Key Takeaway
Court reverses Maya Assurance IME no-show case due to failure to prove timely mailing of scheduling letters, highlighting ongoing issues with IME procedures.
Independent Medical Examinations (IMEs) are a critical component of New York no-fault insurance law, allowing insurance companies to have injured parties examined by their chosen doctors. However, the process is strictly regulated, and insurers must follow specific procedural requirements to successfully deny claims based on IME no-shows.
One of the most fundamental requirements is that IME scheduling letters must be properly and timely mailed to the injured party. When insurance companies fail to establish this basic procedural step, courts will typically reverse denials based on examination no-shows. This case involving Maya Assurance Company illustrates a recurring problem where IME no-show cases are being overturned due to procedural failures.
The burden of proof lies with the insurance company to demonstrate that proper notice was given. Without adequate evidence of timely mailing, even legitimate concerns about medical necessity become irrelevant, as the procedural foundation for the IME itself becomes legally defective.
Jason Tenenbaum’s Analysis:
Alleviation Med. Servs., P.C. v Maya Assur. Co., 2015 NY Slip Op 51238(U)(App. Term 2d Dept. 2015)
“Plaintiff correctly argues on appeal that defendant’s motion papers failed to establish that the letters scheduling the IMEs of plaintiff’s assignor had been timely mailed”
Why is every Maya IME no-show case getting reversed or ending up in disaster?
Key Takeaway
Insurance companies must maintain meticulous records and provide concrete evidence of timely IME scheduling letter mailings. Maya Assurance’s repeated failures in this area demonstrate that procedural compliance is just as important as the substantive medical issues in no-fault cases. Proper documentation and proof of mailing procedures are essential for successful IME-based claim denials.
