Key Takeaway
Court ruling explores whether IME notices were properly and timely mailed in no-fault insurance case, raising questions about timing requirements relative to bill receipt.
When insurance companies deny no-fault benefits based on a patient’s failure to appear for an Independent Medical Examination (IME), the timing and proper mailing of the IME notice becomes crucial. The court must determine whether the insurer followed proper procedures in scheduling the examination and notifying the patient.
In New York No-Fault Insurance Law cases, insurers often use no-show defenses to deny claims. However, they must prove they complied with all procedural requirements, including proper notice. This case from the First Department raises an interesting procedural question about what constitutes “timely” mailing of IME notices.
The distinction matters because if an insurer fails to properly schedule an IME or provide adequate notice, they cannot use the patient’s non-appearance as grounds for denial. Courts have previously addressed various aspects of IME notice requirements and have been strict about procedural compliance in no-show cases.
Jason Tenenbaum’s Analysis:
Acupuncture Solutions, P.C. v Lumbermans Mut. Cas. Co., 2015 NY Slip Op 50346(U)(App. Term 1st Dept. 2015)
“The defendant-insurer made a prima facie showing of entitlement to summary judgment dismissing the action for first-party no-fault benefits by establishing that it timely and properly mailed the notices for independent medical examinations (IMEs) to plaintiff’s assignor, and that the assignor failed to appear”
So here is the question. Did the “timely and properly mail the notices” include gearing the mailings to the receipt of Plaintiff’s bill?
I think the answer is no, as the basic construct of a first department no-show motion would not call for same. But I need to read the record before I can give an answer.
Key Takeaway
This case highlights the procedural complexities in no-fault IME scheduling. While the court found the insurer properly mailed IME notices, the timing question—whether notices must be coordinated with bill receipt—remains unresolved and requires further examination of the case record to determine the full scope of “timely” notice requirements.
