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.
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 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.
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.
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)
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.
