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Illogical
No-Fault

Illogical

By Jason Tenenbaum 8 min read

Key Takeaway

New York appellate court highlights inconsistencies in no-fault insurance law regarding IME request timing and policy voiding procedures in healthcare provider billing disputes.

This article is part of our ongoing no-fault coverage, with 271 published articles analyzing no-fault issues across New York State. Attorney Jason Tenenbaum brings 24+ years of hands-on experience to this analysis, drawing from his work on more than 1,000 appeals, over 100,000 no-fault cases, and recovery of over $100 million for clients throughout Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx. For personalized legal advice about how these principles apply to your specific situation, contact our Long Island office at (516) 750-0595 for a free consultation.

Court Decision Exposes Logical Gap in No-Fault Insurance Law

A recent New York appellate court decision has highlighted a perplexing inconsistency in no-fault insurance law that raises questions about how insurance companies can deny coverage. The case involves the fundamental question of when an insurance policy becomes void and how that affects different healthcare providers’ billing rights.

The court’s ruling in Acupuncture Approach, P.C. v Allstate Ins. Co. focuses on the insurance company’s failure to properly establish the timing of their Independent Medical Examination (IME) requests. This timing issue becomes crucial because no-fault regulations require insurers to follow specific procedures and deadlines when requesting these examinations.

Jason Tenenbaum’s Analysis:

Acupuncture Approach, P.C. v Allstate Ins. Co., 2015 NY Slip Op 50318(U)(App. Term 1st Dept. 2015)

“defendant failed to satisfy its initial burden of establishing, prima facie, “that it requested IMEs in accordance with the procedures and time frames set forth in the no-fault implementing regulations” (Unitrin Advantage Ins. Co. v Bayshore Physical Therapy, PLLC, 82 AD3d 559, 560 , lv denied 17 NY3d 705 ). In this regard, there is no indication in the record as to when defendant received plaintiff-provider’s no-fault claims and thus no basis to determine the timeliness of defendant’s IME requests.”

If the failure to appear at IMEs/EUOs voids the policy ab initio, then how could the billing of provider where the letters are within 15 business days of receipt of the billing of that providers be relevant? Clearly, this decision would only allow the billing of certain providers to be voided. This is incongruous to underpinniings of Unitrin

Key Takeaway

This decision creates a logical inconsistency in no-fault law: if a policy is voided from the beginning when someone fails to appear for required examinations, then timing of IME requests shouldn’t matter for individual providers. The court’s approach suggests only some providers’ claims can be voided, which contradicts established legal principles about when insurance policies become invalid.

Legal Context

Why This Matters for Your Case

New York's no-fault insurance system, established under Insurance Law Article 51, is one of the most complex insurance frameworks in the country. Every motorist must carry Personal Injury Protection coverage that pays medical expenses and lost wages regardless of fault, up to $50,000 per person.

But insurers routinely deny valid claims using peer reviews, EUO scheduling tactics, fee schedule reductions, and coverage defenses. The Law Office of Jason Tenenbaum has handled over 100,000 no-fault cases since 2002 — from initial claim submissions through arbitration before the American Arbitration Association, trials in Civil Court and Supreme Court, and appeals to the Appellate Term and Appellate Division. Jason Tenenbaum is one of the few attorneys in the state who both writes his own appellate briefs and tries his own cases.

His 2,353+ published legal articles on no-fault practice are cited by attorneys throughout New York. Whether you are dealing with a medical necessity denial, an EUO no-show defense, a fee schedule dispute, or a coverage question, this article provides the kind of detailed case-law analysis that helps practitioners and claimants understand exactly where the law stands.

About This Topic

New York No-Fault Insurance Law

New York's no-fault insurance system requires every driver to carry Personal Injury Protection (PIP) coverage that pays medical expenses and lost wages regardless of who caused the accident. But insurers routinely deny, delay, and underpay valid claims — using peer reviews, IME no-shows, and fee schedule defenses to avoid paying providers and injured claimants. Attorney Jason Tenenbaum has litigated thousands of no-fault arbitrations and court cases since 2002.

271 published articles in No-Fault

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Common Questions

Frequently Asked Questions

What is New York's no-fault insurance system?

New York's no-fault insurance system, codified in Insurance Law Article 51, requires all drivers to carry Personal Injury Protection (PIP) coverage. This pays for medical expenses, lost wages (up to $2,000/month), and other basic economic loss regardless of who caused the accident, up to $50,000 per person. However, to sue for pain and suffering, you must meet the 'serious injury' threshold under Insurance Law §5102(d).

How do I fight a no-fault insurance claim denial?

