Key Takeaway
New York court ruling clarifies timing requirements for IME requests under no-fault insurance regulations, highlighting tensions between different regulatory provisions.
No-fault insurance litigation often involves complex timing requirements that can determine whether an insurer’s actions are valid or constitute grounds for denial of claims. A recent appellate decision sheds light on the interplay between different regulations governing Independent Medical Examinations (IMEs), particularly when insurers request examinations before receiving formal claim forms.
The tension between regulatory provisions creates strategic considerations for both insurers and healthcare providers in no-fault cases. Understanding when IME letters do not need to be sent to provider can be crucial for compliance, while the timing of such requests often becomes a point of contention in litigation.
Jason Tenenbaum’s Analysis:
Easy Care Acupuncture P.C. v Praetorian Ins. Co., 2015 NY Slip Op 51524(U)(App. Term 1st Dept. 2015)
“Contrary to plaintiff’s specific contention, defendant was entitled to request the IMEs prior to its receipt of plaintiff’s claim forms (see 11 NYCRR 65-1.1 may reasonably require”]; Steven Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720, 721 ; see also Inwood Hill Med., P.C. v General Assur. Co., 10 Misc 3d 18, 19-20 ).”
In American Transit v. Longevity, we learned for the first time that 65-3.5(d) plays into the calculus of whether an IME letter is timely relative to the claim. It would seem to me that scheduling IME’s prior to receipt of the claim forms would be the best way of complying with this regulation and avoiding a Longevity issue. This regulation and 65-1.1 come into disharmony when the IME is scheduled more than 30-days after receipt of the billing, The timing element of 3.5(d) takes second fiddle to the notion that “an insurer has a right to request IMEs “when, and as often as may reasonably require”
So be it. Disharmony is what keeps the law fluid and most of us employed.
Key Takeaway
The Easy Care decision confirms insurers can request IMEs before receiving claim forms, providing a strategy to avoid timing issues under the Longevity factors. However, regulatory disharmony between different provisions creates ongoing litigation opportunities as courts balance timing requirements with insurers’ broad examination rights.
Legal Update (February 2026): The regulations governing Independent Medical Examination procedures under 11 NYCRR Part 65 have undergone several amendments since 2015, particularly affecting timing requirements and procedural standards referenced in this post. Practitioners should verify current provisions of 11 NYCRR 65-1.1 and related sections, as regulatory changes may have modified the standards for IME requests and their relationship to claim form receipt requirements.
