Maya failed to prove mailing of the IME scheduling letters

In New York no-fault insurance cases, insurance companies frequently deny claims by alleging that injured parties failed to appear for scheduled Independent Medical Examinations (IMEs). However, these denials are only valid if the insurer can prove the IME was properly scheduled and communicated to the patient. This procedural requirement has created significant challenges for insurance companies, particularly when their documentation falls short of legal standards.

The case of Sharp View Diagnostic Imaging v. Maya Assurance demonstrates how courts scrutinize the evidence insurers present to support their IME no-show denials. When an insurance company claims a patient failed to appear for an IME, they must establish a clear chain of evidence showing proper scheduling and notification procedures were followed. This burden of proof is more demanding than many insurers initially realize.

Jason Tenenbaum’s Analysis:

Sharp View Diagnostic Imaging, P.C. v Maya Assur. Co., 2015 NY Slip Op 51721(U))(App. Term 2d Dept. 2015)

“Plaintiff correctly argues on appeal that the affidavit submitted by defendant did not sufficiently set forth a standard office practice or procedure that would ensure that the letters scheduling independent medical examinations (IMEs) had been properly addressed and mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 ). As a result, defendant failed to demonstrate that the IMEs had been properly scheduled and, thus, that plaintiff’s assignor had failed to appear at duly scheduled IME”

It seems that Maya gets into trouble on these IME no show cases often.

Legal Significance

The Sharp View decision illustrates the rigorous evidentiary standards insurance carriers must meet when asserting IME no-show defenses. The Appellate Term’s ruling reinforces principles established in earlier decisions like St. Vincent’s Hospital, which require carriers to demonstrate not merely that letters were prepared, but that systematic office procedures ensure letters were properly addressed, stamped, and deposited in the mail.

The court’s analysis reveals a critical distinction between proof of letter creation and proof of letter mailing. Many insurance companies maintain records showing IME scheduling letters were generated and may even retain copies of those letters. However, this documentation alone does not establish that the letters actually reached the postal system and were delivered to the intended recipients.

To satisfy the mailing requirement, carriers must present affidavits from individuals with personal knowledge of the office’s standard mailing procedures. These affidavits must describe the specific steps taken to ensure proper addressing, adequate postage, and actual deposit in the mail. The description should be detailed enough to demonstrate that the procedures, if followed, would make it highly unlikely that a properly addressed letter would fail to be mailed.

The court’s reference to St. Vincent’s Hospital provides important guidance on what constitutes sufficient proof of mailing. That case established that carriers must demonstrate office practices including regular, systematic procedures for addressing and mailing correspondence, verification steps to ensure accuracy, and routine deposit of mail in appropriate receptacles. Generic statements that “letters are mailed in the ordinary course of business” fail to meet this standard.

Maya Assurance’s repeated difficulties with IME no-show cases, as noted by the court, suggest systemic deficiencies in the company’s documentation and proof procedures. This pattern indicates either inadequate office procedures for ensuring letters are actually mailed, or insufficient training of personnel responsible for creating affidavits supporting no-show defenses.

Practical Implications

For insurance carriers seeking to rely on IME no-show defenses, Sharp View provides a roadmap for what evidence will and will not suffice. Carriers should implement comprehensive procedures for documenting the entire lifecycle of IME scheduling letters, from creation through mailing and delivery confirmation.

First, carriers should establish standardized mailing procedures that include multiple verification steps. This might involve having one employee prepare letters, a second employee verify addressing and postage, and a third employee maintain logs of all mail deposited in postal receptacles. The procedures should be documented in written office policies that can be referenced in litigation affidavits.

Second, carriers should maintain detailed logs documenting each step of the mailing process. These logs should include the date letters were prepared, the date they were sealed and stamped, the date they were deposited in the mail, and the identity of employees responsible for each step. Modern document management systems can automate much of this tracking, creating contemporaneous records that carry more evidentiary weight than reconstructed timelines.

Third, affidavits supporting IME no-show defenses must be prepared with care and specificity. The affiant should be someone with direct personal knowledge of the office’s mailing procedures and should be able to testify that those procedures were followed for the specific letters at issue. The affidavit should describe the procedures in detail and explain how those procedures ensure proper mailing.

Fourth, carriers should consider implementing tracking systems for IME scheduling letters. Certified mail provides proof of mailing and delivery, though the additional expense may not be justified for routine IME scheduling. However, for high-value claims or situations where compliance concerns exist, certified mail creates an evidentiary record that eliminates most proof-of-mailing disputes.

Finally, carriers experiencing repeated adverse rulings on IME no-show defenses—like Maya Assurance appears to have experienced—should conduct comprehensive reviews of their procedures and documentation practices. The cost of implementing better systems is likely far less than the cumulative cost of losing claims due to inadequate proof of mailing.

From a litigation perspective, providers defending against IME no-show allegations should carefully scrutinize the carrier’s proof of mailing. Affidavits that provide only conclusory statements about office procedures, without specific descriptions of what those procedures entail, should be challenged as insufficient under Sharp View and St. Vincent’s Hospital.

Key Takeaway

Insurance companies must establish detailed, standard office procedures to prove IME letters were properly mailed. Maya Assurance’s failure to provide sufficient evidence of their mailing procedures resulted in their inability to sustain an IME no-show denial. This case reinforces that vague affidavits without specific procedural details will not satisfy the burden of proof required under New York no-fault insurance law.

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