Why Trust This Analysis
This article is part of our ongoing ime issues coverage, with 149 published articles analyzing ime issues 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.
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)
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(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.
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Legal Context
Why This Matters for Your Case
New York law is among the most complex and nuanced in the country, with distinct procedural rules, substantive doctrines, and court systems that differ significantly from other jurisdictions. The Civil Practice Law and Rules (CPLR) governs every stage of civil litigation, from service of process through trial and appeal. The Appellate Division, Appellate Term, and Court of Appeals create a rich and ever-evolving body of case law that practitioners must follow.
Attorney Jason Tenenbaum has practiced across these areas for over 24 years, writing more than 1,000 appellate briefs and publishing over 2,353 legal articles that attorneys and clients rely on for guidance. The analysis in this article reflects real courtroom experience — from motion practice in Civil Court and Supreme Court to oral arguments before the Appellate Division — and a deep understanding of how New York courts actually apply the law in practice.
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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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