Key Takeaway
Court ruling clarifies that IME scheduling letters sent to attorneys only establish proper notice if there's proof the patient was actually represented by that attorney.
Understanding IME Scheduling Requirements: When Attorney Notification Matters
Independent Medical Examinations (IMEs) are a critical component of New York No-Fault Insurance Law, allowing insurers to assess the medical necessity and extent of claimed injuries. However, the procedural requirements for properly scheduling these examinations can make or break a no-show defense. A recent Appellate Term decision highlights a crucial distinction: simply mailing IME notices to an attorney doesn’t automatically establish proper scheduling unless there’s proof that the attorney actually represents the patient.
This ruling underscores the importance of documentation in no-fault cases, where IME scheduling procedures must be meticulously followed to support subsequent denials. The case demonstrates how technical deficiencies in proving the attorney-client relationship can undermine what might otherwise appear to be a substantiated no-show defense.
Jason Tenenbaum’s Analysis:
Alleviation Med. Servs., P.C. v New York Cent. Mut. Fire Ins. Co., 2017 NY Slip Op 50952(U)(App. Term 2d Dept. 2017)
” To the extent that copies of the IME scheduling letters were sent to an attorney, there is nothing in the record to suggest that plaintiff’s assignor was represented by that attorney. Consequently, defendant’s moving papers failed to demonstrate that the IMEs had been properly scheduled (see Great Health Care Chiropractic, P.C. v Citiwide Auto Leasing, 43 Misc 3d 127, 2014 NY Slip Op 50476 ; Infinity Health Prods., Ltd., 39 Misc 3d 140, 2013 NY Slip Op 50751; cf. Star Med. [*2]Servs., P.C. v Allstate Ins. Co., 11 Misc 3d 131, 2006 NY Slip Op 50344 ) and, thus, that it is entitled to summary judgment dismissing the complaint.”
It looks like upon proof in the record showing that the Assignor is represented by counsel, mailing of the letter to counsel will proof a no-show defense. This would be in accordance with Marte-Rosario.
Key Takeaway
This decision emphasizes that insurance companies cannot rely solely on mailing IME notices to attorneys without establishing that an attorney-client relationship actually exists. The burden remains on the insurer to demonstrate proper scheduling through adequate documentation of representation, highlighting the procedural precision required in no-fault litigation.
