Key Takeaway
Court clarifies that insurance companies don't need to notify healthcare providers when scheduling Independent Medical Examinations under New York No-Fault law.
No-fault insurance disputes often center on procedural requirements that can make or break a case. One common area of confusion involves Independent Medical Examinations (IMEs) — medical evaluations ordered by insurance companies to assess whether ongoing treatment is necessary. Healthcare providers sometimes argue that insurers must notify them when scheduling these examinations, but New York courts have consistently rejected this position.
The Appellate Term’s decision in Pugsley Chiropractic PLLC v MVAIC provides important clarification on IME notification requirements and reinforces established precedent about when insurance companies can rely on IME reports to deny claims. This ruling is particularly significant for healthcare providers who may face claim denials based on IME findings and need to understand the procedural landscape governing these examinations.
Understanding these IME requirements is crucial for both providers and patients navigating New York No-Fault Insurance Law, as procedural missteps can significantly impact the outcome of benefit disputes.
Jason Tenenbaum’s Analysis:
Pugsley Chiropractic PLLC v MVAIC, 2015 NY Slip Op 50718(U)(App. Term 1st Dept. 2015)
(1) Defendant MVAIC made a prima facie showing of entitlement to judgment as a matter of law by demonstrating that it timely denied plaintiff’s first-party no-fault claims based on a sworn independent medical examination (IME) report of its examining chiropractor, which set forth a factual basis and medical rationale for his stated conclusion that the assignor’s injuries were resolved and that there was no need for further chiropractic treatment (see Utica Acupuncture, P.C. v Interboro Ins. Co., 39 Misc 3d 139, 2013 NY Slip Op 50643 )
I am partial to Utica Acupuncture – nothing new there.
(2) “Contrary to the conclusion reached below, defendant was not required to provide notice of the scheduled IME to plaintiff provider (see 11 NYCRR 65-1.1; 65-3.5,; 65-3.6; BR Clinton Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co., 43 Misc 3d 134, 2014 NY Slip Op 60632 ), and the court therefore erred in declining to consider the report on this ground (see V.S. Care Acupuncture PC v MVAIC, 47 Misc 3d 126, 2015 NY Slip Op 50350 ).”
I am surprised that somebody countenanced this argument.
Key Takeaway
The Appellate Term definitively established that insurance companies have no obligation to notify healthcare providers when scheduling IMEs. This ruling reinforces that properly conducted IME reports can serve as valid grounds for claim denials, even when providers aren’t given advance notice of the examination. The decision strengthens insurers’ ability to rely on IME findings to establish medical necessity defenses.
Legal Update (February 2026): Since this post’s publication in 2015, New York’s no-fault regulations under 11 NYCRR Part 65 have undergone several amendments, particularly regarding IME procedures and notification requirements. The regulatory framework governing Independent Medical Examinations, including sections 65-3.5 and 65-3.6, may have been modified through subsequent rulemaking. Practitioners should verify current provisions of 11 NYCRR 65-1 and related sections, as procedural requirements for IME scheduling and provider notifications may differ from those discussed in this 2015 analysis.
