Did the insurer prove its IME/EUO no-show defense: mailed, compliant scheduling requests and the claimant’s nonappearance?

The decision rules on whether the insurer proved the elements of the defense that the injured person or provider failed to appear for an independent medical examination (IME) or examination under oath (EUO): (1) the scheduling letters (initial and follow-up) were mailed to the right person and address; (2) the person did not appear (or appeared and refused to answer), shown by someone with personal knowledge; (3) where the court requires it, the requests complied with 11 NYCRR 65-3.5/65-3.6 (15 business days to request, IME held within 30 days, follow-up within 10 days of a nonappearance, so at least two scheduled exams; in the First Department, a specific objective justification for an EUO under 65-3.5 (e)) or were exempt because sent before the claim was received; and (4) any answer by the claimant: excuse, mutual rescheduling, objection, unreasonableness of the request. It covers summary judgment motions and cross motions, oppositions, trials, default declaratory judgments (CPLR 3215 [f]) and de novo actions after master arbitration.

Settled at the Appellate Division, no conflicting department. No Court of Appeals decision on the elements. The core elements are the same wherever an Appellate Division has spoken: the insurer must prove mailing of the scheduling letters and the nonappearance by someone with personal knowledge (2d Dept Stephen Fogel 2006; 1st Dept Lucas 2013), and that the requests were timely and properly made, with at least two scheduled exams (1st Dept Unitrin 2011, Longevity 2015, Allstate v Pierre 2014; 2d Dept Interboro v Clennon 2014, Nationwide Affinity v George 2020, Quality Health 2023). Two sub-points differ: (1) the First Department requires the insurer to disclose a specific objective justification for an EUO (65-3.5 [e]) or summary judgment is premature (Jaga 2015, Kemper v AB Med 2020, Delacruz 2022, Alicea 2023, Lifeline 2025), while the Appellate Term, Second Department holds objective reasons are not part of the insurer's prima facie case (e.g. 11374, Northern Med. Care 2024); the Second Department Appellate Division has not ruled on it in this database; (2) whether the no-show defense needs a timely denial is a true split, but that is the sister topic no-show-coverage.

Leading authorities · Authority map · Decisions by court · Plain-text version (Markdown)

Leading authorities

Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co. (2006 NY Slip Op 09604) Appellate Division, Second Department, 2006Insurer must prove mailing and nonappearance by personal knowledgeAn insurer moving on an IME no-show must establish prima facie that it mailed the IME notices and that the person failed to appear; affidavits from no one with personal knowledge of the mailings or the nonappearances fail, and the motion is denied regardless of the opposition. Appearance at IMEs requested before or after the claim form is a condition precedent to coverage.
Progressive was required to establish, prima facie, that it mailed the notices of the IMEs to Kim and that he failed to appear for the IMEs. Progressive failed to meet its burden by proof in admissible form, because it submitted no evidence from anyone with personal knowledge of the mailings or of the nonappearances
Unitrin Advantage Ins. Co. v Bayshore Physical Therapy, PLLC (2011 NY Slip Op 01948) Appellate Division, First Department, 2011First Department: requests must follow regulatory time frames; no willfulness neededThe insurer met its prima facie burden by showing it requested the IMEs in accordance with the procedures and time frames of the no-fault regulations and that the assignors did not appear; the providers raised no issue that the requests were unreasonable, and the insurer did not have to show the nonappearance was willful.
Plaintiff satisfied its prima facie burden on summary judgment of establishing that it requested IMEs in accordance with the procedures and time frames set forth in the no-fault implementing regulations, and that defendants’ assignors did not appear. In opposition, defendants failed to raise an issue of fact that the requests were unreasonable
Later history: lv denied 17 NY3d 705 (2011), as cited in later decisions in the database (e.g. American Tr. Ins. Co. v Lucas, post 6526)
Interboro Ins. Co. v Clennon (2014 NY Slip Op 00092) Appellate Division, Second Department, 2014Second Department elements: two demands, two nonappearances, timely denialThe insurer established prima facie entitlement to a declaration of no coverage by showing it twice duly demanded an EUO, the assignor twice failed to appear, and it timely denied the claims; the providers raised no triable issue on the propriety of the demand or on whether the assignor appeared.
the plaintiff insurer established as a matter of law that it twice duly demanded an examination under oath from the appellants’ assignor, who had allegedly been injured in a motor vehicle accident, that the assignor twice failed to appear, and that the plaintiff issued a timely denial of the claims arising from the appellants’ treatment of the assignor
Country-Wide Ins. Co. v Delacruz (2022 NY Slip Op 03068) Appellate Division, First Department, 2022First Department: insurer must disclose EUO's specific objective justificationSummary judgment for the insurer was properly denied as premature because it never provided a specific objective justification for the EUO (11 NYCRR 65-3.5 [e]); without it the insurer did not establish compliance with the regulations, and the providers did not waive the point by failing to object on receipt of the notices.
Plaintiff failed to provide a specific objective justification for requesting the examination under oath (EUO). Plaintiff’s reason for the EUO is essential for defendants to oppose plaintiff’s summary judgment motion and this fact is exclusively within the knowledge and control of the movant
American Tr. Ins. Co. v Longevity Med. Supply, Inc. (2015 NY Slip Op 06761) Appellate Division, First Department, 2015Timely IME scheduling (65-3.5 [d]) is part of prima facie caseAlthough the insurer proved the IME notices were mailed and the claimant did not appear, it failed to show the IMEs were scheduled within the 30-day frame of 11 NYCRR 65-3.5 (d); that proof is part of its prima facie case and cannot be supplied in reply (Friedman, J.P., dissented).
Here, although plaintiff established that the notices of the scheduled IMEs were properly mailed and that Estrella did not appear, plaintiff failed to show that the scheduling of the IMEs complied with Insurance Department Regulations (11 NYCRR) § 65-3.5 (d), which prescribes a 30-calendar-day time frame for the holding of IMEs
Mapfre Ins. Co. of N.Y. v Manoo (2016 NY Slip Op 04446) Appellate Division, First Department, 2016Pre-claim EUO requests are exempt from verification time framesThe insurer made its prima facie showing by proving timely mailed EUO notices and three nonappearances; the 65-3.5/65-3.6 notification requirements do not apply to an EUO scheduled before the claim form is received, and once the claim arrived the insurer complied with the 65-3.6 (b) follow-up rule by rescheduling within 10 days (with a dissent).
The notification requirements for verification requests under 11 NYCRR 65-3.5 and 65-3.6 do not apply to EUOs that are scheduled prior to the insurance company’s receipt of a claim form
Nassau Ins. Co. v Murray 46 NY2d 828Presumption of receipt from proof of a standard office mailing practice; mere denial of receipt does not rebut it. Cited for proof that the scheduling letters were mailed (e.g. George 2020, Metro Psychological 2016).Not in our database.
Argento v Aetna Cas. & Sur. Co. 184 AD2d 487Failure to submit to an EUO is a material breach precluding recovery; quoted by Interboro v Clennon and Nationwide Affinity v George.Not in our database.
Bulzomi v New York Cent. Mut. Fire Ins. Co. 92 AD2d 878EUO noncompliance as material breach; opponent must show reasonable excuse or partial performance (IDS v Stracar 2014).Not in our database.
Hospital for Joint Diseases v Nationwide Mut. Ins. Co. 284 AD2d 374Mailing must be proved by someone with personal knowledge of the mailing or office practice; cited in Stephen Fogel and Hertz v Active Care.Not in our database.
Westchester County Med. Ctr. v New York Cent. Mut. Fire Ins. Co. 262 AD2d 553Basis of the Appellate Term rule that objections to a verification/EUO request not raised on receipt are not heard; held 'inapposite' to the justification requirement in Country-Wide v Delacruz (1st Dept 2022).Not in our database.

Authority map

Each circle is a decision on this question, placed by court and date; its colour is the position it took. Lines are citations between them. Select a circle (or find a decision by name) to see its links and summary. The same decisions are listed by court below the map.

Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedInsurer failed to prove the scheduling letters were mailed or properly addressedInsurer failed to prove the nonappearance by someone with personal knowledgeInsurer did not show its requests met the regulatory timing, follow-up or justification requirementsProof on the no-show raises a question of fact; neither side wins the point as a matter of lawClaimant showed the nonappearance was excused or the request unreasonable or waivedRing: rules on the question, but another ground decided the caseContrasted, distinguished or limitedDeclined to follow, questioned, overruled or reversedCited Show ordinary citations

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How the rule was applied, by court

Court	Defense proved	Mailing not proved	Nonappearance not proved	Requests not compliant	Triable issue	No-show excused	Total
Appellate Division, First Department	27	3	1	17	0	0	48
Appellate Division, Second Department	4	3	0	0	0	1	8
Appellate Division, Third Department	0	1	0	0	0	0	1
Appellate Division, Fourth Department	2	0	0	0	0	0	2
Appellate Term, First Department	47	6	8	5	3	0	69
Appellate Term, Second Department	474	96	74	74	18	5	741
Trial courts in the First Department	15	4	5	15	0	1	40
Trial courts in the Second Department	40	12	5	25	4	2	88

Decisions (997)

Every decision in our database that rules on this question: highest court first, then by department, newest first. 888 turn on it; the others rule on it alongside a different main ground (marked "also decides"). The one-sentence summaries describe what each court said on this question.

Appellate Division, First Department (48 decisions)

State Farm Mut. Auto. Ins. Co. v Lifeline Med. Imaging, P.C. (2025 NY Slip Op 02025) Appellate Division, First Department, April 3, 2025Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld summary judgment for the insurer premature because it never gave the provider an objective justification for requesting the EUOs, as the regulations require, and did not fully answer discovery seeking its objective standards.
Nationwide Gen. Ins. Co. v Gaines (2025 NY Slip Op 01896) Appellate Division, First Department, April 1, 2025Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurers proved the IME no-show through the scheduler's affidavit of two mailed notices and the IME doctor's consistent affirmations, and rejected the untimeliness objection because the notices preceded receipt of the claims.
Liberty Mut. Ins. Co. v Mercado (2025 NY Slip Op 00631) Appellate Division, First Department, February 4, 2025Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurers proved their EUO no-show defense because they gave a specific, if brief, objective justification for the EUOs, disclosed during discovery, and sent timely EUO requests that the claimants did not attend.
State Farm Mut. Auto. Ins. Co. v Equinox Physical Therapy, P.C. (2024 NY Slip Op 05193) Appellate Division, First Department, October 22, 2024Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailed EUO notices and nonappearance by an attorney with personal knowledge, and pre-claim notices were exempt from the 65-3.5 time frame; speculative need for discovery raised no issue.
Nationwide Gen. Ins. Co. v South (2024 NY Slip Op 00028) Appellate Division, First Department, January 4, 2024Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held the insurers proved the EUO no-show as a separate ground: notices sent within 15 days of the NF-2s, a second EUO within 10 days of the first nonappearance, and transcripts showing nonappearance; no triable issue was raised.
State Farm Fire & Cas. Co. v AA Acupuncture Serv., P.C. (2023 NY Slip Op 03562) Appellate Division, First Department, June 29, 2023Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held, as an additional ground, that the insurer submitted sufficient evidence it owed nothing on claims related to one claimant because she failed to appear for an EUO.
Matter of American Tr. Ins. Co. v Smart Choice Med., P.C. (2023 NY Slip Op 03191) Appellate Division, First Department, June 13, 2023Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held the insurer established the IME no-show defense through the three scheduling letters with an affidavit of mailing and the examining professional's affidavits that the claimant failed to appear, so the arbitration award was vacated.
State Farm Fire & Cas. Co. v Soliman (2023 NY Slip Op 01949) Appellate Division, First Department, April 13, 2023Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedGranted a default declaration of noncoverage because the claimants failed to appear for EUOs noticed within 15 business days of receipt of the NF-3 forms, rejecting the motion court's measurement from the NF-2 forms.

Show all 48 decisions

Country-Wide Ins. Co. v Alicea (2023 NY Slip Op 01474) Appellate Division, First Department, March 21, 2023Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld summary judgment on the EUO no-show premature because the insurer never gave the providers its specific objective justification for the EUO under 65-3.5 (e), and the providers had not waived that objection.
State Farm Mut. Auto. Ins. Co. v All City Family Healthcare Ctr., Inc. (2022 NY Slip Op 04142) Appellate Division, First Department, June 28, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the EUO notices were timely because the 15-business-day period runs from receipt of the verification forms, not the NF-2 application, so the claimants' failure to appear for properly noticed EUOs supported the default declaration.
State Farm Fire & Cas. Co. v Axial Chiropractic, P.C. (2022 NY Slip Op 03487) Appellate Division, First Department, May 31, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held on default that the insurer established the assignors and the vehicle owner failed to appear for properly noticed EUOs, entitling it to a declaration of noncoverage on that cause of action.
Country-Wide Ins. Co. v Delacruz (2022 NY Slip Op 03068) Leading case Appellate Division, First Department, May 10, 2022Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld summary judgment premature because the insurer never disclosed a specific objective justification for the EUO, so it did not establish compliance with the regulations, and the providers did not waive the point by not objecting.
State Farm Mut. Auto. Ins. Co. v AK Global Supply Corp. (2022 NY Slip Op 01890) Appellate Division, First Department, March 17, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved EUO letters were sent within 15 business days of receipt of the NF-3 verification forms (the NF-2 not counting), timely mailed, and that the claimants twice failed to appear, shown by EUO transcripts.
American Tr. Ins. Co. v Alcantara (2022 NY Slip Op 01871) Appellate Division, First Department, March 17, 2022Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer failed to establish prima facie that its IME requests met the 15-business-day and 30-day time frames because its papers did not show when it received the providers' verification forms.
American Tr. Ins. Co. v Acosta (2022 NY Slip Op 01097) Appellate Division, First Department, February 17, 2022Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer failed to make its prima facie case because the record did not show that it requested and scheduled the examinations within the 15-day and 30-day time frames after receiving the claims.
American Tr. Ins. Co. v Martinez (2022 NY Slip Op 00963) Appellate Division, First Department, February 15, 2022Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer failed to make its prima facie case in both actions because the record did not show that it requested and scheduled the IMEs within the 15-day and 30-day time frames after receiving the claims.
State Farm Mut. Auto. Ins. Co. v Surgicore of Jersey City, LLC (2021 NY Slip Op 03536) Appellate Division, First Department, June 3, 2021Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held the insurer sufficiently proved one claimant missed two EUOs despite proper notice, and need not show 65-3.5 compliance because the EUOs were scheduled before any claim form was received.
Unitrin Advantage Ins. Co. v Dowd (2021 NY Slip Op 03012) Appellate Division, First Department, May 11, 2021Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held the EUO request timely as to the surgery claim and the provider's failure to appear established, which defeated all of the provider's claims.
Unitrin Direct Ins. Co. v Beckles (2020 NY Slip Op 06974) Appellate Division, First Department, November 24, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established its disclaimer as a matter of law by showing a provider claim, a timely IME request within 15 days of its receipt, and the claimant's nonappearance at two duly noticed IMEs.
Unitrin Advantage Ins. Co. v Cohen & Kramer M.D., P.C. (2020 NY Slip Op 06474) Appellate Division, First Department, November 12, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved the IME notices were properly mailed despite an added floor designation and that the claimant missed three properly scheduled IMEs; the provider offered no opposing evidence.
Kemper Independence Ins. Co. v AB Med. Supply, Inc. (2020 NY Slip Op 06209) Appellate Division, First Department, October 29, 2020Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsAffirmed denial of the insurer's declaratory summary judgment as premature because it never gave the assignees the specific objective justification for requesting the EUO required by 11 NYCRR 65-3.5 (e).
Kemper Independence Ins. Co. v Cornerstone Chiropractic, P.C. (2020 NY Slip Op 03876) Appellate Division, First Department, July 9, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held the insurer entitled to judgment because the providers failed to appear at two scheduled EUOs, excusing a one-day-late follow-up request as a technical defect given the brief delay and ultimate nonappearance.
Global Liberty Ins. Co. v Evans (2019 NY Slip Op 07716) Appellate Division, First Department, October 29, 2019Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to prove the EUO letters were timely mailed given the claims adjuster's conflicting affidavits and a misdated application, and found fact issues why the assignor left the EUO.
Global Liberty Ins. Co. v Tyrell (2019 NY Slip Op 03691) Appellate Division, First Department, May 9, 2019Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer failed to show it gave the insured proper notice of the IME location, because the scheduling letters showed a doctor's office address different from the one in the doctor's affirmation; clearer reply copies did not cure it.
Hertz Vehicles, LLC v Alluri (2019 NY Slip Op 02480) Appellate Division, First Department, April 2, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedAffirmed the declaration of no coverage because it was undisputed that the provider failed to appear for properly noticed EUOs scheduled before the insurer received its claim.
Hertz Vehicles, LLC v Best Touch PT, P.C. (2018 NY Slip Op 04854) Appellate Division, First Department, June 28, 2018Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsDenied a default declaratory judgment against the providers because nothing showed when the prescribed verification forms were received, so the EUO notices were not shown sent within 15 business days, and the pre-claim exemption did not apply.
Global Liberty Ins. Co. v New Century Acupuncture, P.C. (2018 NY Slip Op 03444) Appellate Division, First Department, May 10, 2018Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to show adequate notice of the rescheduled IME because the letter to the claimant went to the wrong address, so her attorney had no reason to alert her.
Hereford Ins. Co. v Lida's Med. Supply, Inc. (2018 NY Slip Op 03226) Appellate Division, First Department, May 3, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of two IME scheduling letters and nonappearance through examiners' affidavits, and the regulatory time frames did not apply because the IMEs were scheduled before the claims were received.
Unitrin Advantage Ins. Co. v All of NY, Inc. (2018 NY Slip Op 00810) Appellate Division, First Department, February 6, 2018Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the EUO request for two dates of service untimely under 65-3.5(b) because it was sent after the 15 business days had run, while the requests for other bills were timely.
Hertz Vehs. LLC v Significant Care, PT, P.C. (2018 NY Slip Op 00456) Appellate Division, First Department, January 25, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved the EUO no-show: the first request went out within 15 days of the bill's receipt, the follow-up within 10 days of the first nonappearance, and an affidavit of service proved mailing.
Country-Wide Ins. Co. v Radiology of Westchester, P.C. (2017 NY Slip Op 01461) Appellate Division, First Department, February 23, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Vacated the master arbitrator's award as irrational because it ignored the insurer's uncontroverted evidence that the assignor failed to appear for three scheduled EUOs.
Kemper Independence Ins. Co. v Adelaida Physical Therapy, P.C. (2017 NY Slip Op 00916) Appellate Division, First Department, February 7, 2017Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer failed to show its EUO notices were exempt from or complied with the 65-3.5 (b) and 65-3.6 (b) time frames because it offered no evidence of when it received any verification forms.
Matter of Unitrin Advantage Ins. Co. Kemper A. Unitrin Bus. v Professional Health Radiology (2016 NY Slip Op 06767) Appellate Division, First Department, October 13, 2016Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the insurer not entitled to deny the claims for IME nonappearance because it failed to show its scheduling letters contained the mandatory notice of reimbursement for lost earnings and transportation expenses.
Liberty Mut. Ins. Co. v K.O. Med., P.C. (2016 NY Slip Op 06166) Appellate Division, First Department, September 27, 2016Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer failed to prove the EUO no-show because uncertified, unsworn transcripts and no evidence for other dates did not show nonappearance, and nothing showed the requests met the regulatory time frames.
Mapfre Ins. Co. of N.Y. v Manoo (2016 NY Slip Op 04446) Leading case Appellate Division, First Department, June 9, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved its no-show defense: the 65-3.5 time frames did not apply to an EUO requested before the claim form was received, follow-ups were sent within 10 days of each nonappearance, and the insured never appeared.
National Liab. & Fire Ins. Co. v Tam Med. Supply Corp. (2015 NY Slip Op 06763) Appellate Division, First Department, September 15, 2015Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld summary judgment properly denied because the insurer offered no evidence that it requested the EUO within the 65-3.5 (b) time frame after the assignees raised the point.
American Tr. Ins. Co. v Vance (2015 NY Slip Op 06762) Appellate Division, First Department, September 15, 2015Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer failed its prima facie burden because, although it proved mailing of the IME notices and nonappearance, it did not show the IMEs were scheduled within the 30-day frame of 65-3.5 (d).
American Tr. Ins. Co. v Longevity Med. Supply, Inc. (2015 NY Slip Op 06761) Leading case Appellate Division, First Department, September 15, 2015Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld that proof the IMEs were scheduled within 65-3.5 (d)'s 30-day frame is part of the insurer's prima facie case, so proven mailing and nonappearance did not suffice and reply proof could not cure it.
American Tr. Ins. Co. v Clark (2015 NY Slip Op 06759) Appellate Division, First Department, September 15, 2015Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer failed its prima facie burden because, although it proved mailing of the IME notices and nonappearance, it did not show the IMEs were scheduled within the 30-day frame of 65-3.5 (d).
American Tr. Ins. Co. v Jaga Med. Servs., P.C. (2015 NY Slip Op 03925) Appellate Division, First Department, May 7, 2015Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsVacated the declaration for the insurer as premature because the reason for the EUO request and whether the EUOs were timely and properly requested were facts within the insurer's exclusive knowledge needing discovery.
Hertz Corp. v Active Care Med. Supply Corp. (2015 NY Slip Op 00212) Appellate Division, First Department, January 6, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of two EUO notices by certified-mail evidence and nonappearance by the assigned attorney who would have conducted the EUOs, and denied further discovery.
Allstate Ins. Co. v Pierre (2014 NY Slip Op 08921) Appellate Division, First Department, December 23, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved by admissible business-record evidence that each assignor failed to appear at two EUOs, needed not show willfulness, and the address challenge to the notices was unpreserved and unavailing.
American States Ins. Co. v Huff (2014 NY Slip Op 05366) Appellate Division, First Department, July 17, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insured's departure from his EUO before questioning, shown by the admissible certified transcript and an investigator's affidavit, established breach of the EUO condition, available against his assignee providers.
Interboro Ins. Co. v Perez (2013 NY Slip Op 08347) Appellate Division, First Department, December 12, 2013Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the default declaratory judgment properly denied, and a meritorious defense shown, because the insurer did not prove the EUO scheduling letters were mailed to the claimant.
American Tr. Ins. Co. v Leon (2013 NY Slip Op 08124) Appellate Division, First Department, December 5, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved it mailed the IME scheduling notices and that the claimant failed to appear, rejecting the claim that notice to the assignor's attorney was required without proof of representation.
American Tr. Ins. Co. v Marte-Rosario (2013 NY Slip Op 07416) Appellate Division, First Department, November 12, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of the IME notices to the claimant and her counsel and, through the doctor's affidavit, her failure to appear, entitling it to a declaration of no coverage.
American Tr. Ins. Co. v Lucas (2013 NY Slip Op 07273) Appellate Division, First Department, November 7, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the physician's and employee's affidavits, based on personal knowledge and office procedures, established mailing of the exam notices and the claimants' nonappearance, and were not conclusory.
Unitrin Advantage Ins. Co. v Bayshore Physical Therapy, PLLC (2011 NY Slip Op 01948) Leading case Appellate Division, First Department, March 17, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer showed the IMEs were requested within the regulatory procedures and time frames and the assignors did not appear; the providers raised no issue of unreasonableness, and willfulness and physician examiners were not required.

Appellate Division, Second Department (8 decisions)

Quality Health Supply Corp. v Nationwide Ins. (2023 NY Slip Op 02689) Appellate Division, Second Department, May 17, 2023Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer showed timely mailed scheduling letters, the insured's nonappearance at the scheduled EUOs and a timely follow-up under the regulation, and the provider raised no triable issue.
Nationwide Affinity Ins. Co. of Am. v George (2020 NY Slip Op 02801) Appellate Division, Second Department, May 13, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the EUO letters and, through affiants with personal knowledge, nonappearance at two EUOs; the providers showed no mutual rescheduling.
Progressive Cas. Ins. Co. v Metro Psychological Servs., P.C. (2016 NY Slip Op 03485) Appellate Division, Second Department, May 4, 2016Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to establish timely and proper mailing of the EUO scheduling letters because its counsel's affirmation described office practice only conclusorily, so its declaratory judgment motion was denied.
Progressive Advanced Ins. Co. v McAdam (2016 NY Slip Op 03484) Appellate Division, Second Department, May 4, 2016Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to show prima facie a breach of the policies through EUO nonattendance because it offered no proof the EUO requests were mailed.
IDS Prop. Cas. Ins. Co. v Stracar Med. Servs., P.C. (2014 NY Slip Op 02902) Appellate Division, Second Department, April 30, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved two duly demanded EUOs and two nonappearances, and that the assignees' belated offer to appear two years later, without excuse or partial performance, did not cure the breach, so no further chance was warranted.
Interboro Ins. Co. v Clennon (2014 NY Slip Op 00092) Leading case Appellate Division, Second Department, January 8, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved it twice duly demanded an EUO and the assignor twice failed to appear, and the providers raised no triable issue on the demand's propriety or appearance and showed no need for discovery.
Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co. (2006 NY Slip Op 09604) Leading case Appellate Division, Second Department, December 19, 2006Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed its prima facie burden because no one with personal knowledge attested to mailing the IME notices or to the nonappearances, so its motion was denied regardless of the opposition.
Park v Long Is. Ins. Co. (2004 NY Slip Op 09485) Appellate Division, Second Department, December 20, 2004Claimant showed the nonappearance was excused or the request unreasonable or waivedHeld the denial improper because the insured's single refusal to proceed with the EUO unless his wife attended did not meet the insurer's heavy burden of showing a pattern of willful noncooperation, and ordered the EUO rescheduled.

