Illogical

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.

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• Understanding IME No-Shows in New York No-Fault Insurance: Rights, Consequences, and Strategic Considerations
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• No-Fault Verification Requirements: When Partial Compliance Isn’t Enough
• Understanding CPLR 3212(a): Critical Timing Rules for Summary Judgment Motions in New York
• New York No-Fault Insurance Law