Why Trust This Analysis
This article is part of our ongoing additional verification coverage, with 234 published articles analyzing additional verification issues across New York State. Attorney Jason Tenenbaum brings 24+ years of hands-on experience to this analysis, drawing from his work on more than 1,000 appeals, over 100,000 no-fault cases, and recovery of over $100 million for clients throughout Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx. For personalized legal advice about how these principles apply to your specific situation, contact our Long Island office at (516) 750-0595 for a free consultation.
No-fault insurance carriers have specific procedural requirements they must follow when denying claims based on a patient’s failure to appear for an Independent Medical Examination (IME). This case demonstrates how insurers can successfully defend their claim denials by establishing compliance with both verification requirements and IME scheduling protocols under New York No-Fault Insurance Law.
The decision highlights three critical elements that carriers must prove: proper scheduling of IMEs, timely requests for additional verification, and appropriate timing of claim denials. When carriers follow these procedural steps correctly, courts will uphold denials even when patients simply fail to show up for their scheduled examinations.
Jason Tenenbaum’s Analysis:
“Defendant also established that the assignor had failed to appear for the duly scheduled IMEs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 ). Defendant further demonstrated that, upon receipt of the claims, it had timely mailed initial and follow-up requests for written verification (see 11 NYCRR 65-3.5 ; 65-3.8 ; St. Vincent’s Hosp. of Richmond, 50 AD3d 1123). Finally, defendant established that, upon receiving the requested verification, it had timely denied the claims at issue based upon the assignor’s failure to appear for IMEs”
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This case illustrates proper procedural compliance where the first IME date was scheduled within 30 days of receiving the billing. Importantly, the billing was delayed pending additional verification, and the carrier appropriately waited to receive the verification before denying the claims based on the policy violation. This careful sequencing of events - requesting verification first, then scheduling the IME, and finally denying based on non-appearance - demonstrates the methodical approach carriers must take to ensure their denials withstand legal scrutiny.
Key Takeaway
Successful IME no-show denials require carriers to demonstrate three key elements: timely IME scheduling within regulatory requirements, proper verification requests under 11 NYCRR 65-3.5 and 65-3.8, and appropriate timing of the denial. When carriers follow this procedural sequence correctly, courts will uphold claim denials based on patient non-appearance.
Legal Update (February 2026): Since this 2016 post, the procedural requirements for IME scheduling and additional verification requests under 11 NYCRR 65-3.5 and 65-3.8 may have been subject to regulatory amendments or clarifications. The timing requirements and specific procedural steps for claim denials based on IME non-appearance should be verified against current regulations, as enforcement interpretations and compliance standards may have evolved. Practitioners should confirm current provisions in the most recent version of Part 65 before relying on the procedural analysis discussed in this post.
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Legal Context
Why This Matters for Your Case
New York law is among the most complex and nuanced in the country, with distinct procedural rules, substantive doctrines, and court systems that differ significantly from other jurisdictions. The Civil Practice Law and Rules (CPLR) governs every stage of civil litigation, from service of process through trial and appeal. The Appellate Division, Appellate Term, and Court of Appeals create a rich and ever-evolving body of case law that practitioners must follow.
Attorney Jason Tenenbaum has practiced across these areas for over 24 years, writing more than 1,000 appellate briefs and publishing over 2,353 legal articles that attorneys and clients rely on for guidance. The analysis in this article reflects real courtroom experience — from motion practice in Civil Court and Supreme Court to oral arguments before the Appellate Division — and a deep understanding of how New York courts actually apply the law in practice.
About This Topic
Additional Verification in No-Fault Claims
Under New York's no-fault regulations, insurers may request additional verification of a claim within specified time limits. The timeliness, scope, and reasonableness of verification requests — and the consequences of a claimant's failure to respond — are among the most litigated issues in no-fault practice. These articles examine the regulatory framework for verification requests, court decisions on compliance, and the interplay between verification delays and claim determination deadlines.
234 published articles in Additional Verification
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T & J Chiropractic v GEICO: why deficient IME no-show statements defeated the insurer's motion without establishing the provider's right to judgment.
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UB-04 + nothing else does not equal Prima Facie
Court rules UB-04 forms alone don't establish prima facie no-fault claims - NF-5 forms required to trigger 30-day payment period under New York insurance law.
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The first case interpreting Infinity v. Eveready
First appellate case interpreting Infinity v. Eveready timing requirements for no-fault verification requests - Velen Medical Supply decision analysis.
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No show and non receipt
Progressive Health: mutual advance rescheduling was not an IME no-show. Separate mailing and nonreceipt affidavits left claim submission for trial.
May 11, 2017Was this article helpful?
Disclaimer: This article is published by the Law Office of Jason Tenenbaum, P.C. for informational and educational purposes only. It does not constitute legal advice, and no attorney-client relationship is formed by reading this content. The legal principles discussed may not apply to your specific situation, and the law may have changed since this article was last updated.
New York law varies by jurisdiction — court decisions in one Appellate Division department may not be followed in another, and local court rules in Nassau County Supreme Court differ from those in Suffolk County Supreme Court, Kings County Civil Court, or Queens County Supreme Court. The Appellate Division, Second Department (which covers Long Island, Brooklyn, Queens, and Staten Island) and the Appellate Term (which hears appeals from lower courts) each have distinct procedural requirements and precedents that affect litigation strategy.
If you need legal help with a additional verification matter, contact our office at (516) 750-0595 for a free consultation. We serve clients throughout Long Island (Huntington, Babylon, Islip, Brookhaven, Smithtown, Riverhead, Southampton, East Hampton), Nassau County (Hempstead, Garden City, Mineola, Great Neck, Manhasset, Freeport, Long Beach, Rockville Centre, Valley Stream, Westbury, Hicksville, Massapequa), Suffolk County (Hauppauge, Deer Park, Bay Shore, Central Islip, Patchogue, Brentwood), Queens, Brooklyn, Manhattan, the Bronx, Staten Island, and Westchester County. Prior results do not guarantee a similar outcome.
