Key Takeaway
New York court ruling clarifies timing requirements for IME requests under no-fault insurance regulations, highlighting tensions between different regulatory provisions.
This article is part of our ongoing declaratory judgment action coverage, with 202 published articles analyzing declaratory judgment action 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.
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.
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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.
About This Topic
Declaratory Judgment Actions in Insurance Law
Declaratory judgment actions under CPLR 3001 allow insurers and claimants to obtain a judicial determination of their rights under an insurance policy before or during the course of litigation. In the no-fault context, carriers frequently seek declaratory judgments on coverage, fraud, and policy procurement issues. These articles analyze the procedural requirements, strategic considerations, and substantive standards governing declaratory judgment practice in New York insurance disputes.
202 published articles in Declaratory Judgment Action
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Jul 17, 2014Common Questions
Frequently Asked Questions
What is a declaratory judgment action in insurance litigation?
A declaratory judgment action under CPLR 3001 asks the court to determine the rights and obligations of the parties under an insurance policy. In no-fault practice, insurers frequently file declaratory judgment actions to establish that they have no obligation to pay claims — for example, by seeking a declaration that the policy is void due to fraud or material misrepresentation on the application. Defendants can cross-move for summary judgment or raise counterclaims for the unpaid benefits.
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.
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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 declaratory judgment action 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.