Understanding IME No-Shows in New York No-Fault Insurance Cases

Understanding IME No-Shows in New York No-Fault Insurance Cases

Independent Medical Examinations (IME) are a critical component of New York’s no-fault insurance system. When medical providers or injured parties fail to appear for scheduled IMEs, it can result in claim denials that are difficult to overcome. Recent appellate decisions have consistently upheld these denials when insurance companies properly establish their procedural requirements.

Three recent cases from the Appellate Term, Second Department, demonstrate the strict approach New York courts take toward IME no-shows and the burden of proof required for insurance companies to successfully deny claims on this basis.

Key Cases: IME No-Show Denials Sustained

Valdan Acupuncture, P.C. v Global Liberty Ins. Co. of NY

The case Valdan Acupuncture, P.C. v Global Liberty Ins. Co. of NY, 2019 NY Slip Op 51705(U)(App. Term 2d Dept. 2019), established clear procedural requirements for IME denials:

“Defendant established that initial and follow-up letters scheduling IMEs had been timely mailed; that plaintiff’s assignor had failed to appear on either date; and that the claim seeking to recover the sum of $1,224.22 had been timely denied on that ground.”

The court emphasized that when these procedural requirements are met, the burden shifts to the plaintiff to raise a triable issue of fact, which they failed to do in this case.

Tyorkin v Global Liberty Ins.

Similarly, in Tyorkin v Global Liberty Ins., 2019 NY Slip Op 51689(U)(App. Term 2d Dept. 2019), the court reinforced these standards:

“Defendant submitted an affidavit by a supervisor employed by Omnimed Evaluation Services, which had been retained by defendant to schedule IMEs, which affidavit sufficiently established that the IME scheduling letters had been timely mailed. Defendant also established that the assignor had failed to appear for the duly scheduled IMEs.”

This case demonstrates the importance of proper documentation by third-party IME scheduling companies and their ability to provide competent testimony about their procedures.

Addressing Issues: Lidas Med. Supply, Inc. v Global Liberty Ins.

The case Lidas Med. Supply, Inc. v Global Liberty Ins., 2019 NY Slip Op 51688(U)(App. Term 2d Dept. 2019), addressed a common defense raised by plaintiffs – incorrect addresses on IME scheduling letters:

“The record demonstrates conclusively that while the address to which defendant mailed the letters did not include an apartment number, the address matched the one provided by plaintiff’s assignor on the assignor’s sworn application for no-fault benefits (NF-2) and on the assignor’s sworn notice of intention to make claim form which was submitted to defendant.”

This ruling establishes that insurance companies can rely on addresses provided by claimants in their own sworn applications, even if those addresses may be incomplete.

Procedural Requirements for Successful IME Denials

Based on these cases and established New York law, insurance companies must prove the following elements to successfully deny claims based on IME no-shows:

1. Proper Scheduling and Notice

Timely Mailing: IME scheduling letters must be sent within the timeframes required by New York Insurance Department regulations (11 NYCRR 65-3.5(c)).

Proper Address: Letters must be sent to the address provided by the claimant in their sworn applications or other official correspondence.

Required Content: Scheduling letters must include all required information under the regulations, including the date, time, location, and nature of the examination.

2. Documentation of Non-Appearance

Multiple Scheduling Attempts: Most cases involve both initial and follow-up IME scheduling letters, demonstrating good faith efforts to accommodate the examination.

Third-Party Verification: When IME scheduling is handled by third-party companies like Omnimed, their representatives can provide competent testimony about non-appearances.

Contemporary Records: Insurance companies should maintain detailed records of all scheduling correspondence and examination results.

3. Timely Denial

Regulatory Compliance: Denials must be issued within the timeframes required by New York regulations.

Proper Basis: The denial must specifically reference the IME no-show and cite appropriate regulatory authority.

Appeal Rights: Denials must include proper notice of appeal rights and procedures.

Strategic Considerations for Medical Providers

Medical providers and their attorneys should understand both the challenges and opportunities in defending against IME no-show denials:

Challenging IME Denials

Address Verification: While the Lidas case shows courts will accept addresses from sworn applications, providers can still challenge denials when:

• The insurance company had actual notice of a different or corrected address
• The address used was demonstrably incorrect or outdated
• The provider can show they never received the scheduling correspondence

Procedural Defects: Insurance companies must strictly comply with all procedural requirements. Challenges can focus on:

• Whether scheduling letters were sent timely
• Whether letters contained all required information
• Whether denials were issued within required timeframes
• Whether proper foundation was established for third-party testimony

Best Practices for Compliance

Address Management: Providers should ensure that insurance companies have current, accurate addresses for all patients and should promptly notify insurers of any address changes.

