Key Takeaway
New York appellate court clarifies insurance companies must preserve IME no-show defenses for each claim separately, even when denying multiple claims from same provider.
Understanding IME Defense Preservation in No-Fault Insurance Claims
In New York’s no-fault insurance system, insurance companies frequently rely on Independent Medical Examination (IME) no-show defenses to deny claims. However, a recent appellate decision has clarified an important procedural requirement that could significantly impact how insurers handle multiple claims from the same healthcare provider.
The case of Valdan Acupuncture, P.C. v NY Central Mutual Fire Insurance Co. addresses a critical question: when an insurance company denies some claims on grounds other than IME no-shows, can it still use the IME no-show defense for other claims from the same provider? This decision builds upon established precedent regarding IME procedural requirements and provides important guidance for both insurers and healthcare providers navigating the no-fault system.
Jason Tenenbaum’s Analysis:
Valdan Acupuncture, P.C. v NY Cent. Mut. Fire Ins. Co., 2018 NY Slip Op 50739(U)(App. Term 2d Dept. 2018)
Oh its’s real. “Three of the claims at issue in this case, seeking the sums of $1,062.11, $1,420.16 and $1,420.16, respectively, were denied on grounds other than plaintiff’s assignor’s failure to appear for IMEs. Consequently, as plaintiff argues, defendant did not preserve its IME no-show defense as to those claims and, thus, it is not entitled to summary judgment dismissing those claims on that ground ”
Shout out to former no-fault attorney Irena Golodkeyer on her brief. Rumor tells me that she has found greener pastures in the world.
Key Takeaway
This decision establishes that insurance companies must preserve their IME no-show defenses on a claim-by-claim basis. When an insurer denies claims for reasons other than IME non-appearance, it cannot later invoke the no-show defense for those specific claims, even if the patient failed to attend scheduled examinations. This ruling reinforces the importance of consistent defense strategies in New York no-fault insurance litigation.