Appellate Division, Third Department (1 decision)

Matter of Mercury Cas. Co. (Patient Care Assoc.) (2015 NY Slip Op 08891) Appellate Division, Third Department, December 3, 2015Insurer failed to prove the scheduling letters were mailed or properly addressed (also decides)Left in place, as rational, an arbitrator's finding that the IME no-show defense failed because the scheduling letters omitted the insured's apartment letter, holding that dicta suggesting notice to his attorney suffices did not make the award erroneous as a matter of law.

Appellate Division, Fourth Department (2 decisions)

Nationwide Affinity Ins. Co. of Am. v PFJ Med. Care, P.C. (2020 NY Slip Op 00972) Appellate Division, Fourth Department, February 7, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held on renewal that the insurers met their burden on their defense based on the providers' nonappearance at EUOs and the providers raised no triable issue of fact.
Nationwide Affinity Ins. Co. of Am. v Jamaica Wellness Med., P.C. (2020 NY Slip Op 00971) Appellate Division, Fourth Department, February 7, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held the insurers met their burden on the EUO nonappearance defense, the provider raised no triable issue, and speculation that discovery would help did not defeat summary judgment.

Appellate Term, First Department (69 decisions)

RVA Leasing Corp. v Nationwide Mut. Ins. Co. (2026 NY Slip Op 51527(U)) Appellate Term, First Department, September 22, 2026Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailed EUO notices and the provider's nonappearance at the initial and follow-up EUOs, and provided a specific objective justification for the EUOs.
RVA Leasing Corp. v Nationwide Mut. Ins. Co. (2026 NY Slip Op 51528(U)) Appellate Term, First Department, September 22, 2026Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld on an unopposed motion that the insurer showed timely and proper mailing of the EUO notices and the provider's nonappearance at the initial and follow-up EUOs; the reasonableness objection was unpreserved.
Town RX Inc. v Nationwide Mut. Ins. Co. (2025 NY Slip Op 51853(U)) Appellate Term, First Department, November 24, 2025Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer made a prima facie showing that the provider failed to appear at properly scheduled EUOs, with adequate proof the scheduling letters were mailed.
One RX Chemist, Inc. v Nationwide Mut. Ins. Co. (2025 NY Slip Op 51848(U)) Appellate Term, First Department, November 21, 2025Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer made an unopposed prima facie showing that the provider failed to appear at properly scheduled EUOs, with adequate proof the scheduling letters were mailed.
Quazi R. Med. Servs., PC v Nationwide Mut. Ins. Co. (2025 NY Slip Op 51784(U)) Appellate Term, First Department, November 13, 2025Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer made a prima facie showing of the provider's EUO nonappearances, and an initial request sent one day after the 15-day period did not invalidate the requests but only shortened the insurer's time to deny.
Straight Up Chiropractic, PC v MVAIC (2020 NY Slip Op 51243(U)) Appellate Term, First Department, October 23, 2020Insurer failed to prove the scheduling letters were mailed or properly addressed (also decides)Held, alternatively, that the insurer failed to make a prima facie IME no-show showing because the scheduling letters went to an address with the wrong zip code.
Allstate Ins. Co. v Brown (2019 NY Slip Op 51560(U)) Appellate Term, First Department, October 4, 2019Insurer failed to prove the scheduling letters were mailed or properly addressed (also decides)Left in place, as rational, the arbitrator's rejection of the IME no-show defense based on her review of the mailing proof, the claimant's eight prior appearances, and the insurer's adversarial treatment of the claimant.
Satya Drug Corp. v Global Liberty Ins. Co. of N.Y. (2019 NY Slip Op 51505(U)) Appellate Term, First Department, September 20, 2019Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer failed to prove the IME nonappearances because the IME doctor's conclusory affirmation did not explain his recollection 16 months later and the scheduling vendor's affidavit showed no personal knowledge.

Show all 69 decisions

Allstate Ins. Co. v Gandron (2019 NY Slip Op 50562(U)) Appellate Term, First Department, April 17, 2019Proof on the no-show raises a question of fact; neither side wins the point as a matter of law (also decides)On article 75 review, left in place as not irrational the master arbitrator's determination that factual issues existed on whether the insurer complied with 11 NYCRR 65-3.6 (b) and whether the IME nonappearance was excusable.
Village Med. Supply, Inc. v Hereford Ins. Co. (2018 NY Slip Op 51014(U)) Appellate Term, First Department, June 28, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the EUO notices and the assignor's two nonappearances through a scheduling employee with personal knowledge, and the provider raised no triable issue.
Utica Acupuncture P.C. v Amica Mut. Ins. Co. (2017 NY Slip Op 50331(U)) Appellate Term, First Department, March 20, 2017Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer failed to prove the assignor's IME nonappearance because its IME doctor's conclusory affirmation did not state the basis of her recollection, two years later, that the assignor did not appear.
Five Boro Med. Equip., Inc. v Praetorian Ins. Co. (2016 NY Slip Op 51481(U)) Appellate Term, First Department, October 19, 2016Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer failed to prove the assignor's IME nonappearance because its IME doctors' conclusory affidavits did not state the basis of their recollection, three years later, that the assignor did not appear.
Bronx Acupuncture Therapy, P.C. v Hereford Ins. Co. (2016 NY Slip Op 51479(U)) Appellate Term, First Department, October 19, 2016Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsDenied the insurer summary judgment because, with no evidence of when it received the claims, it failed to show the IMEs were scheduled within the 65-3.5 (d) time frames.
Karina K. Acupuncture, P.C. v Hartford Ins. Co. (2016 NY Slip Op 51382(U)) Appellate Term, First Department, September 28, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of IME notices and nonappearance through affidavits of the examining physician and the IME scheduler's employee showing personal knowledge; the provider raised no issue on nonappearance, mailing or reasonableness.
Healthy Way Acupuncture, P.C. v Clarendon Natl. Ins. Co. (2016 NY Slip Op 51381(U)) Appellate Term, First Department, September 28, 2016Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer failed to prove the assignor's IME nonappearance because its IME doctors' conclusory affidavits did not state the basis of their recollection, some eight years later, that the assignor did not appear.
Urban Well Acupuncture, P.C. v Nationwide Gen. Ins. Co. (2016 NY Slip Op 50906(U)) Appellate Term, First Department, June 15, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the IME notices and, through affidavits of the scheduled examiner and the IME scheduler's employee showing personal knowledge, the assignor's nonappearance; the provider raised no issue on nonappearance, mailing or reasonableness.
Metro 8 Med. Equip., Inc. v Esurance Ins. Co. (2016 NY Slip Op 50904(U)) Appellate Term, First Department, June 15, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing and nonappearance at the initial and follow-up EUOs through the assigned attorney's affirmation and the scheduler's affidavit showing personal knowledge; the provider raised no triable issue.
Vladenn Med. Supply, Corp. v American Commerce Ins. Co. (2016 NY Slip Op 50775(U)) Appellate Term, First Department, May 17, 2016Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer failed to prove EUO nonappearance because its attorney's affirmation showed no personal knowledge of office procedures for nonappearances and did not say he was assigned to conduct the EUOs.
Sutphin Complete Med. Care v Hereford Ins. Co. (2016 NY Slip Op 50763(U)) Appellate Term, First Department, May 13, 2016Proof on the no-show raises a question of fact; neither side wins the point as a matter of lawHeld that although the insurer proved proper mailing of the IME notices to the assignor and his attorney, the record raised triable issues as to whether the assignor failed to appear, barring summary judgment for either side.
Omega Diagnostic Imaging, P.C. v Praetorian Ins. Co. (2016 NY Slip Op 50762(U)) Appellate Term, First Department, May 13, 2016Proof on the no-show raises a question of fact; neither side wins the point as a matter of lawHeld that although the insurer proved mailing of the EUO notices and the assignor's nonappearance at both EUOs, its own letters acknowledging his incarceration raised triable issues whether the nonappearance was excusable.
MDJ Med. PC v Delos Ins. Co. (2016 NY Slip Op 50604(U)) Appellate Term, First Department, April 18, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing, EUO requests within the regulatory time frames shown by its dated letters, and two nonappearances through the assigned attorney's affirmation; the provider raised no triable issue.
Village Med. Supply, Inc. v Travelers Prop. Cas. Co. of Am. (2016 NY Slip Op 50339(U)) Appellate Term, First Department, March 21, 2016Insurer failed to prove the nonappearance by someone with personal knowledgeHeld nonappearance unproved because the IME doctors did not state the basis of their recollection a year later and the scheduling vendor's affidavit alone could not supply personal knowledge.
EMA Acupuncture, P.C. v Travelers Ins. Co. (2016 NY Slip Op 50173(U)) Appellate Term, First Department, February 18, 2016Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer failed to make a prima facie showing because no one with personal knowledge attested to the nonappearances; its attorney's affirmation did not describe office procedures for no-shows or claim the affiant would have conducted the EUO.
Metro 8 Med. Equip., Inc. v ELRAC, Inc. (2016 NY Slip Op 50174(U)) Appellate Term, First Department, February 18, 2016Insurer failed to prove the nonappearance by someone with personal knowledgeHeld nonappearance unproved because the IME chiropractor kept no nonappearance records and gave no basis for her recollection 18 months later, and the scheduling vendor's affidavit alone could not establish it.
Life Tree Acupuncture P.C. v Republic W. Ins. Co. (2016 NY Slip Op 50023(U)) Appellate Term, First Department, January 13, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the IME no-show defense established: notices were mailed, IMEs could be requested before the claim forms arrived and complied with regulatory time frames, and examiner and scheduler affidavits proved the nonappearances.
Alfa Med. Supplies, Inc. v Praetorian Ins. Co. (2015 NY Slip Op 51847(U)) Appellate Term, First Department, December 18, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the IME no-show defense established: notices were properly mailed, IMEs could be requested before the claim forms were received, and examiner and scheduler affidavits showed personal knowledge of the repeated nonappearances.
Metro Psychological Servs., P.C. v Mercury Cas. Co. (2015 NY Slip Op 51644(U)) Appellate Term, First Department, November 18, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailed EUO notices and the assignor's nonappearance at the rescheduled and follow-up EUOs, treating a mutually agreed rescheduling as no nonappearance and the later rescheduling as a valid follow-up, with no excuse shown.
Easy Care Acupuncture P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51524(U)) Appellate Term, First Department, October 20, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the IME no-show defense established: notices properly mailed, IMEs could be requested before the claim forms were received, and examiner and scheduler affidavits proved the repeated nonappearances.
Acupuncture Pain Mgt., P.C. v Kemper Cas. Ins. Co. (2015 NY Slip Op 51522(U)) Appellate Term, First Department, October 20, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld, contrary to the lower court, that examiner and scheduler affidavits were competent proof of the assignor's repeated IME nonappearances, and with proven mailing the defense was established.
MRJA Radiology, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51381(U)) Appellate Term, First Department, September 29, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedReversing the lower court, held the examining physician's affirmation and the IME scheduler employee's affidavit competent proof of nonappearance, and the provider raised no issue on nonappearance, mailing or reasonableness.
S.A. Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 50953(U)) Appellate Term, First Department, June 25, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedReversing the lower court, held the examining physician's and chiropractor/acupuncturist's affidavits competent proof of nonappearance, the IME notices proved mailed, and the providers raised no triable issue.
Harmonic Physical Therapy v Encompass Home & Auto Ins. Co. (2015 NY Slip Op 50733(U)) Appellate Term, First Department, May 18, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedReversing the lower court, held the examining physician's affirmation and the IME scheduler employee's affidavit, based on personal knowledge of office no-show practices, competent proof of nonappearance; the IME notices were proved mailed.
Priority Med. Diagnostics, P.C. v New York Cent. Mut. Fire, Ins. Co. (2015 NY Slip Op 50538(U)) Appellate Term, First Department, April 16, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the IME scheduler's affidavit proved mailing of the notices and the examining chiropractor's, acupuncturist's and scheduler's affidavits proved repeated nonappearances; the provider raised no triable issue.
21st Century Acupuncture, P.C. v Allstate Ins. Co. (2015 NY Slip Op 50445(U)) Appellate Term, First Department, April 2, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedRejected the provider's contention and held the acupuncturists' and IME scheduler employee's affidavits competent proof of nonappearance, with the IME notices proved mailed and no triable issue raised.
Acupuncture Solutions, P.C. v Lumbermans Mut. Cas. Co. (2015 NY Slip Op 50346(U)) Appellate Term, First Department, March 23, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailed IME notices and the assignor's nonappearance through affidavits of the examining chiropractor and IME scheduler showing personal knowledge, and the provider raised no issue on nonappearance, mailing or reasonableness.
Acupuncture, Approach, P.C. v Allstate Ins. Co. (2015 NY Slip Op 50318(U)) Appellate Term, First Department, March 16, 2015Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer failed its prima facie burden on the IME no-show defense because the record did not show when it received the claims, leaving no basis to determine whether the IME requests were timely.
River Acupuncture, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 50271(U)) Appellate Term, First Department, March 4, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer showed timely and proper mailing of the IME notices and the assignor's nonappearance, and the provider raised no triable issue on nonappearance, mailing or reasonableness.
SMB Med., P.C. v State Farm Mut. Ins. Co. (2014 NY Slip Op 51853(U)) Appellate Term, First Department, December 30, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the examining physician's affirmation and the IME scheduler employee's affidavit, based on personal knowledge of office practices, competently proved nonappearance, and the provider raised no triable issue.
Alpha Acupuncture, P.C. v Hertz Claim Mgt. Corp. (2014 NY Slip Op 51515(U)) Appellate Term, First Department, October 22, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the IME notices and, through affidavits of the examining chiropractor and the scheduler's employee, the assignor's nonappearance, and the provider raised no issue on nonappearance, mailing or reasonableness.
Sunrise Acupuncture, P.C. v Encompass Auto & Home Ins. Co. (2014 NY Slip Op 51082(U)) Appellate Term, First Department, July 16, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved proper mailing of the IME notices and, through the examining physician's and biller employee's affidavits, the assignor's nonappearance; the provider raised no triable issue on nonappearance, mailing or reasonableness.
MDJ Med., P.C. v Praetorian Ins. Co. (2014 NY Slip Op 50895(U)) Appellate Term, First Department, June 9, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved proper mailing of IME and EUO notices and, through examining physicians' personal-knowledge affidavits, repeated nonappearance; the provider raised no triable issue.
Healthy Way Acupuncture, P.C. v Allstate Ins. Co. (2014 NY Slip Op 50841(U)) Appellate Term, First Department, May 30, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely and proper mailing of the IME notices and the assignor's nonappearance; the provider did not specifically deny nonappearance or raise an issue on mailing or reasonableness.
Stracar Med. Servs. v New York Cent. Mut. Ins. Co. (2014 NY Slip Op 50263(U)) Appellate Term, First Department, February 27, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the examiner's affidavit proved timely, proper mailing of the IME notices and the physician's affidavits proved nonappearance; the provider raised no issue on nonappearance, mailing or reasonableness.
MDJ Med., P.C. v New York Cent. Mut. Ins. Co. (2013 NY Slip Op 51797(U)) Appellate Term, First Department, October 28, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedGranted the insurer summary judgment because it showed timely, proper mailing of the IME notices and the assignor's nonappearance, and the provider raised no issue on nonappearance, mailing or reasonableness of the notices.
Acupuncture Approach PC v MVAIC (2013 NY Slip Op 51676(U)) Appellate Term, First Department, October 15, 2013Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to prove the IME notices were properly addressed and mailed, so its no-show defense raised no triable issue against the provider's prima facie case.
City Care Acupuncture, PC v New York Cent. Mut. Fire Ins. Co. (2013 NY Slip Op 50430(U)) Appellate Term, First Department, March 27, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedGranted the insurer summary judgment because it showed proper mailing of the IME notices and the assignor's nonappearance, and the provider raised no issue on nonappearance, mailing or reasonableness of the notices.
Coast Med. Diagnostic, PC v Praetorian Ins. Co. (2013 NY Slip Op 50381(U)) Appellate Term, First Department, March 20, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely and proper mailing of the IME notices and the assignor's nonappearance, and the provider raised no issue on nonappearance, mailing or reasonableness of the notices.
RDB Med. Care, P.C. v Praetorian Ins. Co. (2013 NY Slip Op 50301(U)) Appellate Term, First Department, March 1, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely and proper mailing of the IME notices and the assignor's nonappearance for the claims in ten causes of action, and the provider did not specifically deny the nonappearance or contest mailing or reasonableness.
Stanley Liebowitz, M.D., P.C. v Unitrin Preferred Ins. Co. (2012 NY Slip Op 52363(U)) Appellate Term, First Department, December 27, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely and proper mailing of IME notices to the assignor and his attorney and the assignor's nonappearance, and the provider raised no issue on nonappearance, mailing or reasonableness.
Seacoast Med., P.C. v Praetorian Ins. Co. (2012 NY Slip Op 52354(U)) Appellate Term, First Department, December 24, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely and proper mailing of IME and EUO notices and the assignor's nonappearance, and the provider did not specifically deny nonappearance or contest mailing or reasonableness.
SK Prime Med. Supply, Inc. v Hertz Claim Mgt. Corp. (2012 NY Slip Op 52192(U)) Appellate Term, First Department, November 28, 2012Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to show the IME notices were properly addressed and mailed, and in any event the provider's proof of misdelivery raised triable issues.
Orthotech Express Corp. v MVAIC (2012 NY Slip Op 51913(U)) Appellate Term, First Department, October 5, 2012Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to show the IME notices were properly addressed and mailed, so no presumption of receipt arose and its no-show defense could not support summary judgment.
Searay Med., P.C. v Praetorian Ins. Co. (2012 NY Slip Op 51383(U)) Appellate Term, First Department, July 26, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer made a prima facie showing of timely, proper mailing of the IME notices and the assignor's nonappearance; the provider did not specifically deny the nonappearance.
Dowd v Praetorian Ins. Co. (2012 NY Slip Op 51160(U)) Appellate Term, First Department, June 25, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely and proper mailing of IME and EUO notices and the assignor's nonappearance, and the provider did not specifically deny nonappearance or contest mailing or reasonableness.
Continental Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 50844(U)) Appellate Term, First Department, May 10, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely and proper mailing of the IME notices and the assignor's nonappearance, and the provider did not specifically deny the nonappearance or otherwise raise a triable issue.
Bath Ortho Supply, Inc. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 50271(U)) Appellate Term, First Department, February 22, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved proper mailing of the EUO notices and the assignor's nonappearance, the provider raised no issue on reasonableness or attendance, and the insurer did not need to show the nonappearance was willful.
Shore Med. Diagnostic, P.C. v Praetorian Ins. Co. (2011 NY Slip Op 52343(U)) Appellate Term, First Department, December 28, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved prima facie that it mailed the IME notices to the assignor and that the assignor failed to appear, and the provider raised no triable issue on reasonableness or nonattendance.
Socrates Med. Health, P.C. v Praetorian Ins. Co. (2011 NY Slip Op 52174(U)) Appellate Term, First Department, December 6, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established mailing of the IME notices and the assignor's nonappearance, and the provider raised no triable issue on the reasonableness of the requests or the nonattendance.
Dov Phil Anesthesiology Group v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 51959(U)) Appellate Term, First Department, November 2, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved prima facie that it mailed the IME notices to the assignor and his attorney and that the assignor failed to appear, and the provider raised no triable issue on reasonableness or nonattendance.
Multi-Specialty Pain Mgt. PC v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 51677(U)) Appellate Term, First Department, September 14, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved prima facie that it properly mailed initial and follow-up IME notices to the assignor and her attorney and that she failed to appear, and the provider raised no triable issue.
Harmonic Physical Therapy, P.C. v Praetorian Ins. Co. (2011 NY Slip Op 51597(U)) Appellate Term, First Department, August 24, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's documentary submissions established prima facie mailing of the IME notices and the assignor's nonappearance, and the provider raised no triable issue on reasonableness or nonattendance.
Excel Radiology Serv., P.C. v Utica Mut. Ins. Co. (2011 NY Slip Op 50751(U)) Appellate Term, First Department, April 28, 2011Insurer failed to prove the scheduling letters were mailed or properly addressedDenied the insurer summary judgment because it did not prove that the IME notices were properly mailed or that the assignor failed to appear.
Center for Orthopedic Surgery, LLP v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 50473(U)) Appellate Term, First Department, March 29, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of the IME notices and nonappearance, and the provider raised no triable issue on reasonableness of the requests or the failure to attend.
Marina v Praetorian Ins. Co. (2010 NY Slip Op 51292(U)) Appellate Term, First Department, July 21, 2010Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved prima facie that it mailed the IME notices to the assignors and that they failed to appear, and the provider raised no triable issue on reasonableness or nonattendance.
Apollo Chiropractic Care, P.C. v Praetorian Ins. Co. (2010 NY Slip Op 50911(U)) Appellate Term, First Department, May 24, 2010Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer showed two IME requests were duly mailed and the assignor missed both dates, and it did not need to produce the policy to prove an IME provision, which the law reads into it.
Inwood Hill Med., P.C. v Allstate Ins. Co. (2007 NY Slip Op 51103(U)) Appellate Term, First Department, May 30, 2007Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer's EUO no-show motion failed because it offered no admissible proof of the dates it received the claims, so it could not show the EUO requests met the regulatory time limits.
SZ Med. P.C. v State Farm Mut. Auto. Ins. Co. (2005 NY Slip Op 51842(U)) Appellate Term, First Department, November 16, 2005Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsRejected the EUO no-show defense because the insurer did not show the policy contained the revised endorsement authorizing EUOs, and the liability policy's cooperation clause could not supply that right.
Inwood Hill Med., P.C. v General Assur. Co. (2005 NY Slip Op 25437) Appellate Term, First Department, October 20, 2005Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved pre-claim IMEs and follow-ups within 10 days were mailed to the assignor's addresses and that he failed to attend, with no issue raised as to reasonableness or nonappearance.
Elite Psychological Servs., P.C. v Trumbull Ins. Co. (2005 NY Slip Op 51427(U)) Appellate Term, First Department, September 9, 2005Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the EUO no-show denial ineffective because the insurer did not show its policy contained the revised endorsement authorizing EUOs, so the EUO requests did not toll the 30 days and the denial was untimely.

Appellate Term, Second Department (741 decisions)

One RX Chemist, Inc. v Nationwide Mut. Ins. Co. (2026 NY Slip Op 51309(U)) Appellate Term, Second Department, June 17, 2026Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing and three nonappearances, and the lower court erred in finding an issue of fact on the reasonableness of the EUO request.
Bridgeview Supply Corp. v Nationwide Mut. Ins. Co. (2026 NY Slip Op 50190(U)) Appellate Term, Second Department, January 16, 2026Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer need not state objective reasons for EUOs and the provider's objection letters disputing the basis raised no triable issue against the established mailing and nonappearance.
GC Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2025 NY Slip Op 51982(U)) Appellate Term, Second Department, December 5, 2025Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's attorney's affirmation sufficiently proved the provider's EUO nonappearances and was not unworthy of belief merely because it was executed about three years after the missed EUOs.
John A. Nasrinpay 2 v State Farm Mut. Auto. Ins. Co. (2025 NY Slip Op 51833(U)) Appellate Term, Second Department, November 7, 2025Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's affidavits proved timely mailing of the EUO scheduling letters, the only element contested on appeal, so dismissal on the no-show ground stood.
Brefni Chiropractic Diagnostics, P.C. v State Farm Mut. Auto. Ins. Co. (2025 NY Slip Op 51518(U)) Appellate Term, Second Department, September 5, 2025Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld an attorney's affirmation that he was present at the EUO site and the provider did not appear sufficed to prove nonappearance without transcripts.
MSB Physical Therapy, P.C. v Nationwide Ins. (2025 NY Slip Op 50830(U)) Appellate Term, Second Department, May 16, 2025Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved a pre-claim initial EUO letter, timely follow-ups after each nonappearance, and the provider's failure to appear at each EUO.
MSB Physical Therapy, P.C. v Nationwide Ins. (2025 NY Slip Op 50831(U)) Appellate Term, Second Department, May 16, 2025Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailed initial and follow-up EUO letters and the provider's nonappearance, and the provider raised no triable issue.
Wellness Diagnostic Imaging, P.C. v American Tr. Ins. Co. (2025 NY Slip Op 50628(U)) Appellate Term, Second Department, April 10, 2025Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held on article 75 review that the master arbitrator rationally upheld the finding that the assignor failed to appear for IMEs, since a stipulation confined the arbitration to that single issue, foreclosing the timeliness objections.

