Key Takeaway
Court ruling highlights evidentiary standards for proving patient no-shows at IMEs, questioning the temporal limits and procedural requirements for valid affidavits.
Independent Medical Examinations (IMEs) are a cornerstone of New York’s no-fault insurance system, allowing insurers to evaluate the medical necessity of treatments and claims. When patients fail to appear for scheduled IMEs, insurance companies often deny related claims. However, proving a “no-show” requires more than simply asserting it happened—especially when significant time has passed between the missed appointment and the legal proceedings.
The Appellate Term’s decision in Village Med. Supply, Inc. v Travelers highlights the evolving standards for what constitutes adequate proof of a patient’s failure to appear at an IME. This case demonstrates how procedural requirements for IME no-shows continue to develop, particularly regarding the quality and specificity of evidence needed to support denial decisions.
Jason Tenenbaum’s Analysis:
Village Med. Supply, Inc. v Travelers Prop. Cas. Co. of Am., 2016 NY Slip Op 50339(U)(App. Term 1st Dept. 2016)
“The affidavits of defendant’s IME doctors lacked probative value, since they failed to state the basis of their recollection, some 12 months later, that the assignor did not appear on the scheduled IME dates”
This is interesting and asks a few questions. First: what is the tempral cut off when the affidavit has to say more than: “I was there and (s)he did not attend tee IME?” Second: I am assuming there has to be a minimal recitation of business practice to prove the no show? The rules with no-shows, both procedurally and substantively keep changing.
Key Takeaway
This decision establishes that IME doctors’ affidavits must provide a sufficient basis for their recollection when substantial time has elapsed. Insurance companies cannot rely on bare assertions of no-shows without explaining how the examining physician remembers specific details from months-old appointments. The ruling suggests that proper documentation and business practices become increasingly important as time passes, potentially requiring detailed record-keeping procedures to substantiate future denials based on patient non-appearance.
