Key Takeaway
New York court clarifies when IME rescheduling constitutes failure to appear and establishes mail delivery presumption standards for no-fault insurance claims.
No-fault insurance disputes often hinge on procedural technicalities that can significantly impact claim outcomes. Two particularly contentious issues involve Independent Medical Examinations (IMEs) and proof of claim receipt. When insurance carriers schedule IMEs, questions frequently arise about what constitutes a legitimate “no-show” versus acceptable rescheduling. Similarly, disputes over whether insurance companies actually received submitted claims create ongoing litigation challenges.
The Appellate Term’s recent decision in Progressive Health Chiropractic addresses both issues, providing crucial guidance for healthcare providers and insurance carriers operating under New York No-Fault Insurance Law. The court’s analysis distinguishes between mutual agreement to reschedule an IME versus unilateral failure to appear, while also establishing evidentiary standards for proving claim receipt through mail delivery presumptions.
These distinctions matter significantly in no-fault practice, where IME compliance issues and documentation requirements frequently determine whether claims are paid or denied. Understanding when rescheduling is acceptable versus when it constitutes grounds for claim denial helps providers navigate the complex procedural landscape of no-fault insurance.
Jason Tenenbaum’s Analysis:
Progressive Health Chiropractic, P.C. v American Tr. Ins. Co., 2017 NY Slip Op 50603(U)(App. Term 2d Dept. 2017)
(1) “we do not consider a mutual rescheduling, which occurs prior to the date of that scheduled IME, to constitute a failure to appear”
(2) “although the affidavit of defendant’s no-fault examiner was sufficient to show that defendant had never received that claim, the affidavit of plaintiff’s employee, in which the affiant stated that he had personally generated and mailed plaintiff’s $1,019.62 claim to defendant, was sufficient to give rise to the presumption that the claim had been received by defendant”
Key Takeaways
This decision provides important clarity for no-fault practitioners. First, mutual rescheduling of an IME before the scheduled date does not constitute a failure to appear, distinguishing cooperative schedule changes from unilateral no-shows. Second, the court reinforced that proper mailing creates a legal presumption of receipt, even when the insurance carrier provides contradictory testimony. Healthcare providers can rely on documented mailing procedures to establish claim submission, shifting the burden to insurers to prove non-receipt with compelling evidence.