Show all 741 decisions

MAZ Chiropractic, P.C. v State Farm Ins. Co. (2025 NY Slip Op 50492(U)) Appellate Term, Second Department, March 28, 2025Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the affirmation of the attorney who was to conduct the EUOs, stating he was present and had personal knowledge that the provider did not appear, sufficient to prove the nonappearance and not unworthy of belief.
Northern Med. Care, P.C. v Nationwide Affinity Ins. Co. of Am. (2024 NY Slip Op 51822(U)) Appellate Term, Second Department, December 19, 2024Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedTreated the owner's appearance with counsel refusing to let him answer, and his later departure before the EUO began, as nonappearances, and held the insurer need not state objective reasons for the EUOs, upholding the defense.
Central Pharm., Inc. v Nationwide Mut. Ins. Co. (2024 NY Slip Op 51557(U)) Appellate Term, Second Department, November 8, 2024Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld there was no triable issue as to the reasonableness of the EUO location because every scheduling letter offered the provider the option to appear virtually, so the insurer was entitled to summary judgment on its EUO no-show defense.
LPM Pharm., Inc. v Nationwide Prop. & Cas. Ins. Co. (2024 NY Slip Op 51191(U)) Appellate Term, Second Department, August 13, 2024Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved two EUO nonappearances because the assignor was orally told the date, time and place of the EUO rescheduled at his own request three days later, and written notice was not required.
GPLW Acupuncture, P.C. v Nationwide Mut. Ins. Co. (2024 NY Slip Op 50395(U)) Appellate Term, Second Department, March 14, 2024Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailed initial and follow-up EUO letters and the provider's nonappearance, rejecting the inconvenient-location issue because the letters offered a virtual appearance.
GPLW Acupuncture, P.C. v Nationwide Mut. Ins. Co. (2024 NY Slip Op 50397(U)) Appellate Term, Second Department, March 14, 2024Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of the EUO letters and nonappearance through the scheduled attorney's affidavits and transcripts, and the virtual-appearance offer defeated the inconvenient-location issue.
Warton Supplies, Inc. v GEICO Indem. Co. (2024 NY Slip Op 50071(U)) Appellate Term, Second Department, January 19, 2024Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld dismissal on the EUO no-show, rejecting the argument that the affirmation proving nonappearance was inadmissible under CPLR 2106 because the attorney was the insurer's staff counsel.
Shafai Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2023 NY Slip Op 50795(U)) Appellate Term, Second Department, July 21, 2023Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's affidavit raised a presumption of timely mailing of the EUO scheduling letters, so dismissal of six causes of action on the EUO no-show defense was affirmed.
Horizon P.T. Care, P.C. v State Farm Mut. Auto. Ins. Co. (2023 NY Slip Op 50442(U)) Appellate Term, Second Department, April 14, 2023Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)For the three causes of action outside the declaratory judgment, held the EUO scheduling letters presumptively timely mailed, leaving the no-show dismissal undisturbed.
Allstate Chiropractic, P.C. v Nationwide Affinity Ins. Co. of Am. (2023 NY Slip Op 50299(U)) Appellate Term, Second Department, March 24, 2023Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held the record showed the second scheduled EUO was not mutually rescheduled, since the insurer declined the provider's request and recorded the nonappearance, so that date counted as a failure to appear.
MT Physical Therapy v Lancer Ins. (2023 NY Slip Op 50297(U)) Appellate Term, Second Department, March 24, 2023Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld that the insurer made a prima facie showing that the assignor's failure to appear for a duly scheduled EUO was a failure to appear under the regulations, and it also established a second nonappearance.
MUA Chiropractic Healthcare, PLLC v Nationwide Mut. Ins. Co. (2022 NY Slip Op 51384(U)) Appellate Term, Second Department, December 29, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved the twice-demanded EUOs and the provider's two nonappearances, and rejected the argument that it also had to show an objective basis for requesting the EUOs to make its prima facie case.
Spring Rehab PT P.C. v Nationwide Affinity Ins. Co. (2022 NY Slip Op 51268(U)) Appellate Term, Second Department, December 2, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of the EUO letters and, through affidavits of the attorneys scheduled to conduct the EUOs and certified nonappearance transcripts, the assignor's failure to appear.
Heal-Rite, P.T., P.C. v State Farm Mut. Auto. Ins. Co. (2022 NY Slip Op 51246(U)) Appellate Term, Second Department, December 2, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the EUO scheduling letters and, through the affirmation of the attorney scheduled to conduct the EUOs, the assignor's failure to appear.
Masigla v Nationwide Affinity Ins. Co. of Am. (2022 NY Slip Op 51239(U)) Appellate Term, Second Department, November 18, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer entitled to summary judgment because EUOs scheduled and missed before the claims were submitted supported the defense, and the insurer did not need to schedule new EUOs after the claims arrived.
Wellness Plaza Acupuncture, P.C. v Nationwide Ins. (2022 NY Slip Op 50934(U)) Appellate Term, Second Department, September 23, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the initial EUO letter, mailed before the claims were received, was not subject to the 15-business-day rule triggered by the NF-2 or another provider's claim, so the defense was established.
Columbus Imaging Ctr., LLC v Erie Ins. Co. of N.Y. (2022 NY Slip Op 50929(U)) Appellate Term, Second Department, September 23, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer showed it properly scheduled the IMEs before receiving the claim and that the assignor failed to appear, reversing the finding that a trial was needed on the defense.
SVP Med Supply, Inc. v GEICO (2022 NY Slip Op 50927(U)) Appellate Term, Second Department, September 23, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld dismissal because the insurer's proof sufficed to establish the provider's failure to appear for the scheduled EUOs.
SVP Med Supply, Inc. v GEICO (2022 NY Slip Op 50931(U)) Appellate Term, Second Department, September 23, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the affirmation of the attorney assigned to conduct the EUOs, stating she was present and would have conducted them, established personal knowledge of nonappearance despite the time elapsed before she signed it.
Nassau Chiropractic Servs., P.C. v Travelers Indem. Co. (2022 NY Slip Op 50933(U)) Appellate Term, Second Department, September 23, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the EUO letters were proved mailed and the attorneys present to conduct the EUOs sufficiently showed the provider's nonappearance, so summary judgment should have been granted.
Parisien v Tri State Consumers Ins. Co. (2022 NY Slip Op 50920(U)) Appellate Term, Second Department, September 16, 2022Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the IME no-show defense unproved because mailing of the scheduling letters was not shown and the scheduled doctor's affirmation showed no personal knowledge of the nonappearance.
Forest Park Acupuncture, P.C. v Nationwide Prop. & Cas. Ins. Co. (2022 NY Slip Op 50915(U)) Appellate Term, Second Department, September 9, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the scheduling letter and, through counsel's affirmation and the EUO transcript, the assignor's nonappearance on the one date left for trial.
MSB Physical Therapy, P.C. v Nationwide Ins. (2022 NY Slip Op 50902(U)) Appellate Term, Second Department, August 19, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the provider raised no issue that the EUOs were not scheduled at reasonably convenient times, because the insurer had granted the provider's repeated requests to reschedule to unspecified dates two months out.
Hands On Physical Therapy Care v Nationwide Ins. (2022 NY Slip Op 50797(U)) Appellate Term, Second Department, August 12, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Upheld the EUO no-show defense on four claims, finding the scheduling letters properly mailed and a timely follow-up letter sent, while the other claims failed only for lack of a timely denial.
ACH Chiropractic, P.C. v Nationwide Ins. (2022 NY Slip Op 50795(U)) Appellate Term, Second Department, August 12, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer sufficiently established timely mailing of the EUO scheduling letters, the provider's only challenge to the no-show defense, so dismissal was affirmed.
RA Med. Servs., P.C. v Lancer Ins. Co. (2022 NY Slip Op 50793(U)) Appellate Term, Second Department, August 12, 2022Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer not entitled to summary judgment because its initial EUO request was sent more than 30 days after it received the claims, making the requests nullities as to those claims.
ACH Chiropractic, P.C. v Nationwide Ins. (2022 NY Slip Op 50782(U)) Appellate Term, Second Department, August 5, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established that the assignor failed to appear for the duly scheduled EUOs, rejecting the provider's challenge; another argument was not considered as raised first on appeal.
SVP Med Supply, Inc. v GEICO (2022 NY Slip Op 50775(U)) Appellate Term, Second Department, July 22, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld an attorney's affirmation that she was in the office on the EUO dates, would have conducted or assigned the EUOs, and that the provider did not appear sufficient prima facie proof of nonappearance.
Warton Supplies, Inc. v GEICO Indem. Co. (2022 NY Slip Op 50770(U)) Appellate Term, Second Department, July 15, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the staff-counsel attorney's affirmation admissible under CPLR 2106 to prove the provider's EUO nonappearance, so the defense was established.
Parisien v Travelers Ins. Co. (2022 NY Slip Op 50622(U)) Appellate Term, Second Department, July 1, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the provider's letters demanding a $5,000 up-front fee to attend and seeking repeated rescheduling to unspecified later dates raised no issue that the EUOs were not scheduled at reasonably convenient times.
Columbus Imaging Ctr., LLC v Nationwide Ins. (2022 NY Slip Op 50620(U)) Appellate Term, Second Department, July 1, 2022Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer failed to establish its IME no-show defense because the examining doctors' affidavits did not show personal knowledge of the assignor's nonappearance, although the scheduling letters were proved mailed.
Citycare Chiropractic, P.C. v Repwest Ins. Co. (2022 NY Slip Op 50619(U)) Appellate Term, Second Department, July 1, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of the IME letters and the assignor's nonappearance, and the assignor's conclusory denial of receipt raised no triable issue.
Ezra Supply, Inc. v State Farm Mut. Auto Ins. Co. (2022 NY Slip Op 50613(U)) Appellate Term, Second Department, June 17, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of the initial and follow-up EUO letters to the proper address and the assignor's failure to appear on either date.
New York Wellness PT, P.C. v State Farm Mut. Auto. Ins. Co. (2022 NY Slip Op 50608(U)) Appellate Term, Second Department, June 17, 2022Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the EUO no-show defense not established because, although the scheduling letters were shown timely mailed, no one with personal knowledge proved the assignor's nonappearance.
Hand By Hand PT, P.C. v Nationwide Prop. & Cas. Ins. Co. (2022 NY Slip Op 50607(U)) Appellate Term, Second Department, June 17, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of initial and follow-up EUO letters and the provider's failure to appear on either date, and the opposition did not rebut that showing.
Metropolitan Surgical Servs., P.C. v 21st Century Ins. Co. (2022 NY Slip Op 50606(U)) Appellate Term, Second Department, June 17, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing and nonappearance, and because the IMEs were scheduled before the claim was received, the follow-up time frames of the regulation did not apply.
Regal Acupuncture, P.C. v Allstate Ins. Co. (2022 NY Slip Op 50604(U)) Appellate Term, Second Department, June 17, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely and proper mailing of the EUO scheduling letters and that appearance was required whether the EUO was demanded before or after the claim, so dismissal on the no-show was affirmed.
Prestige Med., P.C. v Metropolitan Prop. & Cas. Ins. Co. (2022 NY Slip Op 50591(U)) Appellate Term, Second Department, June 10, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the EUO letters, which identified the accident date and assignor, need not specify the bills, and the insurer proved their mailing and the provider's nonappearance.
Sutphin Complete Med. Care, P.C. v Tri-State Consumer Ins. Co. (2022 NY Slip Op 50586(U)) Appellate Term, Second Department, June 10, 2022Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the IME no-show defense unproved because the scheduling letters' mailing was not established and the doctors' affirmations showed no personal knowledge of the nonappearances.
Sanford Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2022 NY Slip Op 50576(U)) Appellate Term, Second Department, June 10, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the affirmation of the attorney present in his office to conduct the EUOs, stating no one appeared, sufficed prima facie to show nonappearance without proof he was present at the exact start times.
PFJ Med. Care, P.C. v Nationwide Ins. (2022 NY Slip Op 50570(U)) Appellate Term, Second Department, June 10, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld defense counsel's affirmations and the EUO transcripts sufficient to establish that the provider failed to appear for the EUOs, rejecting the provider's sole contention.
Dr. Orenbakh Psychologist, P.C. v Nationwide Affinity Ins. Co. of Am. (2022 NY Slip Op 50566(U)) Appellate Term, Second Department, June 10, 2022Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the insurer proved mailing and nonappearance for most claims, but for one claim the initial EUO request came more than 30 days after receipt and was a nullity.
SVP Med Supply, Inc. (B) v GEICO (2022 NY Slip Op 50585(U)) Appellate Term, Second Department, June 10, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of the EUO letters, and its attorney, present to conduct the EUOs, sufficiently showed the provider's nonappearance, so summary judgment was granted.
Pavlova v Nationwide Ins. (2022 NY Slip Op 50559(U)) Appellate Term, Second Department, June 3, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer made its prima facie no-show showing by proving proper mailing of the EUO scheduling letters, and rejected the unpreserved argument that the letters had to be mailed after receipt of the NF-2.
AB Quality Health Supply Corp. v Nationwide Ins. (2022 NY Slip Op 50558(U)) Appellate Term, Second Department, June 3, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailing of the EUO scheduling letters and the assignor's nonappearance, the only issues remaining, and the provider raised no triable issue, so the complaint was dismissed.
Columbus Imaging Ctr., LLC v National Liab. & Fire Ins. Co. (2022 NY Slip Op 50556(U)) Appellate Term, Second Department, June 3, 2022Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the IME no-show defense failed because without proof the scheduling letters were properly mailed the insurer could not show the IMEs were duly scheduled or that the assignor failed to appear.
Warton Supplies, Inc. v GEICO Gen. Ins. Co. (2022 NY Slip Op 50554(U)) Appellate Term, Second Department, June 3, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the EUO letters and, through the affirmation of the attorney present to conduct the EUOs, the provider's nonappearance, so the provider's opposition raised no triable issue.
Parisien v Travelers Ins. Co. (2022 NY Slip Op 50553(U)) Appellate Term, Second Department, June 3, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailing of initial and follow-up EUO letters and the provider's failure to appear on either date, and the provider raised no triable issue.
ACH Chiropractic, P.C. v Nationwide Ins. (2022 NY Slip Op 50448(U)) Appellate Term, Second Department, May 13, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the affidavits of the attorneys scheduled to conduct the EUOs and the certified EUO transcripts sufficed to establish the provider's nonappearance.
NY Wellness Med., P.C. v Nationwide Mut. Ins. Co. (2022 NY Slip Op 50359(U)) Appellate Term, Second Department, April 28, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer entitled to summary judgment because mailing and nonappearance were established and the insurer did not have to state objective reasons for its EUO requests to make its prima facie case.
July, P.T., P.C. v Metropolitan Group Prop. & Cas. Ins. (2022 NY Slip Op 50302(U)) Appellate Term, Second Department, April 1, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the affidavit of the investigator scheduled to conduct the EUOs, with certified transcripts, sufficient to establish that the assignor failed to appear for both EUOs.
Charles Deng Acupuncture, P.C. v Titan Ins. Co. (2022 NY Slip Op 50300(U)) Appellate Term, Second Department, April 1, 2022Insurer failed to prove the nonappearance by someone with personal knowledgeHeld that the insurer failed to prove the provider's EUO nonappearances at trial because its only proof, transcripts of counsel's bust statements, was hearsay and not admissible as business records.
AB Quality Health Supply Corp. v Nationwide Ins. (2022 NY Slip Op 50299(U)) Appellate Term, Second Department, April 1, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of initial and follow-up EUO letters to the address on the NF-3 forms and the assignor's nonappearance, reversing the lower court's finding of a mailing issue.
Arcadia Acupuncture, P.C. v Nationwide Ins. Co. (2021 NY Slip Op 51258(U)) Appellate Term, Second Department, December 22, 2021Proof on the no-show raises a question of fact; neither side wins the point as a matter of lawHeld that although mailing and nonappearance were shown for the later claims, a triable issue existed as to whether the EUOs were scheduled at a place reasonably convenient to the provider.
Warton Supplies, Inc. v GEICO (Gov Empls.) (2021 NY Slip Op 51253(U)) Appellate Term, Second Department, December 22, 2021Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the EUO letters presumptively mailed and the staff-counsel attorney's affirmation admissible to prove the provider's nonappearance, so the no-show defense was established.
Tyorkin v Repwest Ins. Co. (2021 NY Slip Op 51208(U)) Appellate Term, Second Department, December 10, 2021Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the assignor's affidavit merely denying receipt of the IME scheduling letters raised no triable issue, so dismissal on the IME no-show defense stood.
RX for You v Nationwide Ins. Co. of Am. (2021 NY Slip Op 51171(U)) Appellate Term, Second Department, December 3, 2021Proof on the no-show raises a question of fact; neither side wins the point as a matter of lawHeld triable issues existed on whether the EUOs were scheduled at a place reasonably convenient to the claimant and whether the parties had mutually agreed to reschedule one EUO, so summary judgment was denied.
Psychology After Acc., P.C. v New York Cent. Mut. Fire Ins. Co. (2021 NY Slip Op 51072(U)) Appellate Term, Second Department, November 12, 2021Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's proof sufficient to show that the assignors failed to appear for the IMEs, a showing the provider did not rebut, so the insurer was entitled to summary judgment.
Sufficient Chiropractic Care, P.C. v Global Liberty Ins. Co. (2021 NY Slip Op 50959(U)) Appellate Term, Second Department, October 8, 2021Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer showed that it properly scheduled IMEs before receiving the claims and that the assignor failed to appear, which the provider did not rebut, entitling the insurer to summary judgment.
Essential Health Chiropractic, P.C. v National Liab. & Fire Ins. Co. (2021 NY Slip Op 50881(U)) Appellate Term, Second Department, September 9, 2021Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to establish timely and proper mailing of the EUO scheduling letters and the assignor's nonappearance at the IMEs, so it was not entitled to summary judgment.
Solution Bridge, Inc. v GEICO Ins. Co. (2021 NY Slip Op 50731(U)) Appellate Term, Second Department, July 23, 2021Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held, even absent the declaratory judgment, that the insurer proved timely mailed EUO letters and the provider's nonappearance on both dates, unrebutted by the provider.
Englinton Med., P.C. v Ameriprise Ins. Co. (2021 NY Slip Op 50715(U)) Appellate Term, Second Department, July 22, 2021Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the initial and follow-up EUO letters and the provider's nonappearance, and that treating the provider as an adversary was no ground to deny summary judgment, since appearance is a condition precedent to liability.
Hand By Hand PT, P.C. v Titan Indem. Co. (2021 NY Slip Op 50644(U)) Appellate Term, Second Department, July 2, 2021Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailed initial and follow-up EUO letters and the provider's nonappearance on both dates, and no triable issue was raised.
JCC Med., P.C. v Lancer Ins. Co. (2021 NY Slip Op 50485(U)) Appellate Term, Second Department, May 21, 2021Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved at trial that the EUO scheduling letters were timely mailed by first-class mail, the only contested element, so judgment for the provider was reversed and the complaint dismissed.
Madison Prods. of USA, Inc. v 21st Century Ins. Co. (2021 NY Slip Op 50446(U)) Appellate Term, Second Department, May 14, 2021Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailing of the EUO scheduling letters, the only challenged element, so summary judgment dismissing the complaint on the no-show was affirmed.
Jodi Jacobs, D.C., PLLC v Global Liberty Ins. Co. of NY (2021 NY Slip Op 50445(U)) Appellate Term, Second Department, May 14, 2021Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved its IME no-show defense through a scheduling vendor supervisor's affidavit of timely mailing and proof that the assignor failed to appear.
Total Chiropractic, P.C. v Integon Natl. Ins. Co. (2021 NY Slip Op 50443(U)) Appellate Term, Second Department, May 14, 2021Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer not entitled to dismissal because, without proof the IME scheduling letters were properly mailed, it could not show the IMEs were duly scheduled or that the assignor failed to appear.
Ditmas Primary Med. Care, P.C. v Republic W. Ins. Co. (2021 NY Slip Op 50438(U)) Appellate Term, Second Department, May 14, 2021Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the EUO letters and, through the attorney present to conduct the EUOs, the assignor's nonappearance, and the provider raised no triable issue.
Quest Supply, Inc. v Praetorian Ins. Co. (2021 NY Slip Op 50437(U)) Appellate Term, Second Department, May 14, 2021Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedAffirmed summary judgment for the insurer, holding its proof sufficiently established that the assignor failed to appear for the scheduled IMEs.
BNE Clinton Med., P.C. v Republic W. Ins. Co. (2021 NY Slip Op 50433(U)) Appellate Term, Second Department, May 14, 2021Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the EUO letters and, through the attorney present to conduct the EUOs, the provider's nonappearance, and no triable issue was raised.
JFL Med. Care, P.C. v ELRAC, Inc. (2021 NY Slip Op 50434(U)) Appellate Term, Second Department, May 14, 2021Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to show the IMEs were properly scheduled, and thus the assignor's nonappearance, because its affidavit did not describe a mailing practice ensuring proper addressing and mailing of the letters.
Excel Prods., Inc. v Farmington Cas. Co. (2021 NY Slip Op 50441(U)) Appellate Term, Second Department, May 14, 2021Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the EUO requests were nullities as to the claims because the initial request was sent more than 30 days after the insurer received them.
Pavlova v Nationwide Ins. (2021 NY Slip Op 50213(U)) Appellate Term, Second Department, March 12, 2021Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld counsel's affirmations and the EUO transcripts sufficient to show the assignor's nonappearance, and found it irrelevant whether the assignor had counsel because the scheduling letters only had to be mailed to the assignor.
City Anesthesia Healthcare, P.C. v Erie Ins. Co. of N.Y. (2021 NY Slip Op 50135(U)) Appellate Term, Second Department, February 19, 2021Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer properly scheduled pre-claim IMEs that the assignor missed, and rejected the argument that the pre-claim letter had to be mailed within 30 days of receiving the NF-2.
BNE Clinton Med., P.C. v State Farm Mut. Auto Ins. Co. (2021 NY Slip Op 50083(U)) Appellate Term, Second Department, February 5, 2021Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer made its prima facie no-show showing without proving it mailed prescribed forms on learning of the accident, because that is not an element of the EUO no-show defense.
Lenex Servs., Inc. v Global Liberty Ins. of N.Y. (2020 NY Slip Op 51382(U)) Appellate Term, Second Department, November 13, 2020Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer's IME no-show defense failed because its moving papers did not establish that the IME scheduling letters were properly addressed and mailed, so the IMEs were not shown duly scheduled.
A.C. Med., P.C. v Ameriprise Ins. Co. (2020 NY Slip Op 51378(U)) Appellate Term, Second Department, November 13, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held the insurer established timely mailing of initial and follow-up EUO letters and the provider's failure to appear on either date for one provider's claims.
21st Century Pharm., Inc. v Global Liberty Ins. Co. of N.Y. (2020 NY Slip Op 51377(U)) Appellate Term, Second Department, November 13, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the IME scheduler's supervisor's affidavit established timely mailing of the IME letters and the insurer showed the assignor failed to appear, so plaintiff breached a condition precedent to coverage.
Island Life Chiropractic Pain Care, PLLC v Ameriprise Ins. (2020 NY Slip Op 51369(U)) Appellate Term, Second Department, November 13, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailing of initial and follow-up EUO scheduling letters and the assignor's failure to appear on either date, and plaintiff raised no triable issue.
Silver Lotus Acupuncture, P.C. v Global Liberty Ins. Co. of N.Y. (2020 NY Slip Op 51368(U)) Appellate Term, Second Department, November 13, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established proper mailing of the IME scheduling letters and the assignor's failure to appear, so dismissal was affirmed.
NL Quality Med., P.C. v GEICO Ins. Co. (2020 NY Slip Op 51367(U)) Appellate Term, Second Department, November 13, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's proof sufficiently showed the provider failed to appear for the scheduled EUOs, unrebutted, and that the EUO scheduling letters were timely mailed.
21st Century Pharm., Inc. v Integon Natl. Ins. Co. (2020 NY Slip Op 51364(U)) Appellate Term, Second Department, November 13, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer entitled to summary judgment because mailing and nonappearance were established and the insurer need not set forth objective reasons for its EUO requests, rejecting the unreasonableness argument.
Total Chiropractic, P.C. v Hereford Ins. Co. (2020 NY Slip Op 51362(U)) Appellate Term, Second Department, November 13, 2020Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer not entitled to summary judgment on the IME no-show defense because the initial IME was not scheduled within 30 calendar days after receipt of the claims.
NL Quality Med., P.C. v GEICO Ins. Co. (2020 NY Slip Op 51340(U)) Appellate Term, Second Department, November 6, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailing of the EUO scheduling letters and the provider's failure to appear, and the provider raised no triable issue, so three causes of action were dismissed.
Alpine Chiropractic, P.C. v Integon Natl. Ins. Co. (2020 NY Slip Op 51332(U)) Appellate Term, Second Department, November 6, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailing of initial and follow-up IME scheduling letters and the assignor's nonappearance, and plaintiff raised no triable issue; the EUO ground was not reached.
EA Chiropractic Diagnostics, P.C. v GEICO Ins. (2020 NY Slip Op 51331(U)) Appellate Term, Second Department, November 6, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held the IME scheduler's affidavit established timely mailing of the IME letters and the insurer showed the assignor failed to appear, for one claim.
Lacina v Hereford Ins. Co. (2020 NY Slip Op 51329(U)) Appellate Term, Second Department, November 6, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedRejected the provider's challenge and held the scheduler's same-day affidavits proved timely mailing of the IME letters and the examining provider's affidavit proved the assignor's nonappearance.
ESA Med. Supply, Inc. v Nationwide Affinity Ins. Co. of Am. (2020 NY Slip Op 51324(U)) Appellate Term, Second Department, November 6, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved the EUO letters were timely mailed to the address on plaintiff's bills and counsel's contemporaneous affirmations proved the assignor failed to appear for both EUOs.
Tsatskis v Travelers Ins. Co. (2020 NY Slip Op 51323(U)) Appellate Term, Second Department, November 6, 2020Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer failed to establish its EUO no-show defense because the initial EUO request was sent more than 30 days after it received the claims, making the request a nullity as to them.
Charles Deng Acupuncture, P.C. v Travelers Ins. Co. (2020 NY Slip Op 51320(U)) Appellate Term, Second Department, November 6, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailing of initial and follow-up EUO scheduling letters and the assignor's failure to appear on either date, and plaintiff raised no triable issue.
Metro Pain Specialist, P.C. v ELRAC, Inc. (2020 NY Slip Op 51341(U)) Appellate Term, Second Department, November 6, 2020Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to show the IMEs were properly scheduled, and thus the assignor's nonappearance, because its affidavit did not describe a mailing practice ensuring proper addressing and mailing of the letters.
