Key Takeaway
Maya Assurance Company loses three no-show IME cases in 2016, highlighting common defenses used by healthcare providers in no-fault insurance disputes.
This article is part of our ongoing ime issues coverage, with 149 published articles analyzing ime issues 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.
In New York’s no-fault insurance system, Independent Medical Examinations (IMEs) serve as a crucial tool for insurance carriers to evaluate the medical necessity and reasonableness of ongoing treatment. When a patient fails to appear for a scheduled IME—known as a “no-show”—insurers often use this as grounds to deny or discontinue benefits. However, healthcare providers have several potential defenses against such denials.
The regulatory framework governing IME requests imposes strict procedural requirements on insurance carriers. Under 11 NYCRR 65-3.5(c), insurers must provide proper notice that includes specific information about the examination location, date, time, and the consequences of non-compliance. Any deviation from these requirements can render the IME request defective and invalidate a subsequent denial based on the patient’s failure to appear.
The success of a no-show defense typically depends on proving that proper notice wasn’t provided or that the examination request was procedurally defective. Issues can arise with IME notification requirements, timing of the examination request, or whether the insurer followed proper protocols when scheduling the IME. Insurance carriers bear the burden of establishing on summary judgment that they strictly complied with all notice requirements and that the patient actually failed to appear for a properly scheduled examination.
Maya Assurance Company’s pattern of losses in these cases suggests potential procedural weaknesses in their IME scheduling process. For healthcare providers facing similar situations, understanding the technical requirements for valid IME requests is essential for mounting effective defenses in New York no-fault insurance litigation.
Case Background
During 2016, Maya Assurance Company suffered three consecutive defeats in IME no-show cases before the Appellate Term, Second Department. These cases—Harvard Med., P.C. v Maya Assur. Co., 2016 NY Slip Op 51529(U), Liberty Chiropractic, P.C. v Maya Assur. Co., 2016 NY Slip Op 51531(U), and Sharp View Diagnostic Imaging, P.C. v Maya Assur. Co., 2016 NY Slip Op 51534(U)—involved different healthcare providers but shared common procedural deficiencies in Maya’s IME scheduling practices.
In each matter, Maya moved for summary judgment to dismiss the provider’s claims based on the patient’s alleged failure to appear for a scheduled IME. The insurance carrier argued that the no-show constituted a breach of a condition precedent to coverage, thereby relieving Maya of its obligation to pay for submitted claims. However, the Appellate Term found that Maya failed to establish its prima facie entitlement to judgment in each instance.
Jason Tenenbaum’s Analysis
Harvard Med., P.C. v Maya Assur. Co., 2016 NY Slip Op 51529(U)(App. Term 2d Dept. 2016)
Liberty Chiropractic, P.C. v Maya Assur. Co., 2016 NY Slip Op 51531(U)(App. Term 2d Dept. 2016)
Sharp View Diagnostic Imaging, P.C. v Maya Assur. Co., 2016 NY Slip Op 51534(U)(App. Term 2d Dept. 2016)
Legal Significance
The trilogy of Maya Assurance losses highlights the judiciary’s strict approach to IME procedural compliance. Courts will not permit insurance carriers to deny benefits based on technical non-compliance when the carrier itself failed to satisfy its own procedural obligations. This reflects the broader principle in no-fault law that insurance carriers, as sophisticated repeat players in the system, must scrupulously follow regulatory requirements.
The cases also demonstrate that patterns of procedural failure can become institutionalized within an insurance company’s claims handling practices. When an insurer loses multiple cases on similar grounds, it suggests systemic deficiencies in training, quality control, or case management protocols rather than isolated errors.
Moreover, these decisions underscore the importance of developing a complete evidentiary record before moving for summary judgment. Insurance carriers must not only prove that a patient failed to appear, but also affirmatively establish that every procedural prerequisite was satisfied. This includes proper mailing, adequate notice periods, clear communication of examination requirements, and appropriate documentation of the scheduling process.
Practical Implications
For healthcare providers defending against IME no-show denials, these cases provide a blueprint for effective opposition. Providers should carefully scrutinize the IME scheduling correspondence to identify any procedural defects. Common areas of vulnerability include insufficient notice periods, improper mailing addresses, unclear examination instructions, failure to provide required statutory warnings, and inadequate proof of actual mailing and receipt.
