Key Takeaway
Court rules insurance company failed to prove IME no-show due to deficient affidavits lacking personal knowledge, highlighting importance of proper documentation.
Understanding IME No-Show Documentation Requirements
Independent Medical Examinations (IMEs) are crucial tools in New York No-Fault Insurance Law cases, allowing insurance companies to assess the medical necessity and extent of claimed injuries. However, when a patient fails to appear for a scheduled IME, insurers must meet specific evidentiary standards to use that no-show as grounds for claim denial or case dismissal.
The Appellate Term’s recent decision in Compas Med., P.C. v New York Cent. Mut. Fire Ins. Co. demonstrates a critical requirement: healthcare professionals submitting affidavits about IME no-shows must have personal knowledge of the nonappearance. This ruling builds upon established precedent requiring insurers to substantiate their claims with proper documentation, similar to cases involving IME notification requirements and proper mailing procedures.
Jason Tenenbaum’s Analysis:
Compas Med., P.C. v New York Cent. Mut. Fire Ins. Co., 2016 NY Slip Op 50376(U)(App. Term 2d Dept. 2016)
“While defendant submitted properly sworn statements by the chiropractor and doctor who were scheduled to perform the IMEs, neither health care professional demonstrated personal knowledge of the nonappearance of plaintiff’s assignor for the examinations, and, therefore, defendant failed to establish its entitlement to judgment as a matter of law dismissing any causes of action on this ground”’
(The court cited to Alrof and Bright Supply)
We saw the Appellate Term First Department case holding that a 12 month gap between IME and affidavit required a showing in the affidavit as to the basis of personal knowledge. Having not seen the affidavit, I cannot opine on what the deficiency is.
Key Takeaway
Insurance companies cannot rely on conclusory affidavits from healthcare providers regarding IME no-shows. The examining professionals must demonstrate personal knowledge of the patient’s failure to appear, not simply attest to it based on secondhand information or administrative records. This requirement ensures proper foundation for using no-shows as grounds for claim denial.