When a no-fault claim is denied, you can challenge it through mandatory arbitration under the American Arbitration Association's no-fault rules, or by filing a lawsuit in court. Common defenses to denials include challenging the timeliness of the denial, the adequacy of the peer review report, or the insurer's compliance with regulatory requirements. An experienced no-fault attorney can evaluate which strategy gives you the best chance of overturning the denial.

What is the deadline to file a no-fault claim in New York?

Under 11 NYCRR §65-1.1, you must submit a no-fault application (NF-2 form) within 30 days of the accident. Medical providers must submit claims within 45 days of treatment. Missing these deadlines can result in claim denial, though there are limited exceptions for late notice if the claimant can demonstrate a reasonable justification.

What no-fault benefits am I entitled to after a car accident in New York?

Under Insurance Law §5102(b), no-fault PIP covers necessary medical expenses, 80% of lost earnings up to $2,000/month, up to $25/day for other reasonable expenses, and a $2,000 death benefit. These benefits are available regardless of fault, up to the $50,000 policy limit. Claims are paid by your own insurer — not the at-fault driver's.

Can I choose my own doctor for no-fault treatment in New York?

Yes. Under New York's no-fault regulations, you have the right to choose your own physician, chiropractor, physical therapist, or other licensed healthcare provider. The insurer cannot dictate which providers you see. However, the insurer can request an IME with their chosen doctor and may challenge the medical necessity of your treatment through peer review.

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Attorney Jason Tenenbaum

About the Author

Jason Tenenbaum, Esq.

Jason Tenenbaum is the founding attorney of the Law Office of Jason Tenenbaum, P.C., headquartered at 326 Walt Whitman Road, Suite C, Huntington Station, New York 11746. With over 24 years of experience since founding the firm in 2002, Jason has written more than 1,000 appeals, handled over 100,000 no-fault insurance cases, and recovered over $100 million for clients across Long Island, Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, the Bronx, and Staten Island. He is one of the few attorneys in the state who both writes his own appellate briefs and tries his own cases.

Jason is admitted to practice in New York, New Jersey, Florida, Texas, Georgia, and Michigan state courts, as well as multiple federal courts. His 2,353+ published legal articles analyzing New York case law, procedural developments, and litigation strategy make him one of the most prolific legal commentators in the state. He earned his Juris Doctor from Syracuse University College of Law.

24+ years in practice 1,000+ appeals written 100K+ no-fault cases $100M+ recovered

Disclaimer: This article is published by the Law Office of Jason Tenenbaum, P.C. for informational and educational purposes only. It does not constitute legal advice, and no attorney-client relationship is formed by reading this content. The legal principles discussed may not apply to your specific situation, and the law may have changed since this article was last updated.

New York law varies by jurisdiction — court decisions in one Appellate Division department may not be followed in another, and local court rules in Nassau County Supreme Court differ from those in Suffolk County Supreme Court, Kings County Civil Court, or Queens County Supreme Court. The Appellate Division, Second Department (which covers Long Island, Brooklyn, Queens, and Staten Island) and the Appellate Term (which hears appeals from lower courts) each have distinct procedural requirements and precedents that affect litigation strategy.

If you need legal help with a no-fault matter, contact our office at (516) 750-0595 for a free consultation. We serve clients throughout Long Island (Huntington, Babylon, Islip, Brookhaven, Smithtown, Riverhead, Southampton, East Hampton), Nassau County (Hempstead, Garden City, Mineola, Great Neck, Manhasset, Freeport, Long Beach, Rockville Centre, Valley Stream, Westbury, Hicksville, Massapequa), Suffolk County (Hauppauge, Deer Park, Bay Shore, Central Islip, Patchogue, Brentwood), Queens, Brooklyn, Manhattan, the Bronx, Staten Island, and Westchester County. Prior results do not guarantee a similar outcome.

Filed under: No-Fault
Jason Tenenbaum, Personal Injury Attorney serving Long Island, Nassau County and Suffolk County

About the Author

Jason Tenenbaum

Jason Tenenbaum is a personal injury attorney serving Long Island, Nassau & Suffolk Counties, and New York City. Admitted to practice in NY, NJ, FL, TX, GA, MI, and Federal courts, Jason is one of the few attorneys who writes his own appeals and tries his own cases. Since 2002, he has authored over 2,353 articles on no-fault insurance law, personal injury, and employment law — a resource other attorneys rely on to stay current on New York appellate decisions.

Education
Syracuse University College of Law
Experience
24+ Years
Articles
2,353+ Published
Licensed In
7 States + Federal

Discussion

Comments (16)

Archived from the original blog discussion.

