Key Takeaway
New York Appellate Term ruling clarifies what evidence insurers need to prove patient no-shows at IMEs, emphasizing physician affidavits over office records.
Independent Medical Examinations (IMEs) are a cornerstone of New York No-Fault Insurance Law, allowing insurers to verify the medical necessity of claimed treatments. When patients fail to appear for scheduled IMEs, insurers often seek to deny claims entirely. However, proving a “no-show” requires more than just documentation — it demands competent evidence that can withstand judicial scrutiny.
The Appellate Term’s decision in S.A. Med., P.C. v Praetorian Ins. Co. provides crucial guidance on what constitutes sufficient proof of non-appearance. This ruling clarifies the evidentiary standards that have evolved since earlier decisions like those discussed in our analysis of substantiated no-shows and cases where IME notices weren’t properly mailed.
Jason Tenenbaum’s Analysis:
S.A. Med., P.C. v Praetorian Ins. Co**.**, 48 Misc 3d 128(A)(App. Term 2d 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 plaintiffs’ assignor, and that the assignor failed to appear (see American Tr. Ins. Co. v Lucas, 111 AD3d 423 ; American Tr. Ins. Co. v Solorzano, 108 AD3d 449 ). Contrary to the motion court’s conclusion, defendant submitted competent evidence of the assignor’s nonappearance, including the sworn affidavits of the scheduled examining physician and chiropractor/acupuncturist, attesting to the affiants’ personal knowledge of their office practices and policies when an assignor fails to appear for a scheduled IME (see American Tr. Ins. Co. v Lucas, 111 AD3d at 424; Harmonic Physical Therapy v Encompass Home & Auto Ins. Co., 47 Misc 3d 146, 2015 NY Slip Op 50733 ).”
Key Takeaway
The Appellate Term emphasized that sworn physician affidavits demonstrating personal knowledge of office practices constitute competent evidence of patient non-appearance at IMEs. This ruling reinforces that insurers cannot rely solely on administrative records but must present testimony from medical professionals with direct knowledge of their examination procedures and no-show protocols.