Attorney Representation Letters: The analysis notes that IME letters should include both the patient’s address and attorney information. This creates additional opportunities for proper notice.

Documentation: Providers should maintain their own records of any scheduling correspondence received and any efforts made to comply with IME requests.

Comparison with First Department Precedent

The analysis notes an important jurisdictional distinction. The Appellate Term, First Department, does not always follow the strict “contemporaneous” rule that has been applied in some Second Department cases. This creates potential strategic considerations for venue selection when possible.

The reference to the Satya Drug Corp. v Global Liberty Ins. Co. of N.Y., 2019 NY Slip Op 51505(U)(App. Term 1st Dept. 2019) case suggests that different appellate departments may take varying approaches to IME procedural requirements.

Broader Implications for No-Fault Practice

These IME no-show cases reflect broader themes in New York no-fault insurance practice:

Strict Procedural Compliance

New York’s no-fault system demands strict compliance with procedural requirements from all parties. Both insurance companies and medical providers must carefully follow regulatory requirements to preserve their rights.

Burden of Proof Standards

Once insurance companies establish prima facie entitlement to summary judgment, the burden shifts to providers to raise triable issues of fact. This requires more than conclusory allegations – providers must present specific evidence challenging the insurer’s proof.

Third-Party Service Providers

The use of third-party IME scheduling companies is common in the industry. These cases establish that such companies can provide competent evidence of their procedures and patient non-compliance, provided proper foundation is established.

Related No-Fault Insurance Issues

IME no-show cases are part of a broader landscape of no-fault insurance disputes:

• Other IME-related procedural challenges
• Understanding no-fault benefit requirements
• EUO no-show cases and defenses

Frequently Asked Questions About IME No-Shows

What should I do if I never received an IME scheduling letter?

If you believe you never received IME scheduling correspondence, gather evidence to support your position. This might include postal records, evidence that you were at a different address, or documentation that the insurance company had notice of an address change. However, be aware that courts will generally accept that letters were received if they were sent to addresses you provided in sworn applications.

Can an attorney receive IME scheduling letters on behalf of a patient?

The analysis suggests that IME letters should include both patient and attorney information. While insurance companies typically send letters to patients directly, providing current attorney contact information can help ensure proper notice and avoid scheduling conflicts.

What happens if I miss an IME due to a medical emergency or other legitimate reason?

If you have a legitimate reason for missing an IME, contact the insurance company immediately to reschedule. Document your reason (medical records, emergency room visits, etc.) and request a new examination date. However, be aware that the burden will be on you to prove the legitimacy of your absence.

How many times can an insurance company schedule an IME?

New York regulations limit the frequency of IMEs, but insurance companies can typically schedule follow-up examinations if the initial examination was missed. The key is that each scheduling must comply with proper notice requirements.

Can I challenge an IME denial after it’s been issued?

Yes, IME denials can be challenged through arbitration (for individual patients) or litigation (for medical providers). However, these cases show that courts strictly enforce procedural requirements, so challenges must be based on specific procedural failures by the insurance company rather than general disagreement with the denial.

The Importance of Experienced No-Fault Representation

IME no-show cases demonstrate the complex procedural requirements that govern New York’s no-fault insurance system. Both medical providers and injured patients need experienced legal representation to navigate these requirements and protect their rights.

At the Law Office of Jason Tenenbaum, we have extensive experience with all aspects of New York no-fault insurance law, including IME disputes, claim denials, and procedural challenges. We understand the strict requirements courts impose and know how to build effective challenges to improper denials.

Whether you’re a medical provider facing claim denials or an injured person dealing with insurance company demands for examinations, we can help protect your rights and ensure you receive the benefits you’re entitled to under New York law.

Don’t let procedural mistakes or improper insurance company tactics prevent you from receiving the compensation you deserve. Call 516-750-0595 for a free consultation. Our experienced no-fault insurance attorneys are ready to fight for your rights and help you address the complex requirements of New York’s insurance system.

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Legal Update (February 2026): Since this post’s 2019 publication, New York has amended various provisions of 11 NYCRR Part 65, including potential changes to IME notification procedures, denial timeframes, and documentation requirements under section 65-3.5. The regulatory landscape governing IME no-shows and procedural compliance may have evolved, and practitioners should verify current provisions when handling these cases.