IME Notification Requirements in New York No-Fault Cases: Address Matching Rules

Independent Medical Examinations (IMEs) are a critical component of New York’s no-fault insurance system, but they must be properly scheduled with adequate notice to be valid. Recent case law, including Brand Med. Supply, Inc. v Repwest Ins. Co. (2019 NY Slip Op 51183), demonstrates that the address used for IME notification can determine whether an insurance company’s denial of benefits is upheld. Understanding these notification requirements is essential for both healthcare providers and accident victims navigating no-fault claims.

Understanding IME Notification in New York No-Fault Law

Under New York’s no-fault insurance regulations, insurance companies have the right to require claimants to submit to Independent Medical Examinations to verify the necessity and reasonableness of medical treatment. However, this right comes with strict procedural requirements, including proper notification to ensure the examination is conducted fairly.

What is an Independent Medical Examination?

An Independent Medical Examination is a medical evaluation conducted by a physician chosen by the insurance company to assess:

• The extent and nature of injuries claimed
• The medical necessity of requested treatment
• The relationship between injuries and the motor vehicle accident
• The claimant’s current medical condition and prognosis

Legal Foundation for IME Requirements

New York Insurance Law § 5102(d) and 11 NYCRR Part 65 establish the framework for IME requirements, including notification procedures that insurance companies must follow to schedule valid examinations.

The Address Matching Rule: Brand Medical Supply Case Analysis

The Brand Med. Supply, Inc. v Repwest Ins. Co. decision provides crucial guidance on IME notification requirements, specifically addressing when an insurance company’s mailing address satisfies legal notice requirements.

Key Facts of the Brand Medical Supply Case

In this case, the insurance company mailed IME notification letters to the address that matched:

• The address provided on the plaintiff’s medical bill
• The address listed on the assignor’s Assignment of Benefits (AOB)
• The address on the assignor’s NF-2 application for no-fault benefits

The court found that this address matching was sufficient to constitute proper notice, even when the claimant argued they didn’t receive adequate notification.

Court’s Reasoning

The Appellate Term held: “However, the record demonstrates conclusively that the address to which defendant mailed the letters matched the address provided by plaintiff on its bill and by plaintiff’s assignor on the assignor’s application for no-fault benefits (NF-2). Thus, plaintiff has not demonstrated that defendant did not give the assignor proper notice of the IME.”

This decision establishes that mailing IME notices to addresses consistently provided by the claimant or healthcare provider creates a presumption of proper notification.

IME Notification Requirements Under New York Law

Mandatory Notice Elements

IME notifications must include specific information to be legally sufficient:

Timing Requirements:

• At least 10 days advance notice (excluding weekends and holidays)
• Notice must be mailed or personally served
• Reasonable time to arrange attendance

Required Information:

• Date, time, and location of examination
• Name and specialty of examining physician
• Right to have attorney present
• Right to have examination recorded
• Consequences of failure to appear

Address Requirements:
Based on the Brand Medical Supply case and similar decisions, notice should be sent to:

• Address on the NF-2 application for benefits
• Address provided on medical bills or assignments
• Last known address provided by claimant
• Address in insurance company’s file

Consequences of Improper Notice

When insurance companies fail to provide proper IME notification:

• Benefit denials based on “no-show” may be invalid
• Insurance companies may lose their right to examine the claimant
• Previously denied claims may need to be reconsidered
• Additional penalties and interest may apply

Address Documentation Best Practices

For Healthcare Providers and Assignees

To ensure proper IME notification, healthcare providers should:

Maintain Consistent Addresses:

• Use the same address on all no-fault documentation
• Update address information immediately when patients move
• Verify addresses with patients regularly
• Keep records of address changes and dates

Document Address Information:

• Confirm addresses on NF-2 applications match other documents
• Maintain copies of all address-related correspondence
• Document any address discrepancies or issues
• Create paper trails for address verification

For Insurance Companies

Insurance companies must establish procedures to ensure proper notification:

Address Verification:

• Compare addresses across all relevant documents
• Use the most recent address information available
• Document address sources and verification methods
• Maintain records of mailing attempts and deliveries