JT
Jason Tenenbaum Author
Because it’s only the failure to attend timely requested IMEs/EUOs that voids the policy. Nothing illogical about it.
KL
Kurt Lundgren
Its illogical to have NOT put in the proofs and establish the no show.
R
Rookie
Finally some courts and judges are begining to see the limits and the irrationality of Unitrin. This is a second decision by the App Term 1st Dept that at least tries to follow the Regs. Unitrin is an contrary to every aspect of insurance coverage litigation. Even assuming the fact that failure to appear at an EUO or IME is a coverage defense, which a plain reading of the Regs establsihes it is not, still requires a timely and proper disclaimer. Insurer cannot simply sit quetly and later disclaim coverage months or year later. Or yet one better at the same time the file their defective DJs. While this decision does not reach the ultimate conclusion that Unitrin is wrong as a matter of law, this decision does follow and track the language of Unitrin. Before a carrier can rely on the illogical and absurd protections afforded the carrier in Unitrin, it must meet a primary hurdle and establish when it received Providers bills and when it issued its EUO or IME notices. Because in Unitrin the Court did say that despite the untimely or no denial, carrier was successful in establishing its disclaimer of coverage was because it issued tinely and proper IME notices. Thus, before a carrier gets to abscond with the insurance premiums it has collceted and reneged on the coverage it was obligated to provide, it has to establish that it issued its initial IME or EUO notice within 15 business days of receipt of providers NF-3 or NF-2 and must establish that it issued a follow up IME or EUO notice if there was a no show or a mutual rescheduling with in 10 days of that date. Otherwise the carrier gets to say good bye to Unitrin protections.
SB
Stefan B
It’s perfectly logical, even under Unitrin. The requests for the IME must be timely in order to trigger the provisions. A no-show is not a violation of a condition precedent if the insurer didn’t properly trigger that condition in the first place.
A
ANONYMOUS
Proof of mailing and No-Show were in there. Also, case is inconsistent with prior Appellate Term cases with same exact fact patterns
NS
Nathan S
Why is the receipt of these Plaintiff’s bills relevant to whether the request was timely? The reg says the insurer can require an EIP submit to an IME “when, and as often as, the Company may reasonably require.”
JT
Jason Tenenbaum Author
Receipt of the bills is very relevant, because under the no-fault law, the insurer must pay or deny a claim within 30 days. That is the essence of no-fault. If you have a problem with that, address any changes to the legislature.
NS
Nathan S
Except First Department controlling authority says you DON’T need to deny within 30 days for an IME no-show. So when the claim is received is not relevant because the Regulation says an IME can be requested, essentially, at any time. Not to mention the failure to appear at an IME is a defense against all claims retroactive to date of loss, not just the specific claim at issue. And so maybe it’s not “timely” with respect to your bills, but “timely” with respect to a different bill.
SW
Someone who cares
The Unitrin decision lacks looking at the provider’s bills as a starting point as to what to do upon receipt of an NF-3. This case at least FINALLY realizes that the carrier has an obligation, under the regs to do something within 15 business days or within 30 days, if verification not requested. Unitrin was decided in a vacuum without ever considering what the carrier did upon receipt of the NF-3. Which is why Unitrin doesn’t, never and will never make any logical sense.
TH
The Hater
“This is incongruous to [the] underpinniings of Unitrin” What the [] you saying here. Guys this not real law. It’s no fault.
A
ANONYMOUS
Receipt of the bills is irrelevant. What if the IME was requested prior to receipt of any claims and simply upon receipt of the NF-2 or other notice of claim by the EIP? This would make it a pure request as a condition precedent to the policy. Stop thinking in a vacuum, people.
A
ANONYMOUS
Stefan B, a condition precedent is triggered the minute a policy of insurance is purchased and the insured accepts those terms. Pure contract law. We give you insurance, you agree to these terms. Nuff said. Time to stop thinking as a “plaintiff” or “defendant” and think like a lawyer.
KL
Kurt Lundgren
Just wondering, does the carrier ever return the premium once the policy is cancelled back to its inception? Wild guess .. no. Yes, I would agree that the policy conditions are triggered the moment the policy is purchased … but so are the carrier’s obligations. The carrier has an obligation to provide proper notice of the IME, etc.. Policy conditions and insurer obligations are intertwined. “We give you insurance, you agree to the terms” – give me a break! I pay my premium, the carrier has to also fulfill its obligations. That’s also contract law.
AK
Alan Klaus
Unitrin was and will always be bad Law. Of course 1st dept ignorance as usual. Saved the insurance companies a ton of money. Nuff said.
A
ANONYMOUS
Kurt: if you pay a premium and we give you a policy, that means that both parties intend to fulfill obligations. The insurer is ready willing and able to provide insurance. And does. But the insured’s obligations don’t end upon payment of the premium, there are continuing obligations on both ends. SO why would the insurer return the premium? It’s like a lease. You lease a car. you get a car. you pay the premium. You then default on payments. Car must be returned. Do you get back all the money you did pay so far for leasing the car? Nope.
KL
Kurt Lundgren
I appreciate your point bug guy, hope I didnt come across snarky. Why would the insurance company return the premium? Cause voiding a policy ab initio means that there is no coverage. So, I get to lease the car but I cant drive it? I would want my money back. I think Jerry Seinfeld said it best Jerry: I don’t understand. Do you have my reservation? Rental Car Agent: We have your reservation, we just ran out of cars. Jerry: But the reservation keeps the car here. That’s why you have the reservation. Rental Car Agent: I think I know why we have reservations. Jerry: I don’t think you do. You see, you know how to *take* the reservation, you just don’t know how to *hold* the reservation. And that’s really the most important part of the reservation: the holding. Anybody can just take them. Rental Car Agent: Would you like to purchase the renter’s insurance? Jerry: Yeah, you better give me the insurance because I’m going to beat the HELL out of this thing.

