Key Takeaway
New York court rules Maya Assurance failed to prove proper mailing of IME scheduling letters, highlighting the strict procedural requirements insurance companies must meet.
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.
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.