Challenging Inadequate IME Notice

Common Grounds for Challenge

Healthcare providers and claimants can challenge IME notices on several grounds:

Insufficient Advance Notice:

• Less than 10 days notice provided
• Unreasonable scheduling considering holidays or weekends
• Inadequate time to arrange transportation or representation

Improper Address:

• Notice sent to outdated or incorrect address
• Failure to use address from required documents
• Inconsistent addressing across multiple notices

Missing Required Information:

• Incomplete examination details
• Failure to specify examining physician
• Omission of claimant rights information

Strategic Considerations for No-Fault Practitioners

For Healthcare Providers

When representing healthcare providers in no-fault cases:

Proactive Measures:

• Review all address information before submitting initial claims
• Establish protocols for maintaining current patient addresses
• Create systems for receiving and responding to IME notices
• Maintain detailed records of all correspondence

Defensive Strategies:

• Challenge IME notices with procedural defects
• Document any barriers to examination compliance
• Preserve evidence of proper address provision
• Consider alternative examination arrangements when appropriate

For Accident Victims

When advising accident victims about IME requirements:

Education and Preparation:

• Explain IME rights and obligations
• Help coordinate examination scheduling
• Ensure proper address information is maintained
• Prepare clients for examination process

For more information about New York no-fault insurance law, explore these related topics:

• Understanding New York’s No-Fault Insurance Law
• Your Rights and Responsibilities at IME Examinations
• Navigating the No-Fault Claims Process

Frequently Asked Questions About IME Notification

Q: What happens if I don’t receive an IME notice but my benefits are denied for non-appearance?

A: If you can demonstrate that you didn’t receive proper notice due to the insurance company’s failure to use the correct address (as provided on your NF-2 form or medical bills), you may be able to challenge the denial. The insurance company must show they mailed the notice to the address you consistently provided in your documentation.

Q: Can the insurance company require multiple IMEs?

A: Generally, insurance companies are limited in the number of IMEs they can require. Additional examinations must be justified by specific circumstances such as new injuries, changed conditions, or significant time passage. Excessive examination requests may constitute harassment.

Q: Do I have the right to have my attorney present at an IME?

A: Yes, New York law generally allows you to have your attorney present during IMEs. The insurance company must inform you of this right in their examination notice. However, the attorney’s role is typically limited to observing rather than participating in the examination.

Q: What if the examining physician is too far from my home?

A: The examination location should be reasonably convenient. If the proposed location creates undue hardship, you may be able to request an alternative location closer to your home. Document any legitimate scheduling or transportation difficulties.

Q: Can the insurance company deny benefits if I miss an IME due to a medical emergency?

A: No, legitimate medical emergencies that prevent IME attendance should not result in benefit denials if properly documented. Contact the insurance company immediately to reschedule and provide medical documentation of the emergency.

Conclusion

The address matching rule established in Brand Med. Supply, Inc. v Repwest Ins. Co. provides important clarity for IME notification requirements in New York no-fault cases. Insurance companies who mail IME notices to addresses consistently provided by claimants on NF-2 forms, assignments of benefits, and medical bills create a strong presumption of proper notification.

However, the case also highlights the importance of maintaining accurate, consistent address information throughout the no-fault claims process. Healthcare providers must ensure their patients provide current addresses and update this information promptly when changes occur.

Understanding these notification requirements is essential for all participants in New York’s no-fault system. Proper compliance protects the rights of injured persons while enabling insurance companies to conduct necessary medical examinations to evaluate claims fairly.

If you’re dealing with IME notification issues or no-fault benefit denials, don’t navigate the complex requirements alone. Call 516-750-0595 for a free consultation with experienced New York no-fault attorneys who understand the intricacies of IME law and can protect your rights.

This article is for informational purposes only and does not constitute legal advice. Each no-fault case is unique, and you should consult with a qualified attorney about your specific situation.

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Legal Update (February 2026): The IME notification requirements and procedural standards discussed in this 2019 post may have been modified through subsequent amendments to 11 NYCRR Part 65 or interpretive changes in case law regarding address verification and notification protocols. Practitioners should verify current IME scheduling requirements, notification timeframes, and address matching standards under the most recent regulatory provisions and judicial interpretations.