Key Takeaway
New York appellate court clarifies evidence standards for proving IME no-shows, requiring personal knowledge or other appropriate means rather than inadequate documentation.
Proving IME No-Shows: Evidence Standards in New York No-Fault Cases
Independent Medical Examinations (IMEs) are a cornerstone of New York No-Fault Insurance Law, allowing insurance companies to verify the medical necessity and extent of claimed injuries. However, disputes frequently arise when patients fail to appear for scheduled IMEs, leading to coverage denials. The challenge for insurers lies in properly documenting these no-shows to withstand legal scrutiny.
A recent appellate decision provides crucial guidance on the evidence standards required to prove IME non-appearance. This ruling addresses a common problem in no-fault litigation: how insurance companies must substantiate claims that patients failed to attend scheduled examinations. The case highlights the distinction between adequate and inadequate evidence of no-shows, offering important lessons for both insurers and healthcare providers navigating IME-related disputes.
Jason Tenenbaum’s Analysis:
Acupuncture Pain Mgt., P.C. v Kemper Cas. Ins. Co., 2015 NY Slip Op 51522(U)(App. Term 1st Dept. 2015)
The Court limited the issue to following: “Contrary to Civil Court’s determination, defendant submitted competent evidence of the assignor’s nonappearance in the form of the sworn affidavits of the scheduled examining acupuncturist and defendant’s third-party IME scheduler setting forth facts sufficient to demonstrate the affiants’ personal knowledge of the assignor’s repeated failures to appear for the IMEs and the office practices and policies when an assignor fails to appear for a scheduled IME”
Many have been down this road with Judge Capella (the judge who was reversed). The no-show must either be based upon personal knowledge or by other appropriate means. that is from Compas v. Travelers and is quite asute. And, practice and procedure where there is indicia that someone was there to record the no-show will suffice is “appropriate means”.
Key Takeaway
The appellate court established clear evidence standards for proving IME no-shows: insurance companies must provide sworn affidavits demonstrating either personal knowledge of the non-appearance or documentation through “other appropriate means.” Standard office practices and policies with proper indicia of recording no-shows can constitute sufficient evidence when properly documented through competent affidavits.
