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.
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.
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.
Case Background
In Alleviation Med. Servs., P.C. v Maya Assur. Co., the plaintiff medical provider brought an action as assignee of the injured party to recover first-party no-fault benefits. Maya Assurance Company had denied the claims on the ground that the plaintiff’s assignor failed to appear for scheduled independent medical examinations. After the Civil Court ruled in favor of the insurer, the provider appealed to the Appellate Term, Second Department.
The central question on appeal was whether Maya Assurance had met its evidentiary burden to establish the foundational element of its IME no-show defense: proof that the scheduling letters had been timely mailed to the assignor. This threshold requirement is a prerequisite to any IME no-show defense, and without it, the entire defense collapses regardless of whether the assignor actually appeared for the examination.
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?
Legal Significance
This decision is part of a well-documented pattern in the Appellate Term, Second Department, where Maya Assurance Company repeatedly failed to establish proper mailing procedures for IME scheduling notices. The ruling reinforces a foundational principle of New York no-fault law: the burden of proving compliance with procedural requirements rests entirely on the insurer asserting the defense.
Under 11 NYCRR § 65-1.1, no-fault insurers have the right to request that claimants submit to independent medical examinations. However, a denial based on failure to appear is conditioned on the insurer’s compliance with strict procedural requirements, including demonstrable proof of timely mailing. Courts have consistently required that insurers present competent evidence of mailing—typically through an affidavit from a person with personal knowledge of the mailing practices, or through documentary evidence such as certified mail receipts. A bare assertion that letters were sent, without corroborating evidence, will not suffice.
Practical Implications
For insurance defense attorneys, this case underscores the importance of maintaining rigorous mailing protocols. Detailed mailing logs, proof of postage, and affidavits from individuals with personal knowledge of the actual mailing—not merely knowledge of general office procedures—are essential components of a defensible IME no-show case.
For plaintiff’s counsel representing healthcare providers, the lesson is equally clear: always scrutinize the proof of mailing when opposing an IME no-show defense. As the Maya Assurance line of cases demonstrates, many insurers fail to meet this evidentiary threshold, creating a reliable basis for reversal on appeal.
For insurers generally, Maya Assurance’s experience should serve as a cautionary tale about the systemic risks of inadequate mailing documentation. A failure that recurs across multiple cases suggests a systemic deficiency in internal procedures that demands institutional correction.
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. Appellate courts will not hesitate to reverse summary judgments where the insurer’s foundational proof of mailing is lacking, regardless of the merits of the underlying medical dispute.
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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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Oct 1, 2013Common Questions
Frequently Asked Questions
What is an Independent Medical Examination (IME)?
An IME is a medical examination conducted by a doctor chosen by the insurance company to evaluate the claimant's injuries and treatment. In no-fault cases, insurers use IMEs to determine whether ongoing treatment is medically necessary, whether the injuries are causally related to the accident, and whether the claimant has reached maximum medical improvement. The results of an IME can form the basis for a claim denial or cut-off of benefits.
Can I refuse to attend an IME?
No. Under New York's no-fault regulations, attending an IME when properly scheduled is a condition precedent to receiving benefits. However, the insurer must follow specific scheduling procedures — including providing reasonable notice and accommodating certain scheduling conflicts. If the insurer fails to properly schedule the IME or you have a legitimate reason for missing it, the resulting denial may be challenged.
How should I prepare for an Independent Medical Examination?
Be honest and thorough when describing your symptoms, limitations, and treatment history. Arrive on time with photo ID and be prepared for a physical examination that may test your range of motion and functional abilities. The IME doctor works for the insurance company and may spend limited time with you, so clearly communicate your ongoing symptoms. Your attorney can advise you on what to expect and review the IME report for accuracy afterward.
What is maximum medical improvement (MMI) in no-fault cases?
Maximum medical improvement (MMI) means the point at which your condition has stabilized and further treatment is unlikely to produce significant improvement. When an IME doctor determines you have reached MMI, the insurer may cut off further no-fault benefits. However, reaching MMI does not necessarily mean you have fully recovered — you may still have permanent limitations. Your treating physician can dispute the MMI finding through a detailed rebuttal affirmation.
Can I challenge an IME doctor's findings in my no-fault case?
Yes. If an IME results in a denial or cut-off of benefits, your treating physician can submit a sworn affirmation rebutting the IME findings point by point. The rebuttal should reference specific clinical findings, objective test results, and range-of-motion measurements that contradict the IME conclusions. At arbitration or trial, the fact-finder weighs both the IME report and the treating physician's opinion. An experienced no-fault attorney can identify weaknesses in the IME report.
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About the Author
Jason Tenenbaum, Esq.
Jason Tenenbaum is the founding attorney of the Law Office of Jason Tenenbaum, P.C., headquartered at 326 Walt Whitman Road, Suite C, Huntington Station, New York 11746. With over 24 years of experience since founding the firm in 2002, Jason has written more than 1,000 appeals, handled over 100,000 no-fault insurance cases, and recovered over $100 million for clients across Long Island, Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, the Bronx, and Staten Island. He is one of the few attorneys in the state who both writes his own appellate briefs and tries his own cases.
Jason is admitted to practice in New York, New Jersey, Florida, Texas, Georgia, and Michigan state courts, as well as multiple federal courts. His 2,353+ published legal articles analyzing New York case law, procedural developments, and litigation strategy make him one of the most prolific legal commentators in the state. He earned his Juris Doctor from Syracuse University College of Law.
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.
If you need legal help with a ime issues matter, contact our office at (516) 750-0595 for a free consultation. We serve clients throughout Long Island (Huntington, Babylon, Islip, Brookhaven, Smithtown, Riverhead, Southampton, East Hampton), Nassau County (Hempstead, Garden City, Mineola, Great Neck, Manhasset, Freeport, Long Beach, Rockville Centre, Valley Stream, Westbury, Hicksville, Massapequa), Suffolk County (Hauppauge, Deer Park, Bay Shore, Central Islip, Patchogue, Brentwood), Queens, Brooklyn, Manhattan, the Bronx, Staten Island, and Westchester County. Prior results do not guarantee a similar outcome.