Chi P & L Acupuncture, P.C. v Nationwide Ins. Co. (2020 NY Slip Op 51292(U)) Appellate Term, Second Department, October 30, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's proof sufficient to show its attorney was present when the EUOs were scheduled and the provider failed to appear, and that the insurer need not set forth objective reasons for requesting EUOs.
Longevity Med. Supply, Inc. v Nationwide Ins. (2020 NY Slip Op 51133(U)) Appellate Term, Second Department, October 2, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of EUO letters and the assignor's nonappearance, and that an EUO letter mailed before the first claim form was received was not a nullity because appearance is required either way.
Focus Chiropractic, P.C. v Global Liberty Ins. Co. of N.Y. (2020 NY Slip Op 51006(U)) Appellate Term, Second Department, August 28, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailing of the IME scheduling letters and the assignor's nonappearance, and the provider's attorney affirmation raised no triable issue, so the no-show claim was dismissed.
S.O.V. Acupuncture, P.C. v Global Liberty Ins. Co. of N.Y. (2020 NY Slip Op 51004(U)) Appellate Term, Second Department, August 28, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the IME letters to the proper address (the one on the assignor's NF-2) and the assignor's nonappearance, and counsel's affirmation raised no triable issue.
Quest Supply, Inc. v NY Cent. Mut. Fire Ins. Co. (2020 NY Slip Op 51003(U)) Appellate Term, Second Department, August 28, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved proper mailing of the pre-claim IME letters and, through the examining chiropractors' affidavits, the assignor's nonappearance; the provider's challenge to the nonappearance proof lacked merit.
Colin v Global Liberty Ins. Co. of N.Y. (2020 NY Slip Op 51002(U)) Appellate Term, Second Department, August 28, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved the IME letters were mailed to the correct address given in the assignor's NF-2 and claim forms and that the assignor failed to appear, so the complaint was dismissed.
Pavlova v Nationwide Ins. (2020 NY Slip Op 50999(U)) Appellate Term, Second Department, August 28, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's proof sufficiently established that the assignor failed to appear for the scheduled EUOs, rejecting the provider's sole contention and affirming dismissal.
NL Quality Med., P.C. v GEICO Ins. Co. (2020 NY Slip Op 50997(U)) Appellate Term, Second Department, August 28, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the EUO letters, and the affirmation of its attorney, present in her office on the scheduled dates, established the provider's nonappearance; no triable issue was raised.
Psychology YME, P.C. v Global Liberty Ins. Co. of N.Y. (2020 NY Slip Op 50992(U)) Appellate Term, Second Department, August 28, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established as a matter of law that it twice duly demanded an EUO from the assignor and that the assignor twice failed to appear, warranting summary judgment.
Parisien v Ameriprise Ins. (2020 NY Slip Op 50990(U)) Appellate Term, Second Department, August 28, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of the EUO letters and the provider's nonappearance at two EUOs, including one moved to Brooklyn at the provider's request, and no triable issue was raised.
Excel Surgery Ctr., LLC v MVAIC (2020 NY Slip Op 51016(U)) Appellate Term, Second Department, August 27, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer showed prima facie that the assignor failed to appear for two duly scheduled IMEs, and the provider raised no triable issue, so the insurer won summary judgment.
Accelerated Med. Supply, Inc. v Ameriprise Ins. Co. (2020 NY Slip Op 50741(U)) Appellate Term, Second Department, June 18, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedRejected the lower court's view that the EUO letters were defective for not specifying the claims, since they identified the assignor, accident date and file number, and held mailing and nonappearance proved.
Medcare Supply, Inc. v Global Liberty Ins. (2020 NY Slip Op 50231(U)) Appellate Term, Second Department, February 14, 2020Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the IME letters and the assignor's nonappearance, and counsel's affirmation without personal knowledge raised no triable issue.
Active Care Med. Supply Corp. v American Tr. Ins. Co. (2019 NY Slip Op 52068(U)) Appellate Term, Second Department, December 13, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld, contrary to the provider's contentions, that the insurer established timely mailing of the EUO letters and the provider's nonappearance, so dismissal was affirmed.
Omphil Care, Inc. v GEICO Ins. Co. (2019 NY Slip Op 52065(U)) Appellate Term, Second Department, December 13, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld, contrary to the provider's contentions, that the insurer proved timely mailing of the EUO letters and the provider's nonappearance, so summary judgment for the insurer was affirmed.
Crystal Acupuncture, P.C. v Travelers Ins. (2019 NY Slip Op 52055(U)) Appellate Term, Second Department, December 13, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held the insurer proved timely mailing of the EUO scheduling letters and the assignor's failure to appear on both dates, and the provider raised no issue of fact.
Margulis v Travelers Ins. (2019 NY Slip Op 52051(U)) Appellate Term, Second Department, December 13, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the initial and follow-up EUO letters and the provider's nonappearance on both dates, and no triable issue was raised.
Success Rehab, PT, P.C. v Hereford Ins. Co. (2019 NY Slip Op 52031(U)) Appellate Term, Second Department, December 13, 2019Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the IME no-show defense unproven for nine claims because the first IME was not scheduled within 30 days of receipt of those claims; the motion did not address the other three.
Wes Psychological Servs., P.C. v Travelers Ins. Co. (2019 NY Slip Op 52029(U)) Appellate Term, Second Department, December 13, 2019Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer not entitled to summary judgment on its EUO no-show defense because its initial EUO request was sent more than 30 days after it received the claims, making the requests nullities.
Beacon Acupuncture, P.C. v Hertz Claim Mgt. (2019 NY Slip Op 52059(U)) Appellate Term, Second Department, December 13, 2019Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the defense proved for earlier claims (letters mailed, two nonappearances), but for later claims the first EUO letter, sent more than 30 days after receipt, was a nullity.
Big Apple Med. Supply, Inc. v Titan & Nationwide (2019 NY Slip Op 52067(U)) Appellate Term, Second Department, December 13, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established that it twice duly demanded EUOs and that the assignor twice failed to appear, entitling it to summary judgment dismissing the complaint.
Omphil Care, Inc. v GEICO Ins. Co. (2019 NY Slip Op 51979(U)) Appellate Term, Second Department, December 6, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the affirmation of the attorney who was to conduct the EUOs established the provider's nonappearance and the letters were properly mailed, so the insurer's cross motion was granted.
Pro-Align Chiropractic, P.C. v Integon Natl. Ins. Co. (2019 NY Slip Op 51967(U)) Appellate Term, Second Department, December 6, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld, contrary to the provider's arguments, that the insurer proved timely mailing of the IME letters and the assignor's nonappearance, so dismissal was affirmed.
Restoration Chiropractic, P.C. v 21st Century Ins. Co. (2019 NY Slip Op 51961(U)) Appellate Term, Second Department, December 6, 2019Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer's motion should have been denied because its follow-up EUO letter was mailed more than 10 days after the assignor's first nonappearance and was therefore untimely.
Ultra Ortho Prods., Inc. v GEICO Ins. Co. (2019 NY Slip Op 51844(U)) Appellate Term, Second Department, November 15, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's proof established the provider's nonappearance at the EUOs, the only issue left for trial below, and the letters were timely mailed, so the insurer's cross motion was granted.
Allay Med. Servs., P.C. v Travelers Ins. Co. (2019 NY Slip Op 51806(U)) Appellate Term, Second Department, November 8, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld, contrary to the provider's contentions, that the insurer proved timely mailing of the EUO letters and the assignor's nonappearance; other arguments raised first on appeal were not considered.
Easy Care Acupuncture, P.C. v Ameriprise Ins. Co. (2019 NY Slip Op 51794(U)) Appellate Term, Second Department, November 1, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailing of the EUO scheduling letters and the provider's failure to appear, so dismissal of the claims was affirmed.
Bronx Med. Diagnostic, P.C. v Hereford Ins. Co. (2019 NY Slip Op 51793(U)) Appellate Term, Second Department, November 1, 2019Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer failed to establish its EUO no-show defense because its own affiant stated the first EUO scheduling letter was mailed more than 30 days after the claims were received, so the request was untimely.
Chapa Prods. Corp. v MVAIC (2019 NY Slip Op 29341) Appellate Term, Second Department, November 1, 2019Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the EUO no-show could not support dismissal with prejudice because, on the proof submitted, the insurer's EUO requests were nullities for the claims at issue.
Valdan Acupuncture, P.C. v Global Liberty Ins. Co. of NY (2019 NY Slip Op 51705(U)) Appellate Term, Second Department, October 18, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of initial and follow-up IME scheduling letters and the assignor's nonappearance on both dates, and the provider raised no triable issue.
Atlas Orthosurgery, P.C. v American Tr. Ins. Co. (2019 NY Slip Op 51697(U)) Appellate Term, Second Department, October 18, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's proof established proper mailing of the IME scheduling letters, the only contested element, so dismissal on the IME no-show was affirmed.
Body Acupuncture Care, P.C. v Erie Ins. Co. of N.Y. (2019 NY Slip Op 51695(U)) Appellate Term, Second Department, October 18, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of initial and follow-up IME letters to the address on the assignor's sworn application and the assignor's nonappearance on both dates, with no triable issue raised.
Tyorkin v Global Liberty Ins. (2019 NY Slip Op 51689(U)) Appellate Term, Second Department, October 18, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the IME letters through its scheduling vendor's affidavit and also established the assignor's nonappearance, so the provider failed to meet a condition precedent to coverage.
Lidas Med. Supply, Inc. v Global Liberty Ins. (2019 NY Slip Op 51688(U)) Appellate Term, Second Department, October 18, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established that the IME scheduling letters were mailed to a proper address matching the assignor's own sworn forms, the only remaining issue, so its cross motion was granted.
Gentlecare Ambulatory Anesthesia Servs. v GEICO Ins. Co. (2019 NY Slip Op 51684(U)) Appellate Term, Second Department, October 18, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer showed the provider failed to appear for EUOs and need not state objective reasons for requesting them to make its prima facie case.
Acupuncture Approach, P.C. v Global Liberty Ins. Co. of NY (2019 NY Slip Op 51631(U)) Appellate Term, Second Department, October 11, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely and proper mailing of the initial and follow-up EUO scheduling letters, the sole stipulated trial issue, so judgment for the provider was reversed and the complaint dismissed.
21st Century Pharm., Inc. v Ameriprise Ins. Co. (2019 NY Slip Op 51629(U)) Appellate Term, Second Department, October 11, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer did not need to set forth objective reasons for requesting the EUOs to make its prima facie case on the provider's EUO no-show, and affirmed summary judgment.
Ultimate Health Prods., Inc. v Travelers Ins. Co. (2019 NY Slip Op 51620(U)) Appellate Term, Second Department, October 11, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld the nonjury trial finding that the insurer proved the provider failed to appear for the scheduled EUOs, finding no basis on the trial evidence to disturb the credibility-based determination.
Allay Med. Servs., P.C. v Metropolitan Gen. Ins. Co. (2019 NY Slip Op 51617(U)) Appellate Term, Second Department, October 11, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of initial and follow-up EUO letters and the assignor's nonappearance on both dates, with no triable issue raised.
Actual Chiropractic, P.C. v State Farm Ins. (2019 NY Slip Op 51552(U)) Appellate Term, Second Department, September 27, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer did not need to set forth objective reasons for requesting the EUOs to make its prima facie case on the provider's EUO no-show, and affirmed summary judgment.
American Chiropractic Care, P.C. v Hereford Ins. Co. (2019 NY Slip Op 51359(U)) Appellate Term, Second Department, August 16, 2019Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer failed to establish its IME no-show defense because the record showed the first IME scheduling letter was mailed more than 30 days after it received the claims.
Lida's Med. Supply, Inc. v Hereford Ins. Co. (2019 NY Slip Op 51356(U)) Appellate Term, Second Department, August 16, 2019Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer's IME no-show cross motion properly denied because it failed to establish that its follow-up IME scheduling letter was timely under the follow-up rule.
Ocean One Physical Therapy, P.C. v 21st Century Centennial Ins. Co. (2019 NY Slip Op 51272(U)) Appellate Term, Second Department, August 2, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Affirmed dismissal on the EUO no-show defense, holding the EUO scheduling letters sufficient where the provider raised no issue with them.
Zen Acupuncture, P.C. v Ameriprise Ins. Co. (2019 NY Slip Op 51262(U)) Appellate Term, Second Department, August 2, 2019Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the EUO no-show defense failed because the initial EUO request was sent more than 30 days after the insurer received the claims, making the requests nullities as to those claims.
Compas Med., P.C. v American Tr. Ins. Co. (2019 NY Slip Op 51257(U)) Appellate Term, Second Department, August 2, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of EUO letters to the address on the provider's bills and the assignor's nonappearance at the scheduled EUOs.
Acupuncture Now, P.C. v Travelers Ins. Co. (2019 NY Slip Op 51255(U)) Appellate Term, Second Department, August 2, 2019Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held follow-up letters that did not specify the EUO time and place were mere delay letters, so the insurer failed to show timely EUO notices for two claims, while it established mailing and nonappearance for the third.
Brand Med. Supply, Inc. v Repwest Ins. Co. (2019 NY Slip Op 51183(U)) Appellate Term, Second Department, July 19, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedRejected the sole challenge that the IME letters omitted an apartment number, holding they went to the address on the bill and NF-2, so proper notice was given.
Gentlecare Ambulatory Anesthesia Servs. v GEICO Ins. Co. (2019 NY Slip Op 51161(U)) Appellate Term, Second Department, July 12, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer showed the provider failed to appear for EUOs and need not set forth objective reasons for requesting them to make its prima facie case.
New Way Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2019 NY Slip Op 51158(U)) Appellate Term, Second Department, July 12, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer sufficiently established the provider's failure to appear for two scheduled EUOs, rejecting arguments that discovery was needed under CPLR 3212 (f) and that the insurer had to show a reasonable basis for requesting the EUOs.
Central Park Physical Medicine & Rehab., P.C. v IDS Prop. & Cas. Ins. Co. (2019 NY Slip Op 51148(U)) Appellate Term, Second Department, July 11, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedReversed and held the insurer proved its EUO no-show defense: letters proved mailed by first-class mail, so certified-mail doubts did not excuse the nonappearance, which was also proved.
City Chiropractic, P.C. v State Farm Ins. (2019 NY Slip Op 51102(U)) Appellate Term, Second Department, June 28, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer entitled to summary judgment on the EUO no-show because it was not required to state its reasons for the EUOs in the scheduling letters or in response to the provider's objection, so no triable issue of good faith arose.
Excel Med. & Diagnostic, P.C. v Park Ins. Co. (2019 NY Slip Op 50989(U)) Appellate Term, Second Department, June 14, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the affirmation of the doctor who was to perform the IMEs sufficient to establish the assignor's failure to appear, the only issue left for trial, so the insurer was granted summary judgment.
Golden Star Acupuncture, P.C. v Erie Ins. Co. of NY (2019 NY Slip Op 50920(U)) Appellate Term, Second Department, June 7, 2019Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the EUO scheduling letters properly mailed, but the defense counsel's legal assistant's affidavit did not show personal knowledge of the nonappearances, so the insurer made no prima facie showing.
Valdan Acupuncture, P.C. v 21st Century Advantage Ins. Co. (2019 NY Slip Op 50822(U)) Appellate Term, Second Department, May 24, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved its IME no-show defense: the letters went to the only known address, which reply evidence properly showed, and the providers' affirmations proved the nonappearance.
Oleg's Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2019 NY Slip Op 50760(U)) Appellate Term, Second Department, May 10, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the EUO scheduling letters and the provider's nonappearance, and that a different law-firm contact named in the scheduling letter than the attorney affirming nonappearance raised no triable issue.
Gentlecare Ambulatory Anesthesia Servs. v GEICO Ins. Co. (2019 NY Slip Op 50759(U)) Appellate Term, Second Department, May 10, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of EUO letters and the provider's nonappearance and need not set forth objective reasons for the EUOs to make its prima facie case.
Gentlecare Ambulatory Anesthesia Servs. v GEICO Ins. Co. (2019 NY Slip Op 50744(U)) Appellate Term, Second Department, May 10, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's proof sufficient to show the provider failed to appear for the EUOs and that it need not set forth objective reasons for requesting the EUOs as part of its prima facie showing.
Active Care Med. Supply Corp. v American Tr. Ins. Co. (2019 NY Slip Op 50742(U)) Appellate Term, Second Department, May 10, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailing of the EUO scheduling letters and the provider's failure to appear, so dismissal of two causes of action was affirmed.
Bronx Chiropractic Care, P.C. v State Farm Ins. (2019 NY Slip Op 50700(U)) Appellate Term, Second Department, May 3, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld summary judgment on the EUO no-show, rejecting the provider's argument that the insurer had to set forth objective reasons for requesting the EUOs as part of its prima facie showing.
LMS Acupuncture, P.C. v State Farm Mut. Automotive Ins. Co. (2019 NY Slip Op 50696(U)) Appellate Term, Second Department, May 3, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's proof sufficient to show the provider failed to appear for the EUOs and that it need not set forth objective reasons for requesting the EUOs as part of its prima facie showing.
Pavlova v Hartford Ins. Co. (2019 NY Slip Op 50693(U)) Appellate Term, Second Department, May 3, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedRejected the provider's challenge and held the affirmation of the attorney present in his office on the scheduled dates sufficient to prove the provider's EUO nonappearance.
Health Evolve Acupuncture, P.C. v Allstate Ins. Co. (2019 NY Slip Op 50691(U)) Appellate Term, Second Department, May 3, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the affirmations and affidavits of the medical providers who were to perform the IMEs sufficient to establish the assignor's nonappearance, the only issue left for trial, so the insurer was granted summary judgment on those claims.
Preferred Ortho Prods., Inc. v Hereford Ins. Co. (2019 NY Slip Op 50688(U)) Appellate Term, Second Department, May 3, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved proper mailing of the IME scheduling letters and the assignor's nonappearance at the scheduled IMEs.
K.O. Med., P.C. v IDS Prop. Cas. Ins. Co. (2019 NY Slip Op 50687(U)) Appellate Term, Second Department, May 3, 2019Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the initial EUO letter sent more than 30 days after receipt of four claims was a nullity as to them, while the insurer proved mailing and two nonappearances for the remaining claims.
BCc Chiropractic, P.C. v Farmers New Century Ins. Co. (2019 NY Slip Op 50680(U)) Appellate Term, Second Department, May 3, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established that initial and follow-up EUO scheduling letters were timely mailed and that the assignor failed to appear on either date, and the provider raised no triable issue.
Alleviation Med. Servs., P.C. v New York Cent. Mut. Fire Ins. Co. (2019 NY Slip Op 50679(U)) Appellate Term, Second Department, May 3, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedRejected the provider's challenges and held the insurer's proof established proper mailing of the IME scheduling letters and the assignor's failure to appear for the scheduled IMEs.
Gentlecare Ambulatory Anesthesia Servs. v GEICO Ins. Co. (2019 NY Slip Op 50678(U)) Appellate Term, Second Department, May 3, 2019Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the insurer established the EUO no-show elements for the second cause of action but not the first, because the record did not show the follow-up letter scheduling the second EUO was timely sent under 11 NYCRR 65-3.6 (b).
Gentlecare Ambulatory Anesthesia Servs. v GEICO Ins. Co. (2019 NY Slip Op 50677(U)) Appellate Term, Second Department, May 3, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's proof sufficient to demonstrate that the provider failed to appear for the scheduled EUOs and rejected the provider's remaining arguments as unpreserved or meritless.
Serge Chiropractic Servs., P.C. v Farmington Cas. Co. (2019 NY Slip Op 50698(U)) Appellate Term, Second Department, May 3, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved proper mailing of the IME scheduling letters and the assignor's failure to appear, so summary judgment dismissing the complaint was affirmed.
First Class Med., P.C. v Ameriprise Ins. Co. (2019 NY Slip Op 50477(U)) Appellate Term, Second Department, March 28, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the EUO scheduling letters were not defective for failing to specify the claims because they identified the assignor, accident date and file number, and found mailing and the provider's nonappearance at two EUOs established.
Vital Chiropractic, P.C. v Nationwide Ins. Co. (2019 NY Slip Op 50425(U)) Appellate Term, Second Department, March 22, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld, contrary to the provider's contention, that the insurer's proof established proper mailing of the IME scheduling letters and the assignor's failure to appear for the IMEs.
Bronx Chiropractic Care, P.C. v State Farm Ins. (2019 NY Slip Op 50423(U)) Appellate Term, Second Department, March 22, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld dismissal on the EUO no-show defense because the insurer did not have to state its reasons or objective standards for the EUOs, either in the scheduling letters or in reply to the provider's objection.
Actual Chiropractic, P.C. v State Farm Ins. (2019 NY Slip Op 50421(U)) Appellate Term, Second Department, March 22, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer need not set forth objective reasons for requesting EUOs to make its prima facie case, and that it established timely mailed initial and follow-up letters and the provider's nonappearance on both dates.
Parisien v 21st Century Ins. Co. (2019 NY Slip Op 50275(U)) Appellate Term, Second Department, March 8, 2019Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the follow-up EUO letter for one claim was mailed more than 10 days after the first nonappearance and so was untimely, defeating the defense, while the follow-up for the other claim was timely.
Neptune Med. Care, P.C. v Praetorian Ins. Co. (2019 NY Slip Op 51052(U)) Appellate Term, Second Department, March 1, 2019Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer did not prove timely mailing of the EUO and IME scheduling letters, so it failed to show the exams were duly scheduled and missed.
Oleg's Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2019 NY Slip Op 51045(U)) Appellate Term, Second Department, March 1, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of EUO letters and nonappearance; a different law-firm contact named in the letters from the affirming attorney raised no triable issue.
Bronx Chiropractic Care, P.C. v State Farm Ins. (2019 NY Slip Op 51041(U)) Appellate Term, Second Department, March 1, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of EUO letters and nonappearance; neither the office where the letters were generated nor the inter-office transfer of claims raised a triable issue.
Island Life Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2019 NY Slip Op 51038(U)) Appellate Term, Second Department, March 1, 2019Proof on the no-show raises a question of fact; neither side wins the point as a matter of lawAlthough the insurer made a prima facie showing, it held the provider's owner's affidavit that he called to reschedule each EUO, unanswered by anyone with knowledge, raised a triable issue.
Dynamic Balance Acupuncture, P.C. v State Farm Ins. (2019 NY Slip Op 50171(U)) Appellate Term, Second Department, February 8, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer entitled to dismissal on the EUO no-show defense because mailing and nonappearance were established and the provider's unreasonableness argument failed for lack of proof its objection letter was mailed.
Healthy Way Acupuncture, P.C. v Country-Wide Ins. Co. (2019 NY Slip Op 50094(U)) Appellate Term, Second Department, January 18, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld after trial that the insurer proved timely mailing of the IME scheduling letters and the assignor's failure to appear, so the provider could not recover on three bills.
A & F Med., P.C. v Global Liberty Ins. Co. of N.Y. (2018 NY Slip Op 51812(U)) Appellate Term, Second Department, December 7, 2018Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the insurer's EUO no-show defense failed because it did not send the provider the delay letter required by 11 NYCRR 65-3.6 (b) when it sent the second EUO scheduling letter.
Active Care Med. Supply Corp. v Metropolitan Gen. Ins. Co. (2018 NY Slip Op 51782(U)) Appellate Term, Second Department, November 30, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer sufficiently established the provider's failure to appear for two scheduled EUOs, rejecting the provider's challenge to that proof and affirming summary judgment dismissing the complaint.
Charles Deng Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51780(U)) Appellate Term, Second Department, November 30, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer sufficiently established the provider's failure to appear for two scheduled EUOs and declined to consider an argument raised for the first time on appeal, affirming summary judgment for the insurer.
Gentlecare Ambulatory Anesthesia Servs.; Lyonel F. Paul, M.D. v GEICO Ins. Co. (2018 NY Slip Op 51773(U)) Appellate Term, Second Department, November 30, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer demonstrated the provider's nonappearance at the EUOs and need not set forth objective reasons for requesting EUOs to make its prima facie case.
Village Med. Supply, Inc. v Citiwide Auto Leasing Ins. Co. (2018 NY Slip Op 51772(U)) Appellate Term, Second Department, November 30, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's proof established proper mailing of the IME scheduling letters and the assignor's nonappearance, so dismissal was affirmed.
Acupuncture Now, P.C. v American Commerce Ins. Co. (2018 NY Slip Op 51768(U)) Appellate Term, Second Department, November 30, 2018Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held nonappearance at both EUOs proved, but denied dismissal of one claim because the initial EUO request was sent more than 30 days after that claim was received and was a nullity.
JCC Med., P.C. v American Tr. Ins. Co. (2018 NY Slip Op 51764(U)) Appellate Term, Second Department, November 30, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the affirmation of the doctor who was to perform the IMEs sufficient to establish the assignor's nonappearance; the provider's other argument was not considered because raised first on appeal.
Maiga Prods. Corp. v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51763(U)) Appellate Term, Second Department, November 30, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld findings that the provider failed to appear for the EUOs and that the first EUO letter was timely mailed, holding the insurer's practices for receiving mail irrelevant to the mailing affiant's proof.
Oriental Health Acupuncture, P.C. v 21st Century Ins. Co. (2018 NY Slip Op 51761(U)) Appellate Term, Second Department, November 30, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the no-show defense stood because the insurer submitted EUO scheduling letters mailed by its law firm whose sufficiency the provider did not challenge, although other letters were only delay letters.
Stracar Med. Servs. v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51759(U)) Appellate Term, Second Department, November 30, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld dismissal on the EUO no-show, holding that an initial scheduling letter sent one business day late only shortened the time to deny, and the denials were still timely.
Metro Psychological Servs., P.C. v ELRAC, Inc. (2018 NY Slip Op 51760(U)) Appellate Term, Second Department, November 30, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer showed the assignor failed to appear for the scheduled IMEs, supporting summary judgment dismissing the complaint.
