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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)
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“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.
Related Articles
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- New York No-Fault Insurance Law
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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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.
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