Key Takeaway
Court rules insurance companies must provide competent proof with adequate recollection when claiming patients failed to appear for Independent Medical Examinations.
Understanding IME No-Show Requirements: The Recollection Standard
Independent Medical Examinations (IMEs) are a critical component of New York No-Fault Insurance Law, allowing insurance companies to verify the medical necessity of treatments. However, when insurers claim a patient failed to appear for a scheduled IME, they must meet specific evidentiary standards to successfully defend against no-fault claims.
The Appellate Term’s decision in Utica Acupuncture highlights a fundamental issue that frequently arises in no-fault litigation: insurers attempting to dismiss cases based on alleged IME no-shows without providing adequate proof. This case demonstrates the importance of proper documentation and recollection when insurance companies seek to deny coverage based on missed appointments.
Jason Tenenbaum’s Analysis:
Utica Acupuncture P.C. v Amica Mut. Ins. Co., 2017 NY Slip Op 50331(U)(App. Term 1st Dept. 2017)
“Defendant-insurer’s motion for summary judgment dismissing the underlying first-party no-fault action should have been denied, inasmuch as it failed to submit competent proof of the assignor’s nonappearance at scheduled independent medical examinations (IMEs). The conclusory affirmation of defendant’s IME doctor lacked probative value, since she failed to adequately state the basis of her recollection, some two years later, that the assignor did not appear on the scheduled IME dates”
(1) Personal knowledge
(2) Some procedure about no-shows being notated or a review of file and based upon procedure, affiant can affirmatively state the assignor failed to appear.
Key Takeaway
Insurance companies cannot rely on conclusory statements when claiming IME no-shows. The court requires either personal knowledge of the absence or documented procedures showing how no-shows are recorded. Without adequate foundation for recollection, particularly when significant time has passed, insurers’ summary judgment motions will fail.