Legal Resources

Understanding New York No-Fault Law

New York has a unique legal landscape that affects how no-fault cases are litigated and resolved. The state's court system includes the Civil Court (for claims up to $25,000), the Supreme Court (the primary trial court for unlimited jurisdiction), the Appellate Term (which hears appeals from lower courts), the Appellate Division (divided into four Departments, with the Second Department covering Long Island, Brooklyn, Queens, Staten Island, and several upstate counties), and the Court of Appeals (the state's highest court). Each court has its own procedural requirements, local rules, and case-assignment practices that can significantly impact the outcome of your case.

For no-fault matters on Long Island, cases are typically filed in Nassau County Supreme Court (at the courthouse in Mineola) or Suffolk County Supreme Court (in Riverhead). No-fault arbitrations are heard through the American Arbitration Association, which assigns arbitrators throughout the metropolitan area. Workers' compensation claims go to the Workers' Compensation Board, with hearings at district offices across the state. Understanding which forum is appropriate for your case — and the specific procedural rules that apply — is essential for a successful outcome.

The procedural landscape in New York also includes important timing requirements that can affect your case. Most civil actions are subject to statutes of limitations ranging from one year (for intentional torts and claims against municipalities) to six years (for contract actions). Personal injury cases generally have a three-year deadline under CPLR 214(5), while medical malpractice claims must be filed within two and a half years under CPLR 214-a. No-fault insurance claims have their own regulatory deadlines, including 30-day filing requirements for applications and 45-day deadlines for provider claims. Understanding and complying with these deadlines is critical — missing a filing deadline can permanently bar your claim, regardless of how strong your case may be on the merits.

Attorney Jason Tenenbaum regularly practices in all of these venues. His office at 326 Walt Whitman Road, Suite C, Huntington Station, NY 11746, is centrally located on Long Island, providing convenient access to courts and offices throughout Nassau County, Suffolk County, and New York City. Whether you need representation in a no-fault arbitration, a personal injury trial, an employment discrimination hearing, or an appeal to the Appellate Division, the Law Office of Jason Tenenbaum, P.C. brings $24+ years of real courtroom experience to your case. If you have questions about the legal issues discussed in this article, call (516) 750-0595 for a free, no-obligation consultation.

New York's substantive law also presents distinct challenges. In motor vehicle cases, the no-fault system under Insurance Law Article 51 provides first-party benefits regardless of fault, but limits the right to sue for non-economic damages unless the plaintiff establishes a "serious injury" under one of nine statutory categories. This threshold — codified at Insurance Law Section 5102(d) — requires medical evidence showing more than a minor or subjective injury, and courts have developed detailed standards for each category. Fractures must be documented through imaging studies. Claims of permanent consequential limitation or significant limitation of use require quantified range-of-motion testing with comparison to norms. The 90/180-day category demands proof that the plaintiff was unable to perform substantially all of their usual daily activities for at least 90 of the 180 days following the accident.

In employment discrimination cases, the legal standards vary depending on whether the claim arises under state or local law. The New York State Human Rights Law employs a burden-shifting framework: the plaintiff must first establish a prima facie case by showing membership in a protected class, qualification for the position, an adverse employment action, and circumstances giving rise to an inference of discrimination. The burden then shifts to the employer to articulate a legitimate, non-discriminatory reason for its decision. If the employer meets this burden, the plaintiff must demonstrate that the stated reason is pretextual. The New York City Human Rights Law, by contrast, applies a broader standard, asking whether the plaintiff was treated less well than other employees because of a protected characteristic.

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