Key Takeaway
New York court clarifies that IME scheduling requirements are triggered by receiving bills, not NF-2 forms, in no-fault insurance cases.
In New York no-fault insurance cases, timing requirements for Independent Medical Examinations (IMEs) can be a source of confusion for both healthcare providers and insurance companies. A common misconception is that insurers must schedule IMEs within 30 days of receiving an NF-2 form from the healthcare provider. However, a recent Appellate Term decision clarifies this important distinction and reinforces established precedent about when IME scheduling obligations actually begin.
The case of City Anesthesia Healthcare, P.C. v Erie Insurance Co. demonstrates how courts analyze IME scheduling requirements and the consequences when patients fail to appear for properly scheduled examinations. This decision is particularly relevant for providers who may have misunderstood the regulatory framework governing New York No-Fault Insurance Law and IME procedures.
Jason Tenenbaum’s Analysis:
City Anesthesia Healthcare, P.C. v Erie Ins. Co. of N.Y., 2021 NY Slip Op 50135(U)(App. Term 2d Dept. 2020)
“Contrary to the determination of the Civil Court, defendant demonstrated that, before it had received the claim at issue, it properly scheduled independent medical examinations (IMEs) of plaintiff’s assignor, and that the assignor failed to appear for the duly scheduled IMEs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 ). Defendant also demonstrated that it timely denied the claim (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 ), based upon the assignor’s failure to appear for the IMEs. An assignor’s appearance at an IME “is a condition precedent to the insurer’s liability on the policy” (Stephen Fogel Psychological, P.C., 35 AD3d at 722). Plaintiff’s contention that the pre-claim IME scheduling letter was required to be mailed within 30 days of defendant’s receipt of the NF-2 lacks merit (see 11 NYCRR 65-3.5 , ; Appendix 13).”
It is the bill, not the NF-2
Key Takeaway
The court definitively rejected the healthcare provider’s argument that IME scheduling letters must be sent within 30 days of receiving an NF-2 form. Instead, the regulatory framework and established case law make clear that IME scheduling requirements are triggered by receipt of actual claims (bills), not preliminary paperwork. This distinction is crucial for understanding when insurers’ obligations begin and how IME no-show cases are evaluated by courts.
