It’s the 30-day rule

Understanding the 30-Day IME Scheduling Rule in New York No-Fault Cases

In New York no-fault insurance law, timing is everything when it comes to Independent Medical Examinations (IMEs). Insurance companies frequently use IMEs as a defense mechanism to deny legitimate claims, but they must follow strict procedural requirements. One critical rule that often trips up insurers is the 30-day scheduling requirement—a deadline that, when missed, can completely undermine their ability to deny claims based on a patient’s failure to appear.

This regulatory requirement exists to prevent insurance companies from using IMEs as delaying tactics. By mandating that examinations be scheduled promptly after receiving claims, the law ensures that legitimate medical providers can receive timely payment for services rendered to accident victims.

Jason Tenenbaum’s Analysis:

Success Rehab, PT, P.C. v Hereford Ins. Co., 2019 NY Slip Op 52031(U) (App. Term 2d Dept. 2019)

“Contrary to defendant’s contention, defendant did not establish its entitlement to summary judgment. Defendant acknowledged that it had received 9 of the 12 claims at issue between May 13, 2015 and June 19, 2015 and that plaintiff’s assignor’s first IME was scheduled for August 3, 2015. As that IME had not been scheduled to be held within 30 calendar days after defendant had received those claims, defendant did not demonstrate its entitlement to summary judgment dismissing so much of the complaint as sought to recover upon those claims based upon the assignor’s failure to appear for IMEs (see 11 NYCRR 65-3.5 “

Key Takeaway

When insurance companies fail to schedule IMEs within the required 30-day window after receiving claims, they forfeit their right to deny payment based on the patient’s no-show for the examination. This procedural requirement protects medical providers and ensures timely processing of legitimate no-fault claims, even when IME notification issues arise later in the process.