Key Takeaway
Court ruling confirms 30-day IME scheduling requirement under 11 NYCRR 65-3.5(d) in New York no-fault insurance cases, with analysis of precedent hierarchy.
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.
Understanding the 30-Day IME Scheduling Requirement in No-Fault Cases
New York’s no-fault insurance system operates under strict regulatory timelines designed to ensure prompt payment of legitimate claims while providing insurers reasonable time to investigate suspected fraud or unnecessary medical treatment. One crucial deadline governs when insurance companies must schedule Independent Medical Examinations (IMEs) after receiving claim forms.
Under 11 NYCRR 65-3.5(d), insurers must schedule initial IMEs to occur within 30 days of receiving the underlying claim. This regulatory requirement serves important policy objectives by preventing insurers from indefinitely delaying claim resolution through repeated or belated examination requests. When carriers fail to schedule timely IMEs, courts may preclude them from relying on medical necessity or causation defenses.
The 30-day rule has generated substantial litigation as insurers and medical providers dispute whether specific IME scheduling letters comply with regulatory requirements. Courts must balance insurers’ legitimate need to investigate claims against providers’ interest in prompt payment for rendered services. Understanding this balance is essential for practitioners handling IME no-show disputes and related procedural issues.
Case Background
In Irina Acupuncture, P.C. v Nationwide Affinity Ins. Co., the medical provider sued the insurer for unpaid no-fault benefits. The insurer defended by arguing that the provider failed to appear for properly scheduled IMEs, which would constitute grounds for denial under Insurance Law article 51. However, the provider moved for summary judgment, contending that the insurer’s IME scheduling letters violated the 30-day requirement under 11 NYCRR 65-3.5(d).
The trial court examined when the insurer received the underlying claims and when the IMEs were scheduled to occur. Finding that the examinations were not scheduled within 30 days of claim receipt as required by regulation, the Civil Court granted the provider’s motion for summary judgment on certain causes of action and denied the insurer’s cross-motion. The insurer appealed to the Appellate Term, Second Department.
Jason Tenenbaum’s Analysis:
Irina Acupuncture, P.C. v Nationwide Affinity Ins. Co., 2017 NY Slip Op 51461(U)(App. Term 2d Dept. 2017)
“Contrary to defendant’s argument, the Civil Court properly granted the branches of plaintiff’s motion seeking summary judgment on the first two causes of action and denied the branches of defendant’s cross motion seeking summary judgment dismissing those causes of action on the ground that the first independent medical examination had not been scheduled to be held within 30 days of defendant’s receipt of the claims underlying those causes of action, as required by 11 NYCRR 65-3.5 (d) (see W.H.O. Acupuncture, P.C. v Travelers Home & Mar. Ins. Co., 36 Misc 3d 152, 2012 NY Slip Op 51707 ; see also O & M Med., P.C. v Travelers Indem. Co., 47 Misc 3d 134, 2015 NY Slip Op 50476 ).”
This is settled law, not necessarily blog worthy. But, this is a holding that the Appellate Division, First Department and this Court share. Why not cite the 2 cases from the Appellate Division on this topic? Precedent from the Appellate Division, First Department, if not contradictory to precedent from the Appellate Division, Second Department is more binding on the Appellate Term, Second Department than that Court’s own holdings.
Legal Significance and Precedential Value
This decision reaffirms established law regarding IME scheduling timeliness, though Jason Tenenbaum correctly notes an interesting aspect of the court’s citation practices. The Appellate Term relied on its own prior decisions rather than citing Appellate Division First Department cases on the same issue. Under New York’s court hierarchy, Appellate Division decisions generally carry more precedential weight than Appellate Term decisions, particularly when the Appellate Division ruling comes from a different department and does not conflict with the home department’s precedent.
The substantive holding reinforces that the 30-day requirement under 11 NYCRR 65-3.5(d) is mandatory, not discretionary. Insurers cannot schedule IMEs beyond this window and then successfully defend against payment claims by arguing the claimant failed to cooperate. The regulation protects medical providers and claimants from indefinite claim processing delays while still permitting insurers reasonable time to arrange examinations.
Courts across New York’s appellate departments have consistently enforced this timing requirement, demonstrating rare uniformity in an area of law often marked by departmental splits. This consistency benefits practitioners by providing clear guidance about IME scheduling obligations.
Practical Implications
Insurance carriers must implement rigorous tracking systems to ensure IME scheduling letters are sent promptly after receiving claims and that examinations are scheduled within the regulatory window. Missing the 30-day deadline can result in waiver of important coverage defenses, leaving insurers obligated to pay claims they might otherwise have defeated through medical necessity challenges.
Medical providers should routinely verify IME scheduling compliance when defending against no-show allegations. Calculating the 30-day period from claim receipt provides a straightforward defense that can eliminate entire disclaimer letters regardless of whether the provider actually appeared for the examination.
Related Articles
- Understanding IME No-Shows in New York No-Fault Insurance Cases
- IME Notification Requirements in New York No-Fault Cases: Address Matching Rules
- IME No Show: Understanding Confusing Court Interpretations of Duplicate Mailing Requirements
- Nassau County court applies Unitrin ruling on IME no-shows
- New York No-Fault Insurance Law
Legal Update (February 2026): Since this post’s publication in 2017, New York’s no-fault regulations under 11 NYCRR Part 65 have undergone several amendments, including potential modifications to IME scheduling requirements and procedural timelines. Practitioners should verify current provisions of 11 NYCRR 65-3.5(d) and related sections, as regulatory updates may have affected the specific 30-day IME scheduling mandate discussed in this case analysis.
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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Sep 2, 2013Common Questions
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.