Active Care Med. Supply Corp. v American Tr. Ins. Co. (2018 NY Slip Op 51683(U)) Appellate Term, Second Department, November 23, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailing of the EUO scheduling letters and the provider's failure to appear, so dismissal was proper.
Maiga Prods. Corp. v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51681(U)) Appellate Term, Second Department, November 23, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld findings that the provider failed to appear for the EUOs and that the first EUO letter was timely mailed, holding the insurer's practices for receiving mail irrelevant.
Restoration Chiropractic, P.C. v 21st Century Ins. Co. (2018 NY Slip Op 51656(U)) Appellate Term, Second Department, November 16, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld, contrary to the provider's contention, that the insurer's proof established proper mailing of the EUO scheduling letters, upholding dismissal on the no-show defense.
LMS Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51655(U)) Appellate Term, Second Department, November 16, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's proof sufficient to show the provider failed to appear for the EUOs and that it need not set forth objective reasons for the EUO requests to make its prima facie case.
Gentlecare Ambulatory Anesthesia Services; Lyonel F. Paul, M.D. v GEICO Ins. Co. (2018 NY Slip Op 51653(U)) Appellate Term, Second Department, November 16, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's proof raised a presumption the EUO scheduling letters were timely mailed, showed the provider's nonappearance, and that no objective reasons for the EUOs were required for its prima facie case.
PR Med., P.C. v Travelers Home & Mar. Ins. Co. (2018 NY Slip Op 51649(U)) Appellate Term, Second Department, November 16, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailed initial and follow-up EUO scheduling letters and the assignor's nonappearance on both dates, and the provider raised no triable issue.
Maiga Prods. Corp. v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51646(U)) Appellate Term, Second Department, November 16, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailed initial and follow-up EUO scheduling letters and the provider's nonappearance on both dates, and the provider raised no triable issue.
SAMA Physical Therapy, P.C. v Tri State Consumers Ins. Co. (2018 NY Slip Op 51635(U)) Appellate Term, Second Department, November 16, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedRejected the provider's arguments and held the insurer's proof established proper mailing of the IME scheduling letters and the assignor's failure to appear for the IMEs.
Pavlova v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51632(U)) Appellate Term, Second Department, November 16, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's proof sufficient to show the provider failed to appear for the EUOs and that it need not set forth objective reasons for the EUO requests to make its prima facie case.
Jamaica Wellness Med., P.C. v ELRAC, Inc. (2018 NY Slip Op 51637(U)) Appellate Term, Second Department, November 16, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the EUO scheduling letters and the provider's failure to appear, and the provider raised no triable issue, so dismissal was proper.
Active Care Med. Supply Corp. v ELRAC, Inc. (2018 NY Slip Op 51639(U)) Appellate Term, Second Department, November 16, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld dismissal because the insurer's proof sufficed to show the assignor failed to appear for the scheduled IMEs.
Eagle Surgical Supply, Inc. v Farmington Cas. Co. (2018 NY Slip Op 51642(U)) Appellate Term, Second Department, November 16, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld dismissal because the insurer's proof sufficed to show the provider failed to appear for the scheduled EUOs.
Blackman v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51606(U)) Appellate Term, Second Department, November 9, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved proper mailing of the EUO scheduling letters and the assignor's failure to appear, warranting dismissal.
Pugsley Chiropractic, PLLC v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51603(U)) Appellate Term, Second Department, November 9, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer sufficiently established the provider's failure to appear for two scheduled EUOs, so dismissal was affirmed.
Acupuncture Approach, P.C. v NY Cent. Mut. Fire Ins. Co. (2018 NY Slip Op 51601(U)) Appellate Term, Second Department, November 9, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedRejected the wrong-address argument because copies of the IME letters were mailed to the assignor's attorney for the accident, and held the insurer's proof established the assignor's nonappearance.
Acupuncture Now, P.C. v Tri State Consumers Ins. Co. (2018 NY Slip Op 51596(U)) Appellate Term, Second Department, November 9, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedRejected the provider's arguments and held the insurer's proof established proper mailing of the IME scheduling letters and the assignor's failure to appear for the IMEs.
Island Life Chiropractic Pain Care, PLLC v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51594(U)) Appellate Term, Second Department, November 9, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's proof sufficient to show the provider failed to appear for the EUOs and that it need not set forth objective reasons for the EUO requests to make its prima facie case.
Active Care Med. Supply Corp. v American Tr. Ins. Co. (2018 NY Slip Op 51584(U)) Appellate Term, Second Department, November 9, 2018Insurer failed to prove the nonappearance by someone with personal knowledge (also decides)Agreed the insurer's proof was insufficient to establish the provider's failure to appear for the EUOs, although the scheduling letters were proved mailed; the dismissal rested on medical necessity instead.
Island Life Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51552(U)) Appellate Term, Second Department, November 2, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer entitled to dismissal on the EUO no-show defense because its prima facie case was unchallenged and its transmittal of claims between its own offices raised no triable issue.
Island Life Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51551(U)) Appellate Term, Second Department, November 2, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailed initial and follow-up EUO scheduling letters and the assignor's nonappearance on both dates, and the provider raised no triable issue.
Gentlecare Ambulatory Anesthesia Servs. v GEICO Ins. Co. (2018 NY Slip Op 50864(U)) Appellate Term, Second Department, June 8, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailed EUO letters and the provider's nonappearance, and needed no objective reasons for requesting the EUOs to make its prima facie showing.
Maiga Prods. Corp. v 21st Century Ins. Co. (2018 NY Slip Op 50845(U)) Appellate Term, Second Department, June 1, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld dismissal on the EUO no-show defense because the insurer's proof raised a presumption that the EUO scheduling letters were properly mailed.
Gentlecare Ambulatory Anesthesia Servs. v GEICO Ins. Co. (2018 NY Slip Op 50837(U)) Appellate Term, Second Department, June 1, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved proper mailing of the EUO scheduling letters and the provider's failure to appear for the scheduled EUOs, rejecting the provider's contentions.
Compas v Travelers Ins. Co. (2018 NY Slip Op 50821(U)) Appellate Term, Second Department, June 1, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the affirmation of the insurer's attorney, present in his office to conduct the EUOs on the scheduled dates, sufficient to establish the provider's nonappearance.
Active Care Med. Supply Corp. v American Tr. Ins. Co. (2018 NY Slip Op 50820(U)) Appellate Term, Second Department, June 1, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailing of the EUO scheduling letters and the provider's nonappearance, so summary judgment dismissing the complaint was proper.
Renelique Med. Servs., P.C. v Travelers Ins. Co. (2018 NY Slip Op 50817(U)) Appellate Term, Second Department, June 1, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's proof sufficient to show the provider failed to appear for the scheduled EUOs, and refused to consider a contention first raised on appeal, affirming summary judgment for the insurer.
S & R Med., P.C. v ELRAC, Inc. (2018 NY Slip Op 50834(U)) Appellate Term, Second Department, June 1, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedRejected the providers' contentions and held the insurer sufficiently proved proper mailing of the IME scheduling letters and the assignor's failure to appear for the scheduled IMEs.
Pierre J. Renelique, M.D., P.C. v Park Ins. Co. (2018 NY Slip Op 50780(U)) Appellate Term, Second Department, May 25, 2018Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to show the IMEs were properly scheduled because the letters were mailed to a wrong address and to an attorney not shown to represent the assignor.
Gentlecare Ambulatory Anesthesia Servs. v American Tr. Ins. Co. (2018 NY Slip Op 50770(U)) Appellate Term, Second Department, May 25, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the EUO and IME scheduling letters and that the provider and assignor failed to appear, so dismissal was proper.
Remedial Med. Care, P.C. v Park Ins. Co. (2018 NY Slip Op 50769(U)) Appellate Term, Second Department, May 25, 2018Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer did not show the IME scheduling letters were timely mailed, so it failed to prove the IMEs were duly scheduled and the assignor failed to appear.
Active Care Med. Supply Corp. v American Tr. Ins. Co. (2018 NY Slip Op 50767(U)) Appellate Term, Second Department, May 25, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established proper mailing of the EUO scheduling letters and the provider's failure to appear, so dismissal was affirmed.
Parisien v Maya Assur. Co. (2018 NY Slip Op 50766(U)) Appellate Term, Second Department, May 25, 2018Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to show the IMEs were properly scheduled, and thus the assignor's nonappearance, because its affidavit did not describe a mailing practice ensuring proper addressing and mailing of the letters.
Charles Deng Acupuncture, P.C. v ELRAC, Inc. (2018 NY Slip Op 50774(U)) Appellate Term, Second Department, May 25, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's proof sufficient to demonstrate that the assignor failed to appear for the scheduled EUOs, rejecting the provider's only argument against summary judgment.
Charles Deng Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 50740(U)) Appellate Term, Second Department, May 18, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's proof sufficient to establish prima facie that the provider failed to appear for the scheduled EUOs, and the provider raised no triable issue in response.
Valdan Acupuncture, P.C. v NY Cent. Mut. Fire Ins. Co. (2018 NY Slip Op 50739(U)) Appellate Term, Second Department, May 18, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedFor the claim denied on the no-show ground, held the insurer proved the assignor's failure to appear and the proper mailing of the IME scheduling letters, entitling it to summary judgment.
Maiga Prods. Corp. v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 50736(U)) Appellate Term, Second Department, May 18, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailed EUO scheduling letters and the provider's failure to appear, so summary judgment dismissing the complaint should have been granted.
Healthway Med. Care, P.C. v American Commerce Ins. Co. (2018 NY Slip Op 50733(U)) Appellate Term, Second Department, May 18, 2018Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer not entitled to summary judgment on the EUO no-show defense because the initial EUO request was sent more than 30 days after receipt of the claims, making the requests nullities.
Goldstar Equip., Inc. v Mercury Cas. Co. (2018 NY Slip Op 50576(U)) Appellate Term, Second Department, April 13, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailed EUO letters and nonappearance through its attorney present at the scheduled EUOs, and that willfulness need not be shown where the insurer complied with the regulations.
Thomas J. Tesi, M.S., D.C., P.C. v Hereford Ins. Co. (2018 NY Slip Op 50252(U)) Appellate Term, Second Department, February 16, 2018Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer not entitled to summary judgment on the IME no-show defense because the initial IME was not scheduled within 30 calendar days after receipt of the claims.
Motionpro Physical Therapy v Hereford Ins. Co. (2018 NY Slip Op 50251(U)) Appellate Term, Second Department, February 16, 2018Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the insurer failed to establish the defense for one claim because the IME was not scheduled within 30 days of receipt under 65-3.5 (d), but proved mailing, nonappearance and timing for the other claim.
Choice Health Chiropractic, P.C. v American Tr. Ins. Co. (2018 NY Slip Op 50185(U)) Appellate Term, Second Department, February 8, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held the insurer established timely mailed initial and follow-up IME letters and the assignor's failure to appear for both IMEs.
Active Care Med. Supply Corp v American Tr. Ins. Co. (2017 NY Slip Op 51902(U)) Appellate Term, Second Department, December 22, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved proper mailing of the EUO scheduling letters and the provider's failure to appear for the scheduled EUOs.
Greenway Med. Supply Corp. v American Tr. Ins. Co. (2017 NY Slip Op 51901(U)) Appellate Term, Second Department, December 22, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved proper mailing of the EUO scheduling letters and the provider's failure to appear for the scheduled EUOs.
Recover Med. Servs., P.C. v Ameriprise Ins. Co. (2017 NY Slip Op 51892(U)) Appellate Term, Second Department, December 22, 2017Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the EUO requests nullities for bills received more than 30 days before the requests were sent, while rejecting the argument that a delay letter to the provider's attorney was required for the remaining bills.
Compas v Travelers Ins. Co. (2017 NY Slip Op 51890(U)) Appellate Term, Second Department, December 22, 2017Insurer failed to prove the nonappearance by someone with personal knowledgeHeld summary judgment on the EUO no-show defense should have been denied because no one with personal knowledge attested to the provider's failure to appear.
Easy Care Acupuncture, P.C. v 21 Century Advantage Ins. Co. (2017 NY Slip Op 51879(U)) Appellate Term, Second Department, December 22, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's proof sufficient to show the assignor failed to appear for the scheduled EUOs and found the provider's remaining contention meritless, affirming summary judgment dismissing the complaint.
Moon Rehab, P.T., P.C. v Ameriprise Ins. Co. (2017 NY Slip Op 51877(U)) Appellate Term, Second Department, December 22, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the EUO scheduling letters and the provider's failure to appear for the EUOs.
Canon Chiropractic, P.C. v Metlife Ins. Co. (2017 NY Slip Op 51875(U)) Appellate Term, Second Department, December 22, 2017Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer's motion should have been denied because it submitted no proof from anyone with personal knowledge of the assignor's nonappearance at the scheduled EUOs.
Bronx Acupuncture Therapy, P.C. v A. Cent. Ins. Co. (2017 NY Slip Op 51870(U)) Appellate Term, Second Department, December 22, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailed IME scheduling letters and the assignor's failure to appear, showing noncompliance with a condition precedent to coverage, and reversed the denial of summary judgment.
Village Med. Supply, Inc. v Citiwide Auto Leasing Ins. Co. (2017 NY Slip Op 51869(U)) Appellate Term, Second Department, December 22, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the affirmation of the doctor who was to perform the IMEs sufficient to establish the assignor's failure to appear, rejecting the provider's contentions.
Careful Complete Med., P.C. v Delos Ins. Co. (2017 NY Slip Op 51867(U)) Appellate Term, Second Department, December 22, 2017Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer not entitled to summary judgment because its initial EUO request was sent more than 30 days after it received the claims, making the requests nullities.
Healthy Way Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51865(U)) Appellate Term, Second Department, December 22, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer sufficiently established the provider's failure to appear for two scheduled EUOs and rejected the provider's remaining contentions.
Careful Complete Med., P.C. v Hartford Ins. Co. (2017 NY Slip Op 51858(U)) Appellate Term, Second Department, December 22, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the affirmation of the insurer's attorney, present to conduct the EUOs on the scheduled dates, established the provider's nonappearance, and the scheduling letters were shown mailed.
Masigla v National Liab. & Fire Ins. Co. (2017 NY Slip Op 51847(U)) Appellate Term, Second Department, December 22, 2017Insurer failed to prove the scheduling letters were mailed or properly addressedReversed summary judgment for the insurer because its affidavit failed to set forth a standard office practice showing the IME scheduling letters were properly mailed.
Active Care Med. Supply Corp. v ELRAC, Inc. (2017 NY Slip Op 51859(U)) Appellate Term, Second Department, December 22, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld dismissal because the affidavit of the doctor who was to perform the IMEs sufficed to prove the nonappearance.
Eastcoast Metro. Med., P.C. v ELRAC, Inc. (2017 NY Slip Op 51872(U)) Appellate Term, Second Department, December 22, 2017Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the EUO no-show defense failed on summary judgment because the insurer did not establish that the EUO scheduling letters were sent to the assignor's correct address.
Island Life Chiropractic, P.C. v National Liab. & Fire Ins. Co. (2017 NY Slip Op 51843(U)) Appellate Term, Second Department, December 19, 2017Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to show the IMEs were properly scheduled because it did not establish that the scheduling letters were properly mailed, so its cross motion should have been denied.
Charles Deng Acupuncture, P.C. v Unitrin Auto & Home Ins. Co. (2017 NY Slip Op 51834(U)) Appellate Term, Second Department, December 19, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld dismissal on the IME no-show because the insurer's affidavit sufficiently showed timely mailing of the scheduling letters, the only element the provider challenged.
Healthway Med. Care, P.C. v Global Liberty Ins. (2017 NY Slip Op 51807(U)) Appellate Term, Second Department, December 19, 2017Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the IME no-show defense unproved because, without proof the scheduling letters were timely mailed, the insurer could not show the IMEs were duly scheduled.
Faith Acupuncture, P.C. v Global Liberty Ins. (2017 NY Slip Op 51806(U)) Appellate Term, Second Department, December 19, 2017Insurer failed to prove the scheduling letters were mailed or properly addressedHeld that, without proof of timely mailing of the IME scheduling letters, the insurer failed to show the IMEs were properly scheduled and the assignor failed to appear.
Lynbrook PT & OT, PLLC v Ameriprise Ins. Co. (2017 NY Slip Op 51801(U)) Appellate Term, Second Department, December 19, 2017Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the insurer proved mailing and nonappearance for one claim, but for four claims its own papers showed the first EUO letter was sent more than 30 days after receipt.
JYW Med., P.C. v IDS Prop. Ins. Co. (2017 NY Slip Op 51800(U)) Appellate Term, Second Department, December 19, 2017Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Found mailing and nonappearance proved for one provider, but held the EUO letters to the other provider nullities because the first was sent more than 30 days after its claims were received.
Masigla v Travelers Ins. Co. (2017 NY Slip Op 51794(U)) Appellate Term, Second Department, December 19, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the affirmations of the insurer's attorneys, who were present in their offices on the scheduled dates, sufficient to establish the provider's nonappearance at the EUOs, rejecting the provider's challenge.
Daily Med. Equip. Distrib. Ctr., Inc. v ELRAC, Inc. (2017 NY Slip Op 51805(U)) Appellate Term, Second Department, December 19, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedRejected the provider's contention and held the affirmation of the doctor scheduled to perform the IMEs sufficient to establish the assignor's nonappearance.
B.S.A. Chiropractic, P.C. v ELRAC, Inc. (2017 NY Slip Op 51813(U)) Appellate Term, Second Department, December 19, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's proof established proper mailing of the EUO scheduling letters, so summary judgment dismissing the complaint on the EUO no-show defense was affirmed.
Personal Touch Med. Care, P.C. v Maya Assur. Co. (2017 NY Slip Op 51823(U)) Appellate Term, Second Department, December 19, 2017Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the IME no-show defense failed because the insurer's affidavit did not describe a standard office practice ensuring the IME scheduling letters were properly addressed and mailed.
Canon Chiropractic, P.C. v Travelers Prop. Cas. Co. of Am. (2017 NY Slip Op 51826(U)) Appellate Term, Second Department, December 19, 2017Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the IME no-show defense failed on summary judgment because the insurer did not establish that the IME scheduling letters were sent to the assignor's correct address.
Chapa Prods. Corp. v ELRAC, Inc. (2017 NY Slip Op 51841(U)) Appellate Term, Second Department, December 19, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld dismissal because the insurer's proof sufficed to show the assignor failed to appear for the scheduled IMEs.
Past v NY Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 51774(U)) Appellate Term, Second Department, December 15, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the affirmation of the doctor who was to perform the IMEs sufficient to establish the assignor's nonappearance, and, with the other elements unchallenged, granted the insurer summary judgment.
Greenway Med. Supply Corp. v Travelers Ins. Co. (2017 NY Slip Op 51765(U)) Appellate Term, Second Department, December 15, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the affirmation of the insurer's attorney, present in his office to conduct the EUO on the scheduled dates, sufficient to establish the provider's nonappearance, rejecting the provider's contrary contention.
Charles Deng Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51764(U)) Appellate Term, Second Department, December 15, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the affirmation of the attorney present to conduct the EUOs proved the nonappearance, and the owner's claimed rescheduling call raised no triable issue because it went to a different person and number than the letter listed.
Logic Chiropractic, P.C. v Hereford Ins. Co. (2017 NY Slip Op 51754(U)) Appellate Term, Second Department, December 15, 2017Proof on the no-show raises a question of fact; neither side wins the point as a matter of lawHeld the address discrepancy meant proper mailing of the IME scheduling letters was not incontrovertibly established, so mailing remains for trial together with nonappearance.
Stracar Med. Servs., P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51753(U)) Appellate Term, Second Department, December 15, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the affirmation of the insurer's attorney, who was present in her office to conduct the EUOs on the scheduled dates, sufficient to establish the provider's nonappearance, affirming summary judgment for the insurer.
Sama Physical Therapy, P.C. v IDS Prop. Cas. Ins. Co. (2017 NY Slip Op 51751(U)) Appellate Term, Second Department, December 12, 2017Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the defense unproved for two claims because the insurer's own papers showed its first EUO scheduling letter was sent more than 30 days after it received those claims.
Sama Physical Therapy, P.C. v Global Liberty Ins. (2017 NY Slip Op 51736(U)) Appellate Term, Second Department, December 8, 2017Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to show the IMEs were properly scheduled and missed because it did not prove timely mailing of the initial and follow-up scheduling letters.
St. Locher Med., P.C. v IDS Prop. Cas. Ins. Co. (2017 NY Slip Op 51732(U)) Appellate Term, Second Department, December 8, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's proof established that the provider failed to appear for duly scheduled examinations under oath, rejecting the provider's challenge.
Renelique Med. Servs., P.C. v Travelers Ins. Co. (2017 NY Slip Op 51728(U)) Appellate Term, Second Department, December 8, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established that the provider failed to appear for properly scheduled examinations under oath, rejecting the provider's arguments on appeal.
Pierre J. Renelique, M.D., P.C. v Travelers Ins. Co. (2017 NY Slip Op 51718(U)) Appellate Term, Second Department, December 8, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's proof sufficient to presume its verification requests had been properly mailed and to demonstrate that the provider failed to appear for the EUOs, rejecting the provider's contentions on appeal.
Adelaida M. Laga, P.T. v GEICO Ins. Co. (2017 NY Slip Op 51715(U)) Appellate Term, Second Department, December 8, 2017Insurer failed to prove the nonappearance by someone with personal knowledge (also decides)Held the insurer's papers did not establish as a matter of law that the assignor failed to appear for the scheduled IMEs.
Brand Med. Supply, Inc. v ELRAC, Inc. (2017 NY Slip Op 51723(U)) Appellate Term, Second Department, December 8, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedAffirmed denial of renewal because, with no evidence the assignor ever attempted to reschedule the IMEs, proof that the letters' rescheduling contact was a pseudonym would not change the summary judgment on the no-show defense.
Gentlecare Ambulatory Anesthesia Servs. v Geico Ins. Co. (2017 NY Slip Op 51518(U)) Appellate Term, Second Department, November 3, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the EUO letters and the provider's nonappearance, and needed no objective reasons for requesting the EUOs to make its prima facie showing.
TAM Med. Supply Corp. v 21st Century Ins. Co. (2017 NY Slip Op 51510(U)) Appellate Term, Second Department, November 3, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the affirmations of the attorneys scheduled to conduct the EUOs, with certified transcripts of the nonappearances, established that the assignor failed to appear at either EUO.
Flatbush Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51494(U)) Appellate Term, Second Department, November 3, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's attorney's affirmation sufficient to prove the EUO nonappearances because the attorney was present in his office to conduct the EUOs on the scheduled dates.
Chapa Prods. Corp. v Nationwide Ins. (2017 NY Slip Op 51457(U)) Appellate Term, Second Department, October 27, 2017Insurer failed to prove the scheduling letters were mailed or properly addressedReversed summary judgment for the insurer because its papers did not demonstrate proper mailing of the EUO scheduling letters; the claimed mailing affidavit was missing from the record.
K.O. Med., P.C. v IDS Prop. Cas. Ins. Co. (2017 NY Slip Op 51454(U)) Appellate Term, Second Department, October 27, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailing of initial and follow-up EUO letters and the provider's nonappearance on both dates, and the provider raised no triable issue.
Comprehensive Care Physical Therapy, P.C. v State-Wide Ins. Co. (2017 NY Slip Op 51448(U)) Appellate Term, Second Department, October 27, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's affirmation sufficient to establish the provider's failure to appear for the scheduled examinations under oath, rejecting the provider's sole argument, and upheld dismissal of those causes of action.
Sharp View Diagnostic Imaging, P.C. v Esurance (2017 NY Slip Op 51466(U)) Appellate Term, Second Department, October 27, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's proof sufficient to show that the assignor failed to appear for the scheduled EUOs, and noted the provider raised no issue as to the sufficiency of the scheduling letters.
NYS Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 51263(U)) Appellate Term, Second Department, September 22, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailing of initial and follow-up IME letters and the assignor's nonappearance on both dates, and the provider raised no triable issue.
Laga v American Commerce Ins. Co. (2017 NY Slip Op 51254(U)) Appellate Term, Second Department, September 22, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's affirmation sufficient to establish the provider's failure to appear for the scheduled examinations under oath, rejecting the provider's only argument against the cross motion.
AL Acupuncture, P.C. v Geico Ins. Co. (2017 NY Slip Op 51249(U)) Appellate Term, Second Department, September 22, 2017Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to establish mailing of the IME scheduling letters because the scheduling vendor's affidavit was, per the notary, sworn a year before the index number year.
Laga v Lancer Ins. Co. (2017 NY Slip Op 51244(U)) Appellate Term, Second Department, September 22, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's proof sufficiently established that the provider failed to appear for the scheduled EUOs, rejecting the provider's arguments.
T & S Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51240(U)) Appellate Term, Second Department, September 22, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedRejected the provider's sole argument and held that the insurer's initial and follow-up EUO scheduling letters complied with the regulations and tolled its time to pay or deny, so dismissal on the no-show ground stood.
Royal Med. Supply, Inc. v Nationwide Gen. Ins. Co. (2017 NY Slip Op 51235(U)) Appellate Term, Second Department, September 22, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's proof sufficient to demonstrate the assignor's nonappearance at the EUOs and rejected the provider's challenge to proof of mailing of the scheduling letters.
