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Can an insurance carrier deny medical benefits to the date of an acciodent for failure to show up for an IME in NY?

Bronx, NY |

A passenger in a vehicle involved in an accident failed to show up for an IME scheduled by the carrier for the vehicle in which she was riding at the time of the accident. The carrier has denied all benefits back to the date of the accident and not from the date she failed to appear for the IME? Carrier claims it is a new law passed by the NEW York State Insurance, Is this legal what the carrier is doing?

Attorney Answers 8


  1. Yes, but usually if the patient misses the IME two times.


  2. Usually, the examination will be rescheduled. However, failure to appear for a No Fault examination can result in a denial of benefits and the First Department has ruled that this denial of coverage can be retroactive to the date of the accident.

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  3. The quick answer is yes the carrier can deny all benefits as the failure to attend an IME is a policy violation. The real question is whether or not the denial will stand up to scrutiny. Generally speaking, missing one IME will not withstand a challenge to the denial either through litigation or arbitration. If you have an attorney, you should discuss the possibility of challenging the denial. If you don't have one, you may want to consider hiring one.

    Disclaimer- The information you obtain at our web-site or through postings on such sites as this is not, nor is it intended to be, legal advice. You should consult an attorney for specific advice regarding your individual situation. Any response given here is not intended to create, nor does it create an ongoing duty to respond to questions. The response does not form an attorney-client relationship, nor is it intended to be relied upon as legal advice. The response given is based upon the limited facts provided by the person asking the question. To the extent additional or different facts exist, the response may change appropriately.


  4. Yes the carrier can do this. However, usually it is rescheduled. If it is not the first time an appointment was ignored then yes they will, and can. If you are injured you should speak with a personal injury attorney.

    Mr. Pascale is licensed to practice law in the State of New York. The response herein is not legal advice and does not create an attorney/client relationship. The response is in the form of legal education and is intended to provide general information about the matter within the question. Oftentimes the question does not include significant and important facts and time-lines that, if known, could significantly change the reply and make it unsuitable. Mr. Pascale strongly advises the questioner to confer with an attorney in their state in order to insure proper advice is received.


  5. Yes, the insurance carrier can deny benefits under these circumstances. However, you do have legal remedies available to try and fight this denial of benefits so I recommend you secure counsel to assist you with this matter.


  6. A New York attorney will need to advise you.

    Tim


  7. Yes it is totally legal. The other half of my practice is no fault collections. You must appear for a reasonably secheduled IME. If not then you violated a policy condition precedent to coverage. And even if you signed an assignment of benefits to the doctor, for violation of a policy condition precedent to coverage YOU are on the hook for the medical bills.


  8. yes because it is a form of non-cooperation with the ins co. & therefore a policy violation. As the other attys said, ask your atty to contest it, if you only missed one IME.

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