Insurance carriers, conversely, must implement rigorous quality assurance measures for their IME scheduling procedures. This includes maintaining detailed logs of all communications, using certified mail or other trackable delivery methods, ensuring adequate notice periods, and training staff on current regulatory requirements. A single procedural misstep can render an otherwise valid IME request unenforceable.
The Maya cases also illustrate the value of discovery in IME no-show disputes. Providers should not hesitate to demand proof of mailing, copies of all correspondence, and affidavits from individuals with personal knowledge of the carrier’s mailing practices. Generic or conclusory affidavits will not suffice to carry the carrier’s summary judgment burden.
Key Takeaway
These three consecutive losses by Maya Assurance Company demonstrate that no-show defenses require strict adherence to procedural requirements. Healthcare providers should carefully examine the technical aspects of IME scheduling when no-show issues arise, as insurers must meet specific notice and timing requirements for valid IME requests. The pattern of defeats suggests that insurance carriers cannot rely on mere assertions of non-compliance but must instead prove every element of proper IME scheduling through competent evidence.
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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.
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Frequently Asked Questions
What is an Independent Medical Examination (IME)?
An IME is a medical examination conducted by a doctor chosen by the insurance company to evaluate the claimant's injuries and treatment. In no-fault cases, insurers use IMEs to determine whether ongoing treatment is medically necessary, whether the injuries are causally related to the accident, and whether the claimant has reached maximum medical improvement. The results of an IME can form the basis for a claim denial or cut-off of benefits.
Can I refuse to attend an IME?
No. Under New York's no-fault regulations, attending an IME when properly scheduled is a condition precedent to receiving benefits. However, the insurer must follow specific scheduling procedures — including providing reasonable notice and accommodating certain scheduling conflicts. If the insurer fails to properly schedule the IME or you have a legitimate reason for missing it, the resulting denial may be challenged.
How should I prepare for an Independent Medical Examination?
Be honest and thorough when describing your symptoms, limitations, and treatment history. Arrive on time with photo ID and be prepared for a physical examination that may test your range of motion and functional abilities. The IME doctor works for the insurance company and may spend limited time with you, so clearly communicate your ongoing symptoms. Your attorney can advise you on what to expect and review the IME report for accuracy afterward.
What is maximum medical improvement (MMI) in no-fault cases?
Maximum medical improvement (MMI) means the point at which your condition has stabilized and further treatment is unlikely to produce significant improvement. When an IME doctor determines you have reached MMI, the insurer may cut off further no-fault benefits. However, reaching MMI does not necessarily mean you have fully recovered — you may still have permanent limitations. Your treating physician can dispute the MMI finding through a detailed rebuttal affirmation.
Can I challenge an IME doctor's findings in my no-fault case?
Yes. If an IME results in a denial or cut-off of benefits, your treating physician can submit a sworn affirmation rebutting the IME findings point by point. The rebuttal should reference specific clinical findings, objective test results, and range-of-motion measurements that contradict the IME conclusions. At arbitration or trial, the fact-finder weighs both the IME report and the treating physician's opinion. An experienced no-fault attorney can identify weaknesses in the IME report.
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About the Author
Jason Tenenbaum, Esq.
Jason Tenenbaum is the founding attorney of the Law Office of Jason Tenenbaum, P.C., headquartered at 326 Walt Whitman Road, Suite C, Huntington Station, New York 11746. With over 24 years of experience since founding the firm in 2002, Jason has written more than 1,000 appeals, handled over 100,000 no-fault insurance cases, and recovered over $100 million for clients across Long Island, Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, the Bronx, and Staten Island. He is one of the few attorneys in the state who both writes his own appellate briefs and tries his own cases.
Jason is admitted to practice in New York, New Jersey, Florida, Texas, Georgia, and Michigan state courts, as well as multiple federal courts. His 2,353+ published legal articles analyzing New York case law, procedural developments, and litigation strategy make him one of the most prolific legal commentators in the state. He earned his Juris Doctor from Syracuse University College of Law.
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 ime issues 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.