LMS Acupuncture, P.C. v Titan Ins. Co. (2017 NY Slip Op 51229(U)) Appellate Term, Second Department, September 22, 2017Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the defense failed for three claims because the EUO requests were sent more than 30 days after receipt of those claims and were nullities; for the other claims the letters were timely mailed.
Kappa Med., P.C. v Chubb Indem. Ins. Co. (2017 NY Slip Op 51199(U)) Appellate Term, Second Department, September 15, 2017Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the affidavit of the doctor who was to perform the IMEs failed to show, on personal knowledge or otherwise, that the assignor did not appear, so the insurer was denied summary judgment.
Sama Physical Therapy, P.C. v New York Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 51186(U)) Appellate Term, Second Department, September 15, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld the IME no-show defense, holding the insurer's proof sufficient to presume proper mailing of the IME scheduling letters against the provider's challenge.
Chiroworks Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 51159(U)) Appellate Term, Second Department, September 8, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedRejected the provider's challenge to the sufficiency of the insurer's proof and held it established that the assignor failed to appear for the scheduled IMEs.
Charles Deng Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51156(U)) Appellate Term, Second Department, September 8, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's motion papers sufficient to demonstrate that the assignor failed to appear for the scheduled EUOs, rejecting the provider's sole contention on appeal.
Gentlecare Ambulatory Anesthesia Servs. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51152(U)) Appellate Term, Second Department, September 8, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld dismissal on the EUO no-show, finding the insurer's proof of timely and proper mailing of the scheduling letters sufficient.
LMS Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51137(U)) Appellate Term, Second Department, September 8, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailing of initial and follow-up EUO letters and the provider's nonappearance on both dates, and the provider raised no triable issue.
Laga v Amica Mut. Ins. Co. (2017 NY Slip Op 51136(U)) Appellate Term, Second Department, September 8, 2017Insurer failed to prove the scheduling letters were mailed or properly addressedDenied summary judgment on the IME no-show ground because the insurer failed to establish that it had mailed the IME scheduling letters.
K.O. Med., P.C. v ELRAC, Inc. (2017 NY Slip Op 51151(U)) Appellate Term, Second Department, September 8, 2017Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the IME chiropractor's and acupuncturist's affidavits did not establish personal knowledge of the assignor's nonappearance, so the insurer was not entitled to summary judgment.
K.O. Med., P.C. v Mercury Cas. Co. (2017 NY Slip Op 51158(U)) Appellate Term, Second Department, September 8, 2017Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the IME no-show defense failed on summary judgment because the insurer's proof did not raise a presumption that the IME scheduling letters were properly mailed.
Compas Med., P.C. v ELRAC, Inc. (2017 NY Slip Op 51019(U)) Appellate Term, Second Department, August 11, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedRejected the provider's contentions and held the insurer's proof demonstrated that the assignor failed to appear for the scheduled EUOs.
Elmont Rehab P.T., P.C. v New York Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 50961(U)) Appellate Term, Second Department, July 21, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established that it mailed pre-claim initial and follow-up IME letters and that the assignor failed to appear, so the assignor breached a condition precedent to coverage.
Greenway Med. Supply Corp. v Hartford Ins. Co. (2017 NY Slip Op 50960(U)) Appellate Term, Second Department, July 21, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established that it mailed pre-claim initial and follow-up IME letters and that the assignor failed to appear for the duly scheduled IMEs.
Mind & Body Acupuncture, P.C. v Global Liberty Ins. Co. of NY (2017 NY Slip Op 50957(U)) Appellate Term, Second Department, July 21, 2017Insurer failed to prove the scheduling letters were mailed or properly addressedDenied summary judgment because, without proof that the EUO scheduling letters were timely mailed, the insurer could not show the EUOs were properly scheduled or that the assignor missed duly scheduled EUOs.
Alleviation Med. Servs., P.C. v New York Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 50952(U)) Appellate Term, Second Department, July 21, 2017Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to show the IMEs were properly scheduled because the letters went to an incorrect street address and to an attorney not shown to represent the assignor.
Brand Med. Supply, Inc. v Praetorian Ins. Co. (2017 NY Slip Op 50947(U)) Appellate Term, Second Department, July 21, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the scheduling company's affidavit proved timely mailing of the IME letters and the examining provider's affidavit proved the assignor's nonappearance, establishing breach of a condition precedent.
Acupuncture Healthcare Plaza I, P.C. v 21st Century Advantage Ins. Co. (2017 NY Slip Op 50945(U)) Appellate Term, Second Department, July 21, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Rejected the provider's challenge to the IME no-show defense, holding that the scheduling company employee's affidavit established timely mailing of the IME scheduling letters under standard office practices.
Acupuncture Healthcare Plaza I, P.C. v Allstate Ins. Co. (2017 NY Slip Op 50939(U)) Appellate Term, Second Department, July 21, 2017Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the follow-up EUO letter was not mailed within the 65-3.6 (b) time frame, and 65-3.8 (l) does not excuse late follow-ups, so the untimely request defeated the no-show defense.
Apple Massage Therapy, P.C. v Adirondack Ins. Exch. (2017 NY Slip Op 50935(U)) Appellate Term, Second Department, July 21, 2017Claimant showed the nonappearance was excused or the request unreasonable or waivedHeld that the initial EUO had twice been rescheduled by mutual agreement before its date, which is not a failure to appear, so the insurer did not show nonappearance at both an initial and a follow-up EUO.
Utopia Equip., Inc. v ELRAC, Inc. (2017 NY Slip Op 50949(U)) Appellate Term, Second Department, July 21, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld dismissal on the IME no-show because third-party scheduling letters clearly stated they were sent for the insurer's claims processor and the examining doctor's affirmation sufficed to prove the nonappearances.
Sovereigh Acupuncture, P.C. v American Commerce Ins. Co. (2017 NY Slip Op 50922(U)) Appellate Term, Second Department, July 14, 2017Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the defense failed because the first EUO letter for some claims came more than 30 days after receipt, and for the rest the insurer rescheduled each EUO before its date, so no nonappearance occurred.
St. Locher Med., P.C. v IDS Prop. Cas. Ins. Co. (2017 NY Slip Op 50919(U)) Appellate Term, Second Department, July 14, 2017Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer failed to show its first EUO scheduling letter was timely, since by its own account the letter went out more than 30 days after it received the claims.
Mind & Body Acupuncture, P.C. v American Commerce Ins. Co. (2017 NY Slip Op 50918(U)) Appellate Term, Second Department, July 14, 2017Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the affirmation of a partner in the law firm retained to conduct the EUOs did not prove the provider's nonappearance by someone with personal knowledge, so the insurer's summary judgment was reversed.
Doctor Goldshteyn Chiropractic, P.C. v ELRAC, Inc. (2017 NY Slip Op 50923(U)) Appellate Term, Second Department, July 14, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the EUO scheduling letters and the assignor's nonappearance; any doubt about certified-mail duplicates did not excuse the no-show because first-class mailing was not shown insufficient.
Compas Med., P.C. v ELRAC, Inc. (2017 NY Slip Op 50927(U)) Appellate Term, Second Department, July 14, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's affidavits showed timely mailing of the IME scheduling letters, so summary judgment dismissing the complaint on the IME no-show defense was affirmed.
Progressive Health Chiropractic, P.C. v American Tr. Ins. Co. (2017 NY Slip Op 50603(U)) Appellate Term, Second Department, April 27, 2017Claimant showed the nonappearance was excused or the request unreasonable or waivedHeld a mutual rescheduling before the IME date was not a failure to appear, so the insurer did not show nonappearance at both an initial and a follow-up IME.
First Class Med., P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 50593(U)) Appellate Term, Second Department, April 27, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the EUO scheduling letters and, through the attorney who was to conduct the EUOs, the provider's nonappearance. The requests concerned claims received after an earlier EUO.
American Kinetics Lab, Inc. v Warner Ins. Co. (2017 NY Slip Op 50407(U)) Appellate Term, Second Department, March 31, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the IME no-show defense established because the provider's evidence raised no issue of fact that the first scheduled IME had been mutually rescheduled, the provider's sole argument on appeal.
A.O.T. Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 50288(U)) Appellate Term, Second Department, February 27, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved the provider's nonappearance at both scheduled EUOs through an affirmation of the attorney who was responsible for conducting the EUOs, based on personal knowledge.
Professional Health Imaging, P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 50199(U)) Appellate Term, Second Department, February 8, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedReversed a finding of a triable issue on appearance, holding the insurer established timely mailed EUO letters and the provider's nonappearance, and the provider raised no triable issue.
Renelique Med. Servs., P.C. v State Farm Fire & Cas. Co. (2017 NY Slip Op 50163(U)) Appellate Term, Second Department, February 3, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the affirmation of a partner in the insurer's law firm, attesting on personal knowledge, sufficient to establish the provider's failure to appear for EUOs.
Maiga Prods. Corp. v Unitrin Auto & Home Ins. Co. (2017 NY Slip Op 50113(U)) Appellate Term, Second Department, January 20, 2017Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer failed to show nonappearance at two duly scheduled EUOs because earlier EUOs were rescheduled at the assignor's attorney's request and only the last one was missed.
National Med. & Surgical Supply, Inc. v ELRAC, Inc. (2017 NY Slip Op 50028(U)) Appellate Term, Second Department, January 5, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of the EUO letters and, through law-firm receptionists' affidavits, the assignor's nonappearance at both EUOs; objections to the requests were not heard because the provider never responded to them.
A.C. Med., P.C. v Ameriprise Ins. Co. (2016 NY Slip Op 51787(U)) Appellate Term, Second Department, December 7, 2016Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the initial EUO requests late: one went out beyond 15 business days, shortening the time to deny, and the others more than 30 days after receipt, making them nullities that did not toll.
J.K.M. Med. Care, P.C. v Ameriprise Ins. Co. (2016 NY Slip Op 26424) Appellate Term, Second Department, December 7, 2016Insurer failed to prove the scheduling letters were mailed or properly addressed (also decides)Rejected the EUO no-show defense as an alternative ground because the insurer did not prove timely mailing of the scheduling letters, which also omitted the 65-3.5 (e) reimbursement notice.
Golden Earth Chiropractic & Acupuncture, PLLC v Global Liberty Ins. Co. of N.Y. (2016 NY Slip Op 26395) Appellate Term, Second Department, November 25, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held not irrational a master arbitrator's ruling that IME letters promising reimbursement of 'proven' lost earnings still gave proper notice despite departing from the regulation's wording, so the award for the insurer stood.
Fontanella v Allstate Ins. Co. (2016 NY Slip Op 51679(U)) Appellate Term, Second Department, November 17, 2016Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the EUO scheduling letters were not sent within 30 days of receipt of the claims, so the denials were untimely, and declined to reach the proof of nonappearance.
Daily Med. Equip. Distrib. Ctr., Inc. v American Tr. Ins. Co. (2016 NY Slip Op 51621(U)) Appellate Term, Second Department, November 1, 2016Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer's IME no-show cross motion should have been denied because no one with personal knowledge attested to the nonappearance at the IMEs.
Renelique v National Liab. & Fire Ins. Co. (2016 NY Slip Op 51613(U)) Appellate Term, Second Department, November 1, 2016Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to show the IMEs were properly scheduled because it did not establish that the scheduling letters were mailed, so it was not entitled to summary judgment.
Art of Healing Medicine, P.C. v Utica Mut. Ins. Co. (2016 NY Slip Op 51610(U)) Appellate Term, Second Department, November 1, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the EUO scheduling letters and the assignor's failure to appear, entitling it to summary judgment.
Central Park Physical Medicine & Rehab., P.C. v National Liab. & Fire Ins. Co. (2016 NY Slip Op 51598(U)) Appellate Term, Second Department, October 31, 2016Insurer failed to prove the scheduling letters were mailed or properly addressedDenied the insurer summary judgment on the IME no-show defense because it failed to establish that the IME scheduling letters had been timely and properly mailed.
Renelique v Utica Mut. Ins. Co. (2016 NY Slip Op 51530(U)) Appellate Term, Second Department, October 13, 2016Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer's moving papers did not establish that its first EUO scheduling letter was timely, since the insurer itself stated it was sent 35 days after receipt of the claim.
New Way Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 51527(U)) Appellate Term, Second Department, October 13, 2016Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer failed to establish the assignor's IME nonappearance as a matter of law because, among other defects, the affidavit attesting to the second nonappearance was notarized before it was signed.
Integrative Pain Medicine, P.C. v Allstate Ins. Co. (2016 NY Slip Op 51525(U)) Appellate Term, Second Department, October 13, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held that once the insurer established the assignor's failure to appear for duly scheduled EUOs, the assignor could not be given a chance to cure by attending a re-noticed EUO, so summary judgment was granted unconditionally.
Renelique v National Liab. & Fire Ins. Co. (2016 NY Slip Op 51524(U)) Appellate Term, Second Department, October 13, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld dismissal on the IME no-show because the insurer's proof raised a presumption that the scheduling letters had been properly mailed, the provider's sole challenge.
Prime Diagnostic Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 51523(U)) Appellate Term, Second Department, October 13, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of the IME scheduling letters and the assignor's nonappearance; the apartment-number addressing objection was unpreserved and in any event the letters used the address on the no-fault application.
Integrative Pain Medicine, P.C. v Praetorian Ins. Co. (2016 NY Slip Op 51520(U)) Appellate Term, Second Department, October 13, 2016Insurer failed to prove the scheduling letters were mailed or properly addressedDenied the insurer summary judgment on the EUO no-show because its proof did not establish an office practice sufficient to presume proper mailing of the scheduling letters.
Metro Health Prods., Inc. v American Tr. Ins. Co. (2016 NY Slip Op 51517(U)) Appellate Term, Second Department, October 13, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved proper mailing of the EUO scheduling letters and the assignor's failure to appear, so its cross motion dismissing the complaint was properly granted.
Harvard Med., P.C. v Maya Assur. Co. (2016 NY Slip Op 51529(U)) Appellate Term, Second Department, October 13, 2016Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the IME no-show defense failed because the insurer's affidavit did not describe a standard office practice ensuring the IME scheduling letters were properly addressed and mailed.
Kings County Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 51446(U)) Appellate Term, Second Department, October 5, 2016Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer's EUO no-show motion should have been denied because it submitted no proof by anyone with personal knowledge of the provider's nonappearance.
Compas Med., P.C. v ELRAC, Inc. (2016 NY Slip Op 51439(U)) Appellate Term, Second Department, October 5, 2016Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer's motion should have been denied because the doctor scheduled to perform the IMEs did not establish personal knowledge of the assignor's nonappearance.
Stracar Med. Servs., P.C. v Allstate Prop. & Cas. Ins. Co. (2016 NY Slip Op 51431(U)) Appellate Term, Second Department, September 27, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the record raised no question about the reasonableness of the orthopedic IME requests, and the provider could not object to them anyway because the assignor never responded to the requests.
EMA Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 51428(U)) Appellate Term, Second Department, September 27, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved proper mailing of the IME scheduling letters and that the assignor failed to appear for the duly scheduled IMEs.
Arguelles, M.D., P.C. v American Tr. Ins. Co. (2016 NY Slip Op 51422(U)) Appellate Term, Second Department, September 27, 2016Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer's IME no-show cross motion should have been denied because it submitted no proof from anyone with personal knowledge of the assignor's nonappearance.
Stracar Med. Servs. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 51415(U)) Appellate Term, Second Department, September 27, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer sufficiently proved the provider's failure to appear for two EUOs, and that the provider, having never responded to the requests, could not challenge their reasonableness or need discovery on it.
Compas Med., P.C. v Travelers Insurance Company (2016 NY Slip Op 51424(U)) Appellate Term, Second Department, September 27, 2016Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer's EUO no-show defense failed because it submitted no proof from anyone with personal knowledge of the provider's nonappearance at the examinations under oath.
Actual Chiropractic, P.C. v Mercury Cas. Co. (2016 NY Slip Op 51435(U)) Appellate Term, Second Department, September 27, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailing of the EUO scheduling letters and the assignor's failure to appear for the duly scheduled EUOs, entitling it to dismissal.
K.O. Med., P.C. v Allstate Ins. Co. (2016 NY Slip Op 51367(U)) Appellate Term, Second Department, September 19, 2016Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer's moving papers failed to establish as a matter of law that the assignor failed to appear for the duly scheduled IMEs.
Arguelles, M.D., P.C. v American Tr. Ins. Co. (2016 NY Slip Op 51366(U)) Appellate Term, Second Department, September 19, 2016Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer not entitled to summary judgment on the IME no-show claim because it submitted no proof from anyone with personal knowledge of the assignor's nonappearance.
Ortho Passive Motion, Inc. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 51364(U)) Appellate Term, Second Department, September 19, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved that it mailed initial and follow-up IME letters before receiving the claims and that the assignor failed to appear, entitling it to summary judgment.
Compas Med., P.C. v American Tr. Ins. Co. (2016 NY Slip Op 51361(U)) Appellate Term, Second Department, September 19, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved proper mailing of the EUO scheduling letters and the assignor's failure to appear, so dismissal was proper.
Compas Med., P.C. v American Tr. Ins. Co. (2016 NY Slip Op 51360(U)) Appellate Term, Second Department, September 19, 2016Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to prove timely mailing of the EUO scheduling letters because its two affidavits conflicted on which letters were mailed, so it was not entitled to summary judgment.
AVM Chiropractic, P.C. v 21st Century Ins. Co. (2016 NY Slip Op 51354(U)) Appellate Term, Second Department, September 19, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer demonstrated that the assignor failed to appear for the scheduled EUOs, rejecting the provider's challenge.
Tam Med. Supply Corp. v Tri State Consumers Ins. Co. (2016 NY Slip Op 51350(U)) Appellate Term, Second Department, September 19, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the affirmation of the doctor scheduled to perform the IMEs sufficed to establish that the assignor failed to appear for the scheduled IMEs.
Restoration Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 51325(U)) Appellate Term, Second Department, September 15, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of the IME scheduling letters and, contrary to the provider's argument, that the assignor failed to appear for the duly scheduled IMEs.
Daily Med. Equip. Distrib. Ctr., Inc. v National Liab. & Fire Ins. Co. (2016 NY Slip Op 51323(U)) Appellate Term, Second Department, September 15, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld dismissal on the IME no-show because the insurer's affidavits established timely and proper mailing of the scheduling letters, the provider's only challenge.
Infinite Ortho Prods., Inc. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 51320(U)) Appellate Term, Second Department, September 15, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's proof of mailing of the IME scheduling letters and of the assignor's nonappearance sufficient, declining to consider an addressing argument not raised below.
TAM Med. Supply Corp. v American Tr. Ins. Co. (2016 NY Slip Op 51318(U)) Appellate Term, Second Department, September 15, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held the examining doctor's affidavit established, prima facie, that the assignor failed to appear for IMEs on the stated dates, showing a breach of a condition precedent to coverage.
Sin Med., P.C. v Travelers Ins. Co. (2016 NY Slip Op 51246(U)) Appellate Term, Second Department, August 18, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the EUO scheduling letters, without needing a CPLR 4518 foundation, and the assignor's nonappearance through sworn stenographic transcripts, so summary judgment was granted.
City Care Acupuncture, P.C. v Ameriprise Ins. Co. (2016 NY Slip Op 51036(U)) Appellate Term, Second Department, June 23, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld that the assignor's appearance at the second EUO did not defeat the defense because the insurer showed the EUO was mutually rescheduled at the assignor's request so counsel could attend, and the assignor missed the rescheduled date.
Professional Health Imaging, P.C. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 51026(U)) Appellate Term, Second Department, June 23, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer sufficiently proved the provider's failure to appear for two EUOs, and that the provider, never having responded to the requests, could not object to their reasonableness or need discovery on it.
Professional Health Imaging, P.C. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 50997(U)) Appellate Term, Second Department, June 22, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved the provider missed two EUOs; the provider's objection letter, unproven as sent and dated after the second no-show, was untimely, so reasonableness could not be raised or explored in discovery.
Vladenn Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 50928(U)) Appellate Term, Second Department, June 6, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing and, through its attorney present to conduct the EUOs, nonappearance; it need not show justification for the EUO requests or willfulness, and the provider identified no discovery warranting delay.
IMA Acupuncture, P.C. v Allstate Ins. Co. (2016 NY Slip Op 50926(U)) Appellate Term, Second Department, June 6, 2016Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer failed to establish its EUO no-show defense because the affirmation of a partner in the law firm retained to conduct the EUOs was not made on personal knowledge.
Longevity Med. Supply, Inc. v Praetorian Ins. Co. (2016 NY Slip Op 50924(U)) Appellate Term, Second Department, June 6, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the affidavits of the doctor and chiropractor scheduled to perform the IMEs sufficient to establish the assignor's nonappearance, the only issue left for trial, so the insurer was entitled to summary judgment.
Alleviation Med. Servs., P.C. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 50922(U)) Appellate Term, Second Department, June 6, 2016Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer failed to prove nonappearance because the scheduled IME doctor did not establish personal knowledge of it; letters sent to different addresses also raised an issue on receipt.
New Way Med. Supply Corp. v American Tr. Ins. Co. (2016 NY Slip Op 50917(U)) Appellate Term, Second Department, June 6, 2016Insurer failed to prove the nonappearance by someone with personal knowledgeHeld that although the EUO letters were timely mailed, the insurer offered no proof from anyone with personal knowledge of the assignor's nonappearance, so it failed its prima facie burden.
GL Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 50912(U)) Appellate Term, Second Department, June 6, 2016Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer failed to make a prima facie showing on its IME no-show defense because it submitted no proof by someone with personal knowledge of the assignor's nonappearance.
Alleviation Med. Servs., P.C. v Hertz Co. (2016 NY Slip Op 50909(U)) Appellate Term, Second Department, June 6, 2016Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the affirmation of a partner in the law firm retained to conduct the EUOs was not proof by someone with personal knowledge of the provider's nonappearance.
New Quality Med., P.C. v Allstate Ins. Co. (2016 NY Slip Op 50872(U)) Appellate Term, Second Department, June 3, 2016Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer's motion should have been denied because it offered no proof by anyone with personal knowledge that the provider failed to appear for the scheduled EUOs.
New Quality Med., P.C. v Allstate Ins. Co. (2016 NY Slip Op 50871(U)) Appellate Term, Second Department, June 3, 2016Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer's cross motion properly denied because it submitted no proof by anyone with personal knowledge that the provider failed to appear for the scheduled EUOs.
Great Health Care Chiropractic, P.C. v Tri State Consumers Ins. Co. (2016 NY Slip Op 50864(U)) Appellate Term, Second Department, June 3, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's affidavits sufficient to establish that the assignor failed to appear for duly scheduled IMEs, a condition precedent to liability, and declined to consider the provider's other argument raised first on appeal.
MB Advanced Equip., Inc. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 50863(U)) Appellate Term, Second Department, June 3, 2016Proof on the no-show raises a question of fact; neither side wins the point as a matter of lawHeld that the examiners' affidavits showed the assignors' nonappearance, but their earlier sworn statements placing them elsewhere on the IME dates raised a triable issue, and counsel's reply lacked personal knowledge to resolve it.
LMS Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 50862(U)) Appellate Term, Second Department, June 3, 2016Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer failed to establish the IME no-show defense because the scheduled examining doctor's sworn statements did not show personal knowledge of the assignor's nonappearance.
Acupuncture Healthcare Plaza I, P.C. v Hertz Co. (2016 NY Slip Op 50865(U)) Appellate Term, Second Department, June 3, 2016Insurer failed to prove the nonappearance by someone with personal knowledgeHeld both the EUO and IME branches should have been denied because no one with personal knowledge, including the scheduled IME doctors, showed the assignor's nonappearance.
Professional Health Imaging, P.C. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 50698(U)) Appellate Term, Second Department, April 25, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer sufficiently established the provider's failure to appear for two duly scheduled EUOs, and objections to the reasonableness of the requests not raised during claims processing could not be raised in litigation.
Actual Chiropractic, P.C. v A. Cent. Ins. Co. (2016 NY Slip Op 50397(U)) Appellate Term, Second Department, March 23, 2016Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to prove timely mailing of the IME scheduling letters, so it did not show the IMEs were properly scheduled or that the assignor breached a condition precedent.
Delta Diagnostic Radiology, P.C. v Kemper Ins. Co. (2016 NY Slip Op 50396(U)) Appellate Term, Second Department, March 23, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's affidavits sufficient to establish the assignor's failure to appear for duly scheduled IMEs, a condition precedent to liability, and found the provider raised no triable issue.
Alleviation Med. Servs., P.C. v Hertz Co. (2016 NY Slip Op 50399(U)) Appellate Term, Second Department, March 23, 2016Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the orthopedist's affirmation and chiropractor's affidavit failed to show, by personal knowledge or other appropriate means, that the assignor did not appear for the IMEs.
