Key Takeaway
Court rules that insurance company cannot use IME no-show defense when initial IME wasn't scheduled within required 30-day timeframe under New York regulations.
Understanding IME Scheduling Requirements in No-Fault Cases
Independent Medical Examinations (IMEs) are a critical component of New York No-Fault Insurance Law, allowing insurance companies to evaluate the medical necessity and extent of claimed injuries. However, insurers must follow strict procedural requirements when scheduling these examinations, including specific timing mandates that can significantly impact their ability to deny claims.
When an insurance company fails to properly schedule an IME within the regulatory timeframe, they may lose important defenses in subsequent litigation. The scheduling requirements under New York’s no-fault regulations are designed to ensure prompt resolution of claims while protecting the rights of injured parties. Understanding these timing requirements is essential for both healthcare providers and patients navigating the no-fault system.
The procedural missteps in IME scheduling can have far-reaching consequences for insurance companies seeking to defend against provider claims, as demonstrated in recent appellate decisions addressing these regulatory violations.
Jason Tenenbaum’s Analysis:
Total Chiropractic, P.C. v Hereford Ins. Co., 2020 NY Slip Op 51362(U)(App. Term 2d Dept. 2020)
“However, contrary to defendant’s further argument, defendant did not demonstrate that it is entitled to summary judgment dismissing the complaint based on plaintiff’s assignor’s failure to appear for IMEs, as the initial IME had not been scheduled to be held within 30 calendar days after defendant’s receipt of plaintiff’s claims (see 11 NYCRR 65-3.5 ).”
Post claim action.
Key Takeaway
Insurance companies cannot rely on a patient’s IME no-show as grounds for claim denial when they failed to schedule the initial examination within the required 30-day period. This regulatory compliance failure undermines the insurer’s defense and may prevent them from obtaining summary judgment, even when the patient fails to appear for the examination.
