Key Takeaway
Court ruling on IME no-show disclaimer timing - denial valid after verification received despite prior grounds for disclaimer existing under NY no-fault law.
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.
In New York’s no-fault insurance system, carriers face complex procedural requirements when denying claims based on multiple grounds. A particularly challenging scenario arises when an insurance company has grounds to disclaim coverage based on an assignor’s failure to appear for Independent Medical Examinations (IMEs), but the claim itself has been tolled pending receipt of verification materials. The intersection of these two procedural requirements creates strategic questions: When must a disclaimer be issued? Can carriers wait until verification is received before disclaiming on IME no-show grounds that arose earlier?
This issue frequently generates litigation because plaintiffs argue that carriers waive their IME no-show defenses by failing to disclaim immediately when the no-show occurs. Carriers counter that tolling provisions suspend all time requirements, including disclaimer deadlines, until verification is provided. The Longevity Medical Supply case addresses this recurring dispute and provides important guidance on the relationship between verification tolling and disclaimer timing.
Case Background
In Longevity Medical Supply, Inc. v Citiwide Auto Leasing, the medical supply company submitted a claim for durable medical equipment provided to an injured patient. Before Citiwide received the claim, the carrier had already scheduled initial and follow-up IMEs for the assignor. The patient failed to appear for both scheduled examinations, giving Citiwide grounds to disclaim coverage based on lack of cooperation.
However, when Citiwide eventually received the claim form, the carrier determined that verification was necessary and sent initial and follow-up verification requests. Only after receiving the requested verification did Citiwide issue its denial based on the earlier IME no-shows. Longevity argued this disclaimer was untimely because grounds for disclaimer existed when the no-shows occurred, and the carrier’s obligation to disclaim within 30 days should have run from that point. The carrier maintained that the verification request tolled all time requirements, making the post-verification disclaimer timely.
Jason Tenenbaum’s Analysis
Longevity Med. Supply, Inc. v Citiwide Auto Leasing, 2017 NY Slip Op 51880(U)(App. Term 2d Dept. 2017)
“In support of its motion, defendant established that, before it had received the claim at issue, it had mailed letters scheduling an initial and follow-up IME (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 ). Defendant also established that the assignor had failed to appear for the scheduled IMEs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 ). Defendant further demonstrated that, upon receipt of the claim at issue, it had timely mailed initial and follow-up requests for written [*2]verification (see St. Vincent’s Hosp. of Richmond, 50 AD3d 1123). Finally, defendant established that, upon receiving the requested verification, it had timely denied the claim at issue based upon the assignor’s failure to appear for IMEs (see St. Vincent’s Hosp. of Richmond, 50 AD3d 1123; Alev Med. Supply, Inc. v New York Cent. Mut. Fire Ins. Co., 38 Misc 3d 143, 2013 NY Slip Op 50258 ). Plaintiff failed to raise a triable issue of fact in opposition.”
This is the famous fact pattern. Bill is delayed for delayed for verification. The IME is timely scheduled and there is a double no-show. Eventual denial comes when the verification is received. Plaintiff argues that the denial is late because the disclaimer should have been issued when grounds to disclaim existed. The carrier argues that the bill is tolled until verification is received. Again, the court held that a disclaimer is timely when it is issued following receipt of late verification notwithstanding the grounds existing prior,
Legal Significance
The Appellate Term’s decision in Longevity Medical Supply resolves an important question about the interplay between verification tolling and disclaimer timing requirements under 11 NYCRR 65-3.8. The court adopted the position that verification requests toll all statutory timeframes, including the 30-day period for issuing disclaimers of coverage. This holding prevents carriers from being placed in the untenable position of having to disclaim before receiving information necessary to evaluate the claim.
The decision follows the reasoning established in St. Vincent’s Hospital of Richmond v Government Employees Insurance Co. and related cases holding that tolling provisions operate broadly to suspend claim processing obligations. This interpretation recognizes the practical reality that carriers often need verification materials to properly investigate claims and determine whether coverage defenses apply. Requiring premature disclaimers based on incomplete information would undermine the verification process and potentially result in erroneous coverage determinations.
However, the decision also creates strategic considerations for carriers. While tolling protects carriers from premature disclaimer requirements, it does not eliminate the obligation to act reasonably. Carriers must still schedule IMEs timely, send appropriate verification requests, and issue denials within reasonable timeframes once verification is received. The decision protects carriers who follow proper procedures but does not excuse delays attributable to carrier inaction.
Practical Implications for No-Fault Practitioners
Healthcare providers challenging IME no-show disclaimers must recognize that verification tolling extends disclaimer deadlines even when grounds for disclaimer existed earlier. Simply arguing that the carrier “knew” about the no-show months before denying the claim will not succeed if the claim was properly tolled for verification. Providers should instead focus on whether the verification request was proper, whether the carrier actually needed the requested information, and whether the denial was timely issued after verification was received.
For insurance carriers, this case reinforces the importance of proper verification practice. When claims are submitted without necessary information, carriers should promptly request verification and clearly document when requests are sent and responses received. The verification request effectively freezes the 30-day clock, but carriers must still act diligently once verification is provided. Delays in processing claims after receiving verification may support arguments that disclaimers were untimely.
The decision also highlights the value of scheduling IMEs before receiving claims when carriers have advance notice of accidents through police reports or direct notifications. Pre-claim IME scheduling, as occurred in Longevity, establishes the basis for no-show defenses regardless of subsequent verification issues and strengthens the carrier’s position in later litigation.
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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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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.
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