Alleviation Med. Servs., P.C. v A Cent. Ins. Co. (2016 NY Slip Op 50383(U)) Appellate Term, Second Department, March 17, 2016Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to prove the IME scheduling letters were timely and properly mailed, so the IMEs were not shown properly scheduled; an attorney's reply affirmation without personal knowledge could not cure this.
Pro Health Acupuncture, P.C. v Praetorian Ins. (2016 NY Slip Op 50380(U)) Appellate Term, Second Department, March 17, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the IME requests through the scheduler's affidavit and nonappearance through the examining provider's affidavit, and the provider raised no triable issue.
Alleviation Med. Servs., P.C. v Farmers New Century Ins. Co. (2016 NY Slip Op 50379(U)) Appellate Term, Second Department, March 17, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established that the IME scheduling letters were timely mailed and that the assignor failed to appear, so the assignor breached a condition precedent to coverage.
Compas Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 50376(U)) Appellate Term, Second Department, March 17, 2016Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer failed to establish the IME no-show defense because the sworn statements of the scheduled chiropractor and doctor did not show personal knowledge of the assignor's nonappearance.
Meridian Psychological Servs., P.C. v Allstate Ins. Co. (2016 NY Slip Op 50375(U)) Appellate Term, Second Department, March 16, 2016Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer failed to prove nonappearance at the second EUO because its witness checked only from 11:30 for an EUO scheduled at 11:00, although mailing was proved.
New Way Med. Supply Corp. v American Tr. Ins. Co. (2016 NY Slip Op 50370(U)) Appellate Term, Second Department, March 16, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the EUO scheduling letters and the assignor's nonappearance, showing breach of a condition precedent to coverage.
Alleviation Med. Servs., P.C. v Hertz Co. (2016 NY Slip Op 50371(U)) Appellate Term, Second Department, March 16, 2016Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the affirmation of a partner in the law firm retained to conduct the EUOs did not supply proof by someone with personal knowledge of the provider's nonappearance.
Ultimate Health Prods., Inc. v American Tr. Ins. Co. (2016 NY Slip Op 50330(U)) Appellate Term, Second Department, March 15, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the EUO scheduling letters and the assignor's failure to appear for the duly scheduled EUOs.
Atlantic Radiology Imaging, P.C. v Metropolitan Prop. & Cas. Ins. Co. (2016 NY Slip Op 50321(U)) Appellate Term, Second Department, March 11, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held the provider had no potentially meritorious opposition because the insurer's affidavits and certified transcripts proved proper addressing and timely mailing of the EUO letters and nonappearance at both EUOs.
Bay LS Med. Supplies, Inc. v Allstate Ins. Co. (2016 NY Slip Op 50319(U)) Appellate Term, Second Department, March 11, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the no-show defense established because the scheduling letters were mailed and the provider's nonappearances were shown, and its objections to the letters' form were not heard since it never responded to the EUO requests.
Atlantic Radiology Imaging, P.C. v Esurance Ins. Co. (2016 NY Slip Op 50315(U)) Appellate Term, Second Department, March 11, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld dismissal because the employee's affidavit proved mailing of the EUO letters, and the attack on the law firm partner's affirmation failed since it was not the proof offered of nonappearance.
XVV, Inc. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 50312(U)) Appellate Term, Second Department, March 11, 2016Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the IME no-show defense unproved because the insurer did not establish timely mailing of the scheduling letters, so it could not show the assignor missed duly scheduled IMEs.
Great Health Care Chiropractic, P.C. v Allstate Ins. Co. (2016 NY Slip Op 50311(U)) Appellate Term, Second Department, March 11, 2016Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the EUO no-show defense unproved because the insurer did not show timely mailing of the initial and follow-up scheduling letters, so the EUOs were not shown properly scheduled.
Compas Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 50307(U)) Appellate Term, Second Department, March 11, 2016Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the sworn statements of the scheduled chiropractor and doctor did not show personal knowledge of the assignor's nonappearance, so the IME no-show defense was not established.
Great Health Care Chiropractic, P.C. v Maya Assur. Co. (2016 NY Slip Op 50308(U)) Appellate Term, Second Department, March 11, 2016Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to show the IMEs were properly scheduled, and thus the assignor's nonappearance, because its affidavit did not describe a mailing practice ensuring proper addressing and mailing of the letters.
Gl Acupuncture, P.C. v Maya Assur. Co. (2016 NY Slip Op 50310(U)) Appellate Term, Second Department, March 11, 2016Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the IME no-show defense failed because the insurer's affidavit did not describe a standard office practice ensuring the IME scheduling letters were properly addressed and mailed, so it did not show duly scheduled IMEs.
Contemporary Acupuncture, P.C. v Allstate Ins. Co. (2016 NY Slip Op 50464(U)) Appellate Term, Second Department, March 7, 2016Insurer failed to prove the scheduling letters were mailed or properly addressedDenied the insurer summary judgment on the EUO no-show because, among other things, it did not prove that the EUO notices had been properly and timely mailed.
Excel Imaging, P.C. v Allstate Ins. Co. (2015 NY Slip Op 51896(U)) Appellate Term, Second Department, December 18, 2015Proof on the no-show raises a question of fact; neither side wins the point as a matter of lawHeld a triable issue existed whether the assignor failed to appear, because the insurer's own letter showed an adjournment was requested before the first EUO and the record did not show whether it was mutually rescheduled.
Compas Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51776(U)) Appellate Term, Second Department, December 2, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the IME scheduling letters and the assignor's nonappearance, rejecting the provider's contrary contention; the EUO nonappearance was not reached.
Acupuncture Healthcare Plaza I, P.C. v 21st Century Ins. Co. (2015 NY Slip Op 51716(U)) Appellate Term, Second Department, November 20, 2015Proof on the no-show raises a question of fact; neither side wins the point as a matter of lawHeld a triable issue of fact on the propriety of the address to which the IME scheduling letters were sent precluded summary judgment on the no-show claims.
Delta Diagnostic Radiology, P.C. v American Tr. Ins. Co. (2015 NY Slip Op 51711(U)) Appellate Term, Second Department, November 20, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established that the EUO scheduling letters were timely mailed and that the assignor failed to appear for the duly scheduled EUOs, a breach of a condition precedent to coverage.
Alleviation Med. Servs., P.C. v Esurance (2015 NY Slip Op 51715(U)) Appellate Term, Second Department, November 20, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the EUO scheduling letters and the assignor's nonappearance, and the provider raised no triable issue.
Sharp View Diagnostic Imaging, P.C. v Maya Assur. Co. (2015 NY Slip Op 51721(U)) Appellate Term, Second Department, November 20, 2015Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the IME no-show defense failed because the insurer's affidavit did not describe a standard office practice ensuring the IME scheduling letters were properly addressed and mailed, so it did not show duly scheduled IMEs.
Compas Med., P.C. v Farm Family Cas. Ins. Co. (2015 NY Slip Op 51704(U)) Appellate Term, Second Department, November 19, 2015Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer not entitled to summary judgment on its EUO no-show defense because it submitted no proof by anyone with personal knowledge of the assignor's nonappearance.
Compas Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51699(U)) Appellate Term, Second Department, November 19, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the IME and EUO scheduling letters and the assignor's nonappearance, and the provider raised no triable issue.
New Quality Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51697(U)) Appellate Term, Second Department, November 19, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of IME and EUO scheduling letters and the assignor's nonappearance, and the provider raised no triable issue.
Compas Med., P.C. v MVAIC (2015 NY Slip Op 51705(U)) Appellate Term, Second Department, November 19, 2015Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the defense not established because, although a stenographic transcript showed nonappearance at the second EUO, there was no admissible proof the assignor failed to appear for the first.
Compas Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51679(U)) Appellate Term, Second Department, November 13, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the claims examiner's affidavit established timely mailing of the IME scheduling letters and the assignor's failure to appear, a breach of a condition precedent to coverage.
Barakat Med. Care, P.C. v Nationwide Ins. Co. (2015 NY Slip Op 51677(U)) Appellate Term, Second Department, November 13, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of the EUO letters and the assignor's nonappearances and need not show an objective basis for the EUOs as part of its prima facie case.
Delta Diagnostic Radiology, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51676(U)) Appellate Term, Second Department, November 13, 2015Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to prove its no-show defenses because there was no evidence the IME letters were mailed and only a conclusory attorney's affirmation as to the EUO nonappearances.
Delta Diagnostic Radiology, P.C. v Country Wide Ins. Co. (2015 NY Slip Op 51672(U)) Appellate Term, Second Department, November 13, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer showed the IME scheduling letters were timely mailed and the assignor did not appear for the duly scheduled IMEs, and the provider raised no triable issue.
Compas Med., P.C. v American Tr. Ins. Co. (2015 NY Slip Op 51671(U)) Appellate Term, Second Department, November 13, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailing of the EUO scheduling letters and the assignor's failure to appear, without reaching the IME no-show proof.
Active Chiropractic, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51668(U)) Appellate Term, Second Department, November 13, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the no-show defense established through the conducting attorney's personal knowledge of both nonappearances, and that transcripts showing a different assignor's no-shows raised no triable issue.
Compas Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51667(U)) Appellate Term, Second Department, November 13, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailing of the IME and EUO scheduling letters and the assignor's nonappearances, though one claim was lost because its denial was untimely.
Great Health Care Chiropractic, P.C. v Travelers Ins. Co. (2015 NY Slip Op 51665(U)) Appellate Term, Second Department, November 12, 2015Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the EUO no-show defense not established because the first EUO scheduling letter went out about 50 days after the claim was received, outside the 15-business-day limit of 65-3.5 (b).
Mind & Body Acupuncture, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51658(U)) Appellate Term, Second Department, November 12, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the scheduling letters were not mere delay letters, were timely mailed, and the assignor failed to appear for the duly scheduled IMEs and EUOs.
Palafox PT, P.C. v State Farm Mut. Auto. Ins. Co. (2015 NY Slip Op 51653(U)) Appellate Term, Second Department, November 12, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the EUO no-show defense established by proof of mailing and the conducting attorney's affirmation of nonappearance; no objective justification or willfulness was required, and no CPLR 3212 (f) need for discovery was shown.
IMA Acupuncture, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51633(U)) Appellate Term, Second Department, November 9, 2015Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the scheduled chiropractor's sworn statement failed to show by personal knowledge or other appropriate means the assignor's nonappearance at both IMEs, so the insurer was not entitled to summary judgment.
New Way Med. Supply Corp. v Praetorian Ins. Co. (2015 NY Slip Op 51632(U)) Appellate Term, Second Department, November 9, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the IME and EUO scheduling letters and the assignor's nonappearance, and the provider raised no triable issue on the fourth cause of action.
Delta Diagnostic Radiology, P.C. v American Tr. Inc. Co. (2015 NY Slip Op 51629(U)) Appellate Term, Second Department, November 9, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's affidavit established timely and proper mailing of the EUO scheduling letters, so summary judgment dismissing the complaint on the EUO no-show defense was affirmed.
Village Med. Supply, Inc. v Travco Ins. Co. (2015 NY Slip Op 51599(U)) Appellate Term, Second Department, October 30, 2015Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer's motion should have been denied because the attorney's affirmation did not unequivocally show that counsel was present on the scheduled EUO dates, so no one with personal knowledge proved the nonappearance.
Ultimate Health Prods., Inc. v American Tr. Ins. Co. (2015 NY Slip Op 51592(U)) Appellate Term, Second Department, October 30, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established that the EUO scheduling letters were timely mailed and that the assignor failed to appear for the duly scheduled EUOs.
Alleviation Med. Servs., P.C. v Allstate Ins. Co. (2015 NY Slip Op 51591(U)) Appellate Term, Second Department, October 30, 2015Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer not entitled to summary judgment because the doctor's affirmation did not show, by personal knowledge or other appropriate means, the assignor's nonappearance at both IMEs.
Compas Med., P.C. v Geico Ins. Co. (2015 NY Slip Op 51590(U)) Appellate Term, Second Department, October 30, 2015Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer's cross motion should have been denied because the examiners' affidavits and affirmation stated only in conclusory fashion that the assignor failed to appear at the IMEs.
Compas Med., P.C. v Travelers Ins. Co. (2015 NY Slip Op 51568(U)) Appellate Term, Second Department, October 26, 2015Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the sworn statement of the attorney assigned to conduct the EUOs failed to show by personal knowledge or other appropriate means that the provider missed both EUOs, so summary judgment for the insurer was denied.
Metro Health Prods., Inc. v State Farm Mut. Auto. Ins. Co. (2015 NY Slip Op 51451(U)) Appellate Term, Second Department, September 30, 2015Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer could not prove the provider's EUO nonappearance solely through an unanswered notice to admit, because the admission sought went to the heart of the controversy and was improper.
Compas Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51467(U)) Appellate Term, Second Department, September 17, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the IME and EUO scheduling letters and the assignor's nonappearance, and the provider raised no triable issue.
Healing Art Acupuncture, P.C. v Country Wide Ins. Co. (2015 NY Slip Op 51465(U)) Appellate Term, Second Department, September 17, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer showed the IME scheduling letters were timely mailed and the assignor failed to appear, which supported dismissal of most claims; one claim survived only because the denial was not shown timely.
New Way Med. Supply Corp. v Company (2015 NY Slip Op 51461(U)) Appellate Term, Second Department, September 17, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the IME scheduling letters and the assignor's nonappearance, and the provider raised no triable issue, so the insurer's cross motion was granted.
Metro Health Prods., Inc. v State Farm Mut. Auto. Ins. Co. (2015 NY Slip Op 51419(U)) Appellate Term, Second Department, September 17, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the EUO letters proved mailed and the provider's nonappearance proved by the attorney present for the EUOs; objections to the requests were not heard because the provider never responded, and willfulness need not be shown.
Sunlight Med. Care, P.C. v Esurance Ins. Co. (2015 NY Slip Op 51410(U)) Appellate Term, Second Department, September 16, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedRejected the provider's argument that the EUO letters went to the wrong address, since the record showed they were mailed to the address given on the bills, the NF-2 and the assignment, so the insurer's defense prevailed.
Compas Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51408(U)) Appellate Term, Second Department, September 16, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the IME and EUO scheduling letters and the assignor's nonappearance, and the provider raised no triable issue.
New Quality Med., P.C. v Allstate Ins. Co. (2015 NY Slip Op 51405(U)) Appellate Term, Second Department, September 16, 2015Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer failed to show its EUO scheduling letters tolled its time to deny because the letters did not name the assignor, his date of loss or the applicable claim number.
Ultimate Health Prods., Inc. v American Tr. Ins. Co. (2015 NY Slip Op 51404(U)) Appellate Term, Second Department, September 16, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld dismissal on the EUO no-show because the insurer proved timely mailing of the scheduling letters, the only element the provider disputed.
Compas Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51403(U)) Appellate Term, Second Department, September 16, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the IME and EUO scheduling letters and the assignor's nonappearance, and the provider raised no triable issue.
Clove Med. Supply, Inc. v IDS Prop. Cas. Ins. Co. (2015 NY Slip Op 51401(U)) Appellate Term, Second Department, September 16, 2015Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer's motion properly denied because it offered no proof by anyone with personal knowledge that the provider failed to appear for the scheduled EUOs.
Hammond v Unitrin Advantage Ins. Co. (2015 NY Slip Op 51241(U)) Appellate Term, Second Department, August 6, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the IME scheduler's affidavit proved timely mailing of the scheduling letters and the examining professional's affidavit proved the assignor's nonappearance, so dismissal should have been granted.
Right Aid Med. Supply Corp. v Hartford Ins. Co. (2015 NY Slip Op 51236(U)) Appellate Term, Second Department, August 6, 2015Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer failed to make a prima facie showing of nonappearance because the attorney's affirmation did not unequivocally show he was present at the court reporter's office on either EUO date.
Alleviation Med. Servs., P.C. v Maya Assur. Co. (2015 NY Slip Op 51238(U)) Appellate Term, Second Department, August 6, 2015Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the IME no-show defense failed because the insurer's motion papers did not establish that the IME scheduling letters were timely mailed, so it did not show the IMEs were properly scheduled.
Delta Diagnostic Radiology, P.C. v Hertz Co. (2015 NY Slip Op 51242(U)) Appellate Term, Second Department, August 6, 2015Proof on the no-show raises a question of fact; neither side wins the point as a matter of lawHeld the insurer not entitled to summary judgment on the IME no-show defense because the record raised a triable issue as to the propriety of the address to which the IME scheduling letters were sent.
Great Health Care Chiropractic, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51224(U)) Appellate Term, Second Department, August 5, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedRejected the provider's arguments and held the insurer proved the assignor failed to appear for the duly scheduled IMEs, a condition precedent to liability.
Neptune Med. Care, P.C. v Ameriprise Auto & Home Ins. (2015 NY Slip Op 51220(U)) Appellate Term, Second Department, August 5, 2015Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the EUO scheduling letters nullities for the bills at issue because they were sent more than 15 business days, indeed more than 30 days, after receipt, and an earlier toll did not permit late requests.
Arcadia Imaging, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51208(U)) Appellate Term, Second Department, August 5, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the IME scheduler president's affidavit proved timely mailing of the scheduling letters and the examining professionals' affidavits proved the assignor's nonappearance, so dismissal should have been granted.
Delta Diagnostic Radiology, P.C. v Esurance (2015 NY Slip Op 51212(U)) Appellate Term, Second Department, August 5, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedRejected the provider's challenge and held the insurer established that the EUO scheduling letters were timely mailed and that the assignor failed to appear for the duly scheduled EUOs.
Gutierrez v Elrac, Inc. (2015 NY Slip Op 51215(U)) Appellate Term, Second Department, August 5, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's affidavits showed timely mailing of the IME scheduling letters, so summary judgment dismissing the complaint on the IME no-show defense was affirmed.
Delta Diagnostic Radiology, P.C. v Auto One Ins. Co. (2015 NY Slip Op 51032(U)) Appellate Term, Second Department, July 7, 2015Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer's motion should have been denied because the sworn statements of the scheduled acupuncturist and doctor did not show personal knowledge of the assignor's nonappearance.
New Way Med. Supply Corp. v American Tr. Ins. Co. (2015 NY Slip Op 50809(U)) Appellate Term, Second Department, May 19, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedRejected the provider's contention and held the insurer proved timely mailing of the EUO scheduling letters and the assignor's failure to appear.
Great Health Care Chiropractic, P.C. v Esurance (2015 NY Slip Op 50807(U)) Appellate Term, Second Department, May 19, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedRejected the provider's challenge and held the insurer established that the EUO scheduling letters were timely mailed and that the assignor failed to appear for the duly scheduled EUOs.
Bay Ls Med. Supplies, Inc. v Chubb Indem. Ins. Co. (2015 NY Slip Op 50790(U)) Appellate Term, Second Department, May 18, 2015Proof on the no-show raises a question of fact; neither side wins the point as a matter of lawHeld the insurer not entitled to summary judgment because IME scheduling letters addressed to a differently spelled name could not be said as a matter of law to have notified the assignor, leaving a triable issue.
Great Health Care Chiropractic, P.C. v Unitrin Advantage Ins. Co. (2015 NY Slip Op 50782(U)) Appellate Term, Second Department, May 18, 2015Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer not entitled to summary judgment on its EUO no-show defense because neither its claim representative nor its EUO counsel established actual mailing or a standard mailing practice for the scheduling letters.
New Way Med. Supply Corp. v Praetorian Ins. Co. (2015 NY Slip Op 50780(U)) Appellate Term, Second Department, May 18, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the chiropractic IME letters and the assignor's nonappearance, making it unnecessary to reach the challenge to proof of the orthopedic IME and EUO no-shows.
T & J Chiropractic, P.C. v Geico Ins. Co. (2015 NY Slip Op 50772(U)) Appellate Term, Second Department, May 18, 2015Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer's cross motion should have been denied because neither the chiropractor nor the doctor scheduled to perform the IMEs showed personal knowledge of the assignor's nonappearance.
Gutierrez v Farmington Cas. Co. (2015 NY Slip Op 50781(U)) Appellate Term, Second Department, May 18, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the IME scheduling letters, supporting dismissal of the complaint on the no-show defense; the provider's other challenges were meritless or unpreserved.
Delta Diagnostic Radiology, P.C. v Esurance (2015 NY Slip Op 50785(U)) Appellate Term, Second Department, May 18, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedRejected the provider's challenge and held the insurer established that the EUO scheduling letters were timely mailed and that the assignor failed to appear for the duly scheduled EUOs.
Delta Diagnostic Radiology, P.C. v Maya Assur. Co. (2015 NY Slip Op 50786(U)) Appellate Term, Second Department, May 18, 2015Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to show the IMEs were properly scheduled, and thus the assignor's nonappearance, because its affidavit did not describe a mailing practice ensuring proper addressing and mailing of the letters.
Great Health Care Chiropractic, P.C. v Esurance (2015 NY Slip Op 50787(U)) Appellate Term, Second Department, May 18, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's papers established that the assignor failed to appear for duly scheduled EUOs, rejecting the provider's sole contention on the cross motion.
Longevity Med. Supply, Inc. v Praetorian Ins. Co. (2015 NY Slip Op 50685(U)) Appellate Term, Second Department, May 1, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedReversing a ruling requiring an objective justification, held no regulation requires one, the EUO letters and two nonappearances were proved, and the provider's objections were barred because it never responded to the requests.
VE Med. Care, P.C. v State Farm Mut. Auto. Ins. Co. (2015 NY Slip Op 50603(U)) Appellate Term, Second Department, April 16, 2015Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer failed to establish as a matter of law that the provider did not appear for properly scheduled EUOs and reversed summary judgment for the insurer. It relied on precedents rejecting nonappearance proof from affiants without personal knowledge.
Metro Psychological Servs., P.C. v 21st Century N. Am. Ins. Co. (2015 NY Slip Op 50470(U)) Appellate Term, Second Department, April 7, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedReversing a ruling requiring an objective justification, held none is required by regulation, and the paralegal's mailing affidavit and EUO transcripts proved mailed notices and nonappearance.
EMC Health Prods., Inc. v Travelers Ins. Co. (2015 NY Slip Op 50475(U)) Appellate Term, Second Department, March 26, 2015Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer failed to establish as a matter of law that the provider did not appear for properly scheduled EUOs, so its cross motion should have been denied.
O & M Med., P.C. v Travelers Indem. Co. (2015 NY Slip Op 50476(U)) Appellate Term, Second Department, March 26, 2015Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the EUO no-show defense failed because the first EUO scheduling letter was mailed nearly three months after receipt of the claim, beyond the 15-business-day limit, rendering it a nullity so no EUO was duly scheduled.
T & J Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2015 NY Slip Op 50406(U)) Appellate Term, Second Department, March 17, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the EUO letters proved mailed and the provider's nonappearance proved by the attorney present for the EUOs; objections to the requests were not heard because the provider never responded, so no discovery was needed.
Metro Health Prods., Inc. v State Farm Mut. Auto. Ins. Co. (2015 NY Slip Op 50402(U)) Appellate Term, Second Department, March 17, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the EUO scheduling letters proved mailed and the provider's objections to the requests barred because it never responded to them, so discovery on reasonableness was unnecessary.
Performance Plus Med., P.C. v Utica Mut. Ins. Co. (2015 NY Slip Op 50399(U)) Appellate Term, Second Department, March 16, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the EUO and IME scheduling letters and the assignor's failure to appear for any of the properly scheduled exams, so dismissal should have been granted.
Tong Li v Praetorian Ins. Co. (2015 NY Slip Op 50397(U)) Appellate Term, Second Department, March 16, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held the IME scheduler's affidavit proved timely mailing of the requests and the examining providers' affirmations proved nonappearance, establishing the insurer's prima facie case; a discovery-stipulation issue prevented judgment.
Cortland Med. Supply, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 50394(U)) Appellate Term, Second Department, March 16, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the IME scheduler's affidavit proved timely mailing of the requests and the examining providers' affirmations and affidavit proved the assignor's nonappearance, so dismissal should have been granted.
Longevity Med. Supply, Inc. v Praetorian Ins. Co. (2015 NY Slip Op 50393(U)) Appellate Term, Second Department, March 16, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the scheduler's affidavit proved timely mailing of the IME requests and the examining providers' affirmations proved the assignor's nonappearance, so the no-show defense defeated both causes of action.
Longevity Med. Supply, Inc. v Geico Ins. Co. (2015 NY Slip Op 50392(U)) Appellate Term, Second Department, March 16, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's affidavits sufficient to establish that the assignor failed to appear for duly scheduled EUOs, so dismissal of the complaint was proper.
Healing Art Acupuncture, P.C. v Maya Assur. Co. (2015 NY Slip Op 50387(U)) Appellate Term, Second Department, March 13, 2015Insurer failed to prove the scheduling letters were mailed or properly addressedHeld that, lacking adequate proof of mailing of the IME scheduling letters, the insurer failed to show the IMEs were properly scheduled and the assignor failed to appear.
Avicenna Med. Arts, PLLC v Unitrin Advantage Ins. Co. (2015 NY Slip Op 50382(U)) Appellate Term, Second Department, March 12, 2015Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer's own papers showed its follow-up EUO requests were untimely under the 10-day follow-up rule, so its no-show defense failed for those claims.
