Key Takeaway
New York court finds triable issues when insurance company claims IME no-show without proper foundation, highlighting burden of proof requirements in no-fault cases.
IME No-Show Defense Fails Due to Lack of Personal Knowledge
Independent Medical Examinations (IMEs) are a crucial component of New York No-Fault Insurance Law, allowing insurance companies to verify medical claims and treatment necessity. However, when insurers claim a patient failed to appear for a scheduled IME, they must establish proper foundation for their allegations. A recent appellate decision demonstrates how courts are scrutinizing the quality of evidence insurers present when asserting IME no-shows as grounds for claim denial.
The case highlights a growing trend in New York courts examining whether insurance company representatives have sufficient personal knowledge to testify about events that occurred months earlier. This scrutiny mirrors earlier decisions that questioned how witnesses could credibly attest to specific acts performed nearly a year ago without proper documentation or foundation.
Jason Tenenbaum’s Analysis:
Sutphin Complete Med. Care v Hereford Ins. Co., 2016 NY Slip Op 50763(U)(App. Term 1st Dept. 2016)
“the record raises triable issues as to whether the assignor failed to appear for the scheduled IMEs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720, 721 ; Village Med. Supply, Inc. v Travelers Prop. Cas. Co. of Am., 51 Misc 3d 126, 2016 NY Slip Op 50339 ; Metro 8 Med. Equip., Inc. v ELRAC, Inc., 50 Misc 3d 140, 2016 NY Slip Op 50174 ).”
The triable issue of facts mirror what we saw starting in the Westmed v. State Farm case: how can somebody aver to an act performed 12 months ago without establishing a foundation for the fact? This Court seems to be running with the line of cases unique to this court.
Key Takeaway
Insurance companies cannot simply claim IME no-shows without proper evidentiary foundation. Courts are increasingly demanding that insurers demonstrate how their witnesses have personal knowledge of events from months earlier, creating substantiated no-show requirements that go beyond mere assertions. This trend provides stronger protection for healthcare providers challenging claim denials.
