IME no-show unsuccessful

The Critical Importance of Accurate Addresses in IME Notice Requirements

Independent Medical Examinations (IMEs) serve as a crucial tool for insurance carriers investigating no-fault claims, but insurers must strictly comply with procedural requirements when scheduling these examinations. One of the most fundamental requirements—sending notice to the correct address—proved fatal to the insurance carrier’s defense in Pierre J. Renelique, M.D., P.C. v Park Insurance Co., demonstrating how seemingly simple administrative errors can undermine otherwise legitimate claim denials.

The case illustrates a broader principle in New York no-fault law: insurance companies bear the burden of proving they properly scheduled IMEs when asserting no-show defenses. This burden includes demonstrating that scheduling letters were sent to addresses that appeared on claim forms or were otherwise known to be correct. When insurers mail IME notices to wrong addresses while simultaneously sending correspondence to attorneys without establishing the attorney’s authorization to accept such service, courts will find the IME improperly scheduled and reject no-show defenses.

Case Background

Dr. Pierre J. Renelique’s medical practice provided treatment to an injured patient and submitted no-fault claim forms seeking reimbursement from Park Insurance Company. The NF-3 form—the standard claim form in New York’s no-fault system—clearly indicated that the patient’s address was “2307 Morris Ave, #2C, Bronx NY 10453.” However, when Park Insurance scheduled an IME to investigate the claim, the carrier sent the scheduling letters to “2497 Grant Avenue, Basement, Bronx, NY 10468”—an entirely different address in the Bronx.

The patient, not surprisingly, failed to appear for the IME at the scheduled date and time. After all, the patient never received notice because it was sent to an address where the patient did not reside. Park Insurance then denied the underlying claim based on the patient’s failure to comply with the IME request, treating the no-show as grounds for complete denial of benefits. Dr. Renelique’s practice filed suit seeking payment, and Park Insurance moved for summary judgment based on the IME no-show defense.

The insurance carrier attempted to salvage its defense by pointing to copies of the IME scheduling letters that were also sent to an attorney. However, the carrier failed to submit any evidence—such as a Letter of Representation (LOR)—establishing that the patient had authorized this attorney to represent him in the no-fault matter or to accept service on his behalf. Without such authorization, sending letters to an attorney provides no constructive notice to the patient.

Pierre J. Renelique, M.D., P.C. v Park Ins. Co., 2018 NY Slip Op 50780(U)(App. Term 2d Dept. 2018)

“Defendant’s moving papers stated that the IME scheduling letters were sent to plaintiff’s assignor at “2497 Grant Avenue, Basement, Bronx, NY 10468,” but the NF-3 form submitted by plaintiff indicated that the assignor’s address was “2307 Morris Ave, #2C, Bronx NY 10453.” A presumption of receipt arises only where there is proof of a proper mailing (see Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 ; Infinity Health Prods., Ltd. v Redland Ins. Co., 39 Misc 3d 140, 2013 NY Slip Op 50751 Dept, 2d, 11th & 13th Jud Dists 2013]). 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”

Clearly, the carrier was relying on the mailing of the IME letters to the attorney to make up for incorrect mailing of the letters to the Assignor. The carrier failed (it appears) to place the LOR in the moving papers. But even assuming this was done, was the attorney for Assignor lulled into believing that the letters were mailed to the correct address? See Global v. New Century Acupuncture, P.C.? The only way not to be lulled is foe the letter to the attorney to include the address of the Assignor on the “cc:” part of the letter.

Legal Significance

The Pierre J. Renelique decision reinforces fundamental principles governing IME notice requirements in New York no-fault cases. First, the presumption of receipt—a crucial evidentiary tool that typically aids insurance carriers in proving notice—only applies when there is proof of mailing to a proper address. Courts will not presume that individuals received mail sent to addresses where they do not reside, regardless of how meticulously the carrier documented its mailing procedures. An affidavit of mailing from a person with impeccable personal knowledge of office procedures cannot overcome the fundamental problem of sending notice to the wrong location.

Second, the decision clarifies that insurance carriers cannot salvage defective IME notices by showing they also sent copies to attorneys unless they establish that those attorneys were authorized to represent the patient. The attorney-client relationship in no-fault matters does not arise by implication or assumption. Carriers must produce Letters of Representation or equivalent documentation proving that patients explicitly authorized attorneys to accept service on their behalf. Without such proof, sending letters to attorneys provides no constructive notice to patients.

Third, as Jason Tenenbaum astutely observes, even when carriers can prove an attorney-client relationship existed, they face additional hurdles regarding what the attorney could reasonably be expected to do with defective notice. If the IME letter sent to the attorney lists an incorrect address for the patient, can the attorney be deemed to have provided adequate notice simply by forwarding the letter to the patient at the correct address? Or does the incorrect address on the carrier’s letter create confusion that excuses the patient’s non-appearance? These questions remain partially unresolved, but the safer practice is for carriers to ensure all IME scheduling letters—whether sent to patients or their attorneys—accurately reflect the patient’s correct address.

Practical Implications

For insurance carriers, this case underscores the critical importance of quality control in the IME scheduling process. Carriers should implement systematic procedures to verify that addresses used in IME scheduling letters match addresses appearing on claim forms. When discrepancies exist—such as when a patient provides one address on an NF-2 form and a different address on an NF-3 form—carriers should investigate which address is current before scheduling the IME. Sending IME notices to multiple addresses may provide additional protection, though carriers should be mindful of privacy concerns when doing so.

When carriers send IME scheduling letters to attorneys as well as patients, they must ensure their litigation files contain Letters of Representation or equivalent documentation establishing the attorney-client relationship. Moreover, as Jason Tenenbaum suggests, best practice dictates that IME letters sent to attorneys should clearly indicate the patient’s address in the “cc:” section or body of the letter. This practice accomplishes two goals: it allows attorneys to verify that carriers are sending notice to correct addresses, and it creates a record showing that attorneys were aware of where the carrier believed the patient resided.

For healthcare providers and their counsel, this decision provides a valuable defense against IME no-show denials. When reviewing denial letters based on IME non-appearances, providers should immediately compare the address used in the IME scheduling letter against addresses appearing on claim forms. Any discrepancy creates a viable challenge to the denial. Additionally, providers should demand proof that any attorney copied on IME correspondence actually represented the patient—insurers frequently send copies to attorneys who handled personal injury claims without verifying whether those attorneys also represented patients for no-fault purposes.

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• IME No Show: Understanding Confusing Court Interpretations of Duplicate Mailing Requirements
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