Co., 2014 NY Slip Op 51863(U)(App. Term 2d Dept, 2014)
“Plaintiff correctly argues on appeal that the affidavit submitted by defendant did not sufficiently set forth a standard office practice or procedure that would ensure that the letters scheduling independent medical examinations (IMEs) had been properly addressed and mailed ”
This is something you do not see too often nowadays: a court stating that the IME letters were not mailed. Most reversals or issues seems to involve the proof of no show. Of course, this only invites a trial where the vendor will have to prove that the letters were mailed.
Key Takeaway
This decision emphasizes the critical importance of establishing and documenting standard office procedures for mailing IME scheduling letters. Insurance companies must ensure their affidavits detail specific mailing protocols rather than simply asserting that letters were sent. Without proper procedural documentation, even substantiated no-show claims can fail, leading to costly trial proceedings where insurers must prove basic mailing compliance.