I.V. Med. Supply, Inc. v Praetorian Ins. Co. (2015 NY Slip Op 50380(U)) Appellate Term, Second Department, March 12, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the scheduler's affidavit established timely mailing of the IME requests and the chiropractors' affidavits established the assignor's nonappearance, entitling the insurer to summary judgment.
Ultimate Health Prods., Inc. v Travelers Ins. Co. (2015 NY Slip Op 50377(U)) Appellate Term, Second Department, March 12, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established that the provider failed to appear at either of two duly scheduled EUOs, a condition precedent to liability, so summary judgment for the insurer was proper.
Stracar Med. Servs., P.C. v State Farm Mut. Auto. Ins. Co. (2015 NY Slip Op 25079) Appellate Term, Second Department, March 2, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld that a provider holding only an authorization to pay, like an assignee or representative, was obligated to submit to EUOs, so its failure to appear supported dismissal of its claims.
Power Supply, Inc. v Praetorian Ins. Co. (2015 NY Slip Op 50218(U)) Appellate Term, Second Department, February 24, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer showed timely initial EUO and IME requests within 15 business days, timely follow-ups, and the assignor's nonappearances, and counsel's affirmation raised no triable issue.
XVV, Inc. v Praetorian Ins. Co. (2014 NY Slip Op 51862(U)) Appellate Term, Second Department, December 19, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailing of the IME and EUO scheduling letters and the assignor's nonappearance at the duly scheduled IMEs and EUOs.
Right Solution Med. Supply, Inc. v NY Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 51860(U)) Appellate Term, Second Department, December 19, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the IME scheduler's standard-practice affidavit proved mailing of the scheduling letters and the examining professionals' affidavits proved the assignor's nonappearance, so the insurer was entitled to dismissal of two causes of action.
Coney Is. Physician Care, P.C. v Praetorian Ins. Co. (2014 NY Slip Op 51859(U)) Appellate Term, Second Department, December 19, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the IME scheduler's affidavit proved mailing of the scheduling letters and the examining professionals' affidavits proved the assignor's nonappearance, so summary judgment dismissing the remaining claims was warranted.
Optimal Well-Being Chiropractic, P.c. v Ameriprise Auto & Home Ins. (2014 NY Slip Op 51858(U)) Appellate Term, Second Department, December 19, 2014Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer's EUO no-show defense failed because it submitted no proof from anyone with personal knowledge of the provider's nonappearance at the EUOs.
Flatlands Med., P.C. v Travelers Ins. Co. (2014 NY Slip Op 51856(U)) Appellate Term, Second Department, December 19, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Upheld dismissal of two causes on the EUO no-show because the scheduling letters and denials were proved timely mailed, while other claims survived for failed tolling or concededly late denials.
Faith Acupuncture, P.C. v Maya Assur. Co. (2014 NY Slip Op 51863(U)) Appellate Term, Second Department, December 19, 2014Insurer failed to prove the scheduling letters were mailed or properly addressedHeld that without proof the IME letters were properly mailed the insurer failed to show the IMEs were duly scheduled or that the assignor failed to appear at them.
Compas Med., P.C. v Nationwide Ins. (2014 NY Slip Op 51826(U)) Appellate Term, Second Department, December 17, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer showed the IME scheduling letters were mailed under a standard office practice, so dismissal of the claims denied for the IME no-shows was affirmed.
Compas Med., P.C. v Nationwide Ins. (2014 NY Slip Op 51824(U)) Appellate Term, Second Department, December 17, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailing of the IME and EUO scheduling letters and the assignor's nonappearance, so the assignor failed to comply with conditions precedent to coverage.
Parkview Med. & Surgical, P.C. v Geico Gen. Ins. Co. (2014 NY Slip Op 51822(U)) Appellate Term, Second Department, December 17, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the scheduler's affidavit proved timely mailing of the IME requests and the scheduled examiners' affidavits proved the assignor's nonappearance, entitling the insurer to dismissal of the no-show claims.
True-Align Chiropractic Care, P.C. v Country Wide Ins. Co. (2014 NY Slip Op 51821(U)) Appellate Term, Second Department, December 17, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established that the assignor failed to appear for the scheduled IMEs, rejecting the provider's argument as to the remaining causes of action.
Utopia Equip., Inc. v NY Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 51820(U)) Appellate Term, Second Department, December 17, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held the scheduler's affidavit proved timely mailing of the IME letters under standard practice and the examining professional's affidavit proved the assignor's nonappearance.
XVV, Inc. v Praetorian Ins. Co. (2014 NY Slip Op 51819(U)) Appellate Term, Second Department, December 17, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the scheduler's affidavit established timely mailing of the IME requests and the doctors' affirmations established the assignor's nonappearance, entitling the insurer to summary judgment.
All About Rehabilitation & P.T., P.C. v Praetorian Ins. Co. (2014 NY Slip Op 51815(U)) Appellate Term, Second Department, December 17, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the scheduler's affidavit proved timely mailing of the IME letters under standard practice and the examining professionals' affidavits proved the assignors' nonappearance.
Eagle Surgical Supply, Inc. v Allstate Ins. Co. (2014 NY Slip Op 51798(U)) Appellate Term, Second Department, December 17, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld dismissal on the EUO no-show because the provider, which never responded to the scheduling letters, could not challenge them now, and the letters in any event stated the EUO concerned its eligibility for reimbursement.
Excel Imaging, P.C. v Infinity Select Ins. Co. (2014 NY Slip Op 51796(U)) Appellate Term, Second Department, December 17, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailed EUO letters and two nonappearances, and the provider's objections to the requests could not be heard since the assignor never objected to their reasonableness.
MML Med. Care, P.C. v Praetorian Ins. Co. (2014 NY Slip Op 51792(U)) Appellate Term, Second Department, December 17, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of initial and follow-up EUO letters and nonappearance by certified transcripts; undelivered certified copies did not excuse nonappearance absent evidence that first-class mailing was insufficient.
AP Orthopedic & Rehabilitation, P.C. v Mercury Cas. Co. (2014 NY Slip Op 51794(U)) Appellate Term, Second Department, December 17, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld, contrary to the trial court, that the IME scheduling letters complied with 11 NYCRR 65-3.5 (e), and with the insurer otherwise unchallenged as entitled to judgment, granted its motion.
Great Health Care Chiropractic, P.C. v Maya Assur. Co. (2014 NY Slip Op 51803(U)) Appellate Term, Second Department, December 17, 2014Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer did not show the IMEs were properly scheduled because its papers failed to establish mailing of the scheduling letters, so it was not entitled to summary judgment.
New Way Med. Supply Corp. v MVAIC (2014 NY Slip Op 51805(U)) Appellate Term, Second Department, December 17, 2014Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the defense unproved because, although a transcript showed nonappearance at the second EUO, the insurer offered no admissible proof that the assignor failed to appear for the first scheduled EUO.
Advanced Psychological Care, P.C. v MVAIC (2014 NY Slip Op 51809(U)) Appellate Term, Second Department, December 17, 2014Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to prove the IME letters were properly mailed, so it did not show the IMEs were properly scheduled and its cross motion failed.
Great Health Care Chiropractic, P.C. v Hertz Co. (2014 NY Slip Op 51814(U)) Appellate Term, Second Department, December 17, 2014Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the no-show defense unproved because the insurer did not establish a proper mailing practice for IME notices and offered no one with personal knowledge of the assignor's EUO nonappearance.
All Boro Psychological Servs., P.C. v State Farm Mut. Auto. Ins. Co. (2014 NY Slip Op 51787(U)) Appellate Term, Second Department, December 11, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the EUO letters and the provider's nonappearance at both EUOs; objections to the requests were not heard because the provider never responded to them.
Foster Comprehensive Med., P.C. v Travelers Prop. Cas. Ins. Co. (2014 NY Slip Op 51786(U)) Appellate Term, Second Department, December 11, 2014Insurer failed to prove the scheduling letters were mailed or properly addressedAffirmed judgment for the provider after a nonjury trial because, the issues being whether the insurer timely sent EUO scheduling letters and timely denied the claims, the insurer called no witnesses and presented no evidence.
Lotus Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2014 NY Slip Op 51315(U)) Appellate Term, Second Department, August 20, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the EUO scheduling letters and, through its law-firm partner's affirmation, the provider's failure to appear at both EUOs, a condition precedent to liability.
Natural Therapy Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2014 NY Slip Op 51310(U)) Appellate Term, Second Department, August 20, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of the EUO letters and nonappearance through the attorney present for the EUOs; objections to justification were not heard and discovery on reasonableness was unnecessary since the provider never responded.
Arco Med. NY, P.C. v AIG Indem. Ins. Co. (2014 NY Slip Op 51257(U)) Appellate Term, Second Department, August 8, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the IME scheduler's affidavit established timely mailing of the IME letters and the examining professionals' affidavits established the assignor's nonappearance, entitling the insurer to summary judgment.
Quality Psychological Servs., P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 51256(U)) Appellate Term, Second Department, August 8, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the IME scheduler's affidavit proved timely mailing of the IME letters and the chiropractor's affidavit proved the assignor's nonappearance, entitling the insurer to dismissal.
Longevity Med. Supply, Inc. v IDS Prop. & Cas. Ins. Co. (2014 NY Slip Op 51244(U)) Appellate Term, Second Department, July 28, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of the EUO letters by office-practice affidavit and nonappearance by the EUO attorney's personal knowledge; a late initial request only reduced the time to deny, and reasonableness was not considered absent any response.
By MD, P.C. v NY Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 51232(U)) Appellate Term, Second Department, July 28, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the IME letters and the assignor's nonappearance, and the provider's affidavit did not raise a triable issue as to the assignor's receipt of notice.
Hillside OpenMRI, P.C. v Allstate Ins. Co. (2014 NY Slip Op 51143(U)) Appellate Term, Second Department, July 7, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely EUO letters and two nonappearances for one claim, rejecting the lower court's view that the scheduling notice had to state reasons; unanswered objections were not heard.
Flow Chiropractic, P.C. v Travelers Home & Mar. Ins. Co. (2014 NY Slip Op 51142(U)) Appellate Term, Second Department, July 7, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer entitled to summary judgment on the EUO no-show because no regulation requires the notice to state reasons, and the provider's objections went unheard since it never responded to the EUO requests.
Clinton Place Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50963(U)) Appellate Term, Second Department, May 29, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the IME scheduler's affidavit proved timely mailing of the scheduling letters and the examiner's affidavit proved the assignor's nonappearance, a condition precedent to liability.
SP Chiropractic, P.C. v IDS Prop. & Cas. Ins. Co. (2014 NY Slip Op 50952(U)) Appellate Term, Second Department, May 29, 2014Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer's summary judgment motion properly denied because it offered no proof from anyone with personal knowledge that the provider failed to appear for the EUOs.
J.C. Healing Touch Rehab, P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50635(U)) Appellate Term, Second Department, April 7, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the IME scheduler's affidavit proved timely mailing of the letters and the examiners' affidavits proved the assignor's nonappearance, a condition precedent to liability.
Active Chiropractic, P.C. v Praetorian Ins. Co. (2014 NY Slip Op 50634(U)) Appellate Term, Second Department, April 7, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of initial and follow-up EUO letters and nonappearance by certified transcripts; the provider never responded, so the condition precedent was unmet.
Healing Art Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50633(U)) Appellate Term, Second Department, April 7, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the IME scheduler's standard-practice affidavit established timely mailing of the IME letters, the only issue for trial, entitling the insurer to dismissal.
BR Clinton Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50632(U)) Appellate Term, Second Department, April 7, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the IME letters were proved timely mailed to the assignor and that the regulations did not require mailing the initial scheduling letters to the provider.
Village Med. Supply, Inc. v NY Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50631(U)) Appellate Term, Second Department, April 7, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the IME scheduler's affidavit proved mailing of the scheduling letters and the examining professionals' affidavits proved the assignor's nonappearance, warranting summary judgment for the insurer.
Muhammad Tahir, M.D., P.C. v Hertz Claims Mgt. (2014 NY Slip Op 50625(U)) Appellate Term, Second Department, April 7, 2014Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer's motion properly denied because it submitted no proof from anyone with personal knowledge of the assignor's nonappearance at the EUOs.
Clinton Place Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50472(U)) Appellate Term, Second Department, March 17, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held the scheduler's affidavit proved timely mailing of the IME letters under standard office practice and the chiropractor's affidavit proved the assignor's nonappearance at the scheduled IMEs.
Clinton Place Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50471(U)) Appellate Term, Second Department, March 17, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held the scheduling company's affidavit proved timely mailing of the IME letters and the chiropractor's affidavit proved the assignor failed to appear for the duly scheduled IMEs.
Right Aid Med. Supply Corp. v Utica Mut. Ins. Co. (2014 NY Slip Op 50421(U)) Appellate Term, Second Department, March 11, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely issuance of the EUO scheduling letters and the assignor's failure to appear for either properly scheduled EUO, entitling it to dismissal.
Clinton Place Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50413(U)) Appellate Term, Second Department, March 11, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the scheduler's affidavit proved the IME letters were timely mailed to the assignor, and mailing them to the provider was not required, so the no-show defense succeeded on three claims.
Bay Ls Med. Supplies, Inc. v Mvaic (2014 NY Slip Op 50417(U)) Appellate Term, Second Department, March 11, 2014Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the IME no-show defense unavailable because the scheduling letters were mailed more than 30 days after MVAIC received the claim.
Clove Med. Supply, Inc. v Ameriprise Ins. Co. (2014 NY Slip Op 50357(U)) Appellate Term, Second Department, February 28, 2014Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer failed to show its initial and follow-up EUO requests were timely under 11 NYCRR 65-3.5 (b) and 65-3.6 (b), since the record did not show when it received the claims.
Natural Therapy Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2014 NY Slip Op 50134(U)) Appellate Term, Second Department, January 28, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the EUO letters and nonappearance through the attorney present for the EUOs; the provider's justification objections were barred because it never responded to the requests.
Concourse Chiropractic, PLLC v State Farm Mut. Ins. Co. (2013 NY Slip Op 52225(U)) Appellate Term, Second Department, December 20, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's affidavits proved the EUO notices were timely sent and the provider failed to appear; counsel's affirmation raised no triable issue since the provider never responded to the letters.
Olmeur Med., P.C. v Nationwide Gen. Ins. Co. (2013 NY Slip Op 52031(U)) Appellate Term, Second Department, December 3, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the EUO attorney's affirmation proved the scheduling letters were mailed under the firm's office practice and, from personal knowledge, that the assignor failed to appear at either scheduled EUO.
Art of Healing Medicine, P.C. v Amica Mut. Ins. Co. (2013 NY Slip Op 52014(U)) Appellate Term, Second Department, November 29, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held the scheduler's affidavit proved timely mailing of the IME letters and the examiner's affidavit proved the assignor failed to appear for the scheduled IMEs.
J.C. Healing Touch Rehab, P.C. v Nationwide Ins. (2013 NY Slip Op 52011(U)) Appellate Term, Second Department, November 26, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the EUO scheduling letters under its law firm's standard practices, rejecting the provider's argument, and affirmed dismissal on the EUO no-show.
Five Boro Psychological Servs., P.C. v Utica Mut. Ins. Co. (2013 NY Slip Op 52005(U)) Appellate Term, Second Department, November 26, 2013Claimant showed the nonappearance was excused or the request unreasonable or waivedHeld the insurer did not prove two nonappearances because the initial EUO had been rescheduled by mutual agreement before its date, which is not a failure to appear.
Arco Med. NY, P.C. v Metropolitan Cas. Ins. Co. (2013 NY Slip Op 52001(U)) Appellate Term, Second Department, November 26, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved the EUO letters were mailed under its office practice, the EUOs properly scheduled, and nonappearance via the investigator's affidavit and on-the-record statements.
Vit Acupuncture, P.C. v Praetorian Ins. Co. (2013 NY Slip Op 52000(U)) Appellate Term, Second Department, November 26, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the scheduler's affidavit proved timely mailing of the IME requests and the examining doctor's and chiropractor's affidavits proved the assignor failed to appear.
Jacoby Chiropractic, P.C. v Redland Ins. Co. (2013 NY Slip Op 51998(U)) Appellate Term, Second Department, November 26, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved the assignor's nonappearance at two IMEs through the affidavit of the healthcare professional retained to perform them, and, the other findings being unchallenged, granted its cross motion.
Dream Acupuncture, P.C. v State Farm Fire & Cas. Co. (2013 NY Slip Op 51997(U)) Appellate Term, Second Department, November 26, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of the EUO letters and need not produce the policy to show an EUO provision, since post-2002 policies necessarily contain one.
Eagle Surgical Supply, Inc. v Allstate Indem. Co. (2013 NY Slip Op 52012(U)) Appellate Term, Second Department, November 26, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held a nine-day-late initial EUO request only shortened the time to deny, and refused to hear burdensomeness objections because the provider never responded to the request.
Ortho Prods. & Equip., Inc. v Interboro Ins. Co. (2013 NY Slip Op 52054(U)) Appellate Term, Second Department, November 21, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the EUO scheduling letters and that two assignors failed to appear at either scheduled EUO, and the provider raised no triable issue.
Megacure Acupuncture, P.C. v Lancer Ins. Co. (2013 NY Slip Op 51994(U)) Appellate Term, Second Department, November 21, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailed EUO scheduling letters and the owner's and treating provider's nonappearance, and that a follow-up sent within 10 days of the first nonappearance was not premature, defeating summary judgment on six claims.
Flatbush Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2013 NY Slip Op 51880(U)) Appellate Term, Second Department, October 29, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the EUO no-show defense established because the scheduling letters were shown timely mailed, and the provider's objections to the EUO requests were not heard since it never responded to them, making discovery unnecessary.
Barclays Med., P.C. v NY Cent. Mut. Fire Ins. Co. (2013 NY Slip Op 51758(U)) Appellate Term, Second Department, October 15, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedGranted the insurer summary judgment because the vendor's mailing affidavit proved the IME requests were timely mailed and the examining doctor and chiropractor's affidavits proved the assignor failed to appear.
Right Aid Med. Supply Corp. v Nationwide Ins. (2013 NY Slip Op 51746(U)) Appellate Term, Second Department, October 15, 2013Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the EUO no-show defense failed because the insurer did not comply with 65-3.6 (b) when sending its final EUO letter, failing to identify the party from whom the EUO was requested, so the toll was lost.
Ranbow Supply of N.Y., Inc. v Progressive Northeastern Ins. Co. (2013 NY Slip Op 51729(U)) Appellate Term, Second Department, October 8, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld dismissal on the IME no-show defense because the insurer showed the scheduling letters were sent to the address its insured provided and copies reached the assignor's attorney.
Compas Med., P.C. v Elrac, Inc. (2013 NY Slip Op 51734(U)) Appellate Term, Second Department, October 8, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established the IME no-show defense through a scheduling vendor's affidavit proving timely mailing of the letters and the examining professionals' affidavits proving the assignor's nonappearance.
Canarsie Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2013 NY Slip Op 51457(U)) Appellate Term, Second Department, August 26, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld the EUO no-show defense because the scheduling letters were proved timely mailed and the provider, having never responded to the requests, could not object to their justification or seek discovery on reasonableness.
South Nassau Community Hosp. v Kemper Independence Ins. Co. (2013 NY Slip Op 51384(U)) Appellate Term, Second Department, August 8, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedGranted the insurer summary judgment because the scheduler's affidavit proved timely mailing of the IME letters and the examining chiropractor attested to the assignor's nonappearance; counsel's affirmation raised no triable issue.
Colonia Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2013 NY Slip Op 51266(U)) Appellate Term, Second Department, July 12, 2013Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer failed to establish the assignor's nonappearance at the scheduled IMEs because the IME doctor's affidavit recited a discrepant address for where the examination was to occur.
Eagle Surgical Supply, Inc. v GEICO Gen. Ins. Co. (2013 NY Slip Op 51265(U)) Appellate Term, Second Department, July 12, 2013Insurer failed to prove the nonappearance by someone with personal knowledgeReversed a trial judgment for the insurer because its only witness, a scheduling supervisor relying on his review of the file, lacked personal knowledge of the assignor's nonappearances at the IMEs.
Bright Med. Supply Co. v IDS Prop. & Cas. Ins. Co. (2013 NY Slip Op 51123(U)) Appellate Term, Second Department, July 5, 2013Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer's motion properly denied because it offered no proof from anyone with personal knowledge that the provider failed to appear for the scheduled EUOs.
SP Chiropractic, P.C. v MVAIC (2013 NY Slip Op 51126(U)) Appellate Term, Second Department, July 5, 2013Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to show its initial and follow-up IME letters were properly mailed, so it did not establish the IMEs were properly scheduled.
SS Med. Care, P.C. v Nationwide Ins. (2013 NY Slip Op 51109(U)) Appellate Term, Second Department, July 1, 2013Insurer failed to prove the scheduling letters were mailed or properly addressedDenied the insurer summary judgment because it did not show mailing of EUO follow-up letters after the first nonappearance, and its IME letters went to addresses inconsistent with the NF-2 address its scheduler's practice required.
Right Aid Diagnostic Medicine, P.C. v Travelers Ins. Co. (2013 NY Slip Op 51033(U)) Appellate Term, Second Department, June 17, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedGranted the insurer summary judgment because it proved timely mailing of the IME letters and the examiners' affidavits showed the assignor failed to appear; counsel's affirmation raised no triable issue.
Ss Med. Care, P.C. v Hartford Ins. Co. (2013 NY Slip Op 51032(U)) Appellate Term, Second Department, June 17, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld dismissal on the EUO no-show because the insurer proved mailing of the scheduling letters and denials, the only point the provider contested.
Optimal Well-Being Chiropractic, P.C. v Hertz Co. (2013 NY Slip Op 50902(U)) Appellate Term, Second Department, May 22, 2013Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer's cross motion properly denied because it submitted no evidence from anyone with personal knowledge of the assignor's nonappearances at the EUOs.
Avenue I Med., P.C. v Hertz (2013 NY Slip Op 50840(U)) Appellate Term, Second Department, May 13, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the IME letters and, through the scheduled examiners' affidavits, the assignor's nonappearance, warranting summary judgment on its unopposed motion.
Flatlands Med., P.C. v State Farm Mut. Auto. Ins. Co. (2013 NY Slip Op 50763(U)) Appellate Term, Second Department, May 6, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld the EUO no-show defense because the scheduling letters were proved mailed and the provider, never having responded to the EUO request, could not object to its justification or need discovery on reasonableness.
Flatbush Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2013 NY Slip Op 50758(U)) Appellate Term, Second Department, May 6, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld the EUO no-show defense because the scheduling letters were proved timely mailed and the provider's objections to the EUO requests were not heard since it never responded to them.
Five Boro Psychological Servs., P.C. v State Farm Mut. Auto. Ins. Co. (2013 NY Slip Op 50753(U)) Appellate Term, Second Department, May 6, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld dismissal because the insurer proved timely mailing of the EUO scheduling letters and that the provider failed to appear at either scheduled EUO, appearance being a condition precedent to liability.
Infinity Health Prods., Ltd. v Redland Ins. Co. (2013 NY Slip Op 50751(U)) Appellate Term, Second Department, May 6, 2013Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to show the IMEs were properly scheduled because its letters went to a wrong zip code and to an attorney not shown to represent the assignor.
Quality Psychological Servs., P.C. v Travelers Home & Mar. Ins. Co. (2013 NY Slip Op 50750(U)) Appellate Term, Second Department, May 6, 2013Insurer failed to prove the nonappearance by someone with personal knowledgeHeld a scheduling company's affidavit and letters relaying that the examining professional reported the assignor's nonappearance insufficient to show the assignor actually failed to appear for the IMEs, so no triable issue was raised.
Alrof, Inc. v Safeco Natl. Ins. Co. (2013 NY Slip Op 50458(U)) Appellate Term, Second Department, March 21, 2013Insurer failed to prove the nonappearance by someone with personal knowledgeHeld an attorney's affirmation based on the office file and office practices had no probative value on the provider's nonappearance at the EUO because the attorney lacked personal knowledge, so the insurer's cross motion failed.
Broad St. Acupuncture, P.C. v American Tr. Ins. Co. (2013 NY Slip Op 50453(U)) Appellate Term, Second Department, March 20, 2013Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to establish proper mailing of the IME scheduling letters or the assignor's nonappearance, so it raised no triable issue on that claim.
All Boro Psychological Servs., P.C. v Allstate Ins. Co. (2013 NY Slip Op 50307(U)) Appellate Term, Second Department, February 20, 2013Insurer failed to prove the scheduling letters were mailed or properly addressedDenied the insurer's cross motion because it did not show timely mailing of the IME scheduling letters, leaving its time to pay or deny untolled.
Alev Med. Supply, Inc. v New York Cent. Mut. Fire Ins. Co. (2013 NY Slip Op 50258(U)) Appellate Term, Second Department, February 19, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held the insurer demonstrated timely mailing of initial and follow-up IME requests and the assignor's nonappearance at two IMEs, with the dispute turning on the timeliness of the denials.
Infinity Health Prods., Ltd. v Travelers Ins. Co. (2013 NY Slip Op 50253(U)) Appellate Term, Second Department, February 19, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer did not need new scheduling letters for a later bill, since the provider had already failed to appear for two properly scheduled EUOs for the same accident and assignor.
Compas Med., P.C. v Praetorian Ins. Co. (2013 NY Slip Op 50251(U)) Appellate Term, Second Department, February 19, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailing of the IME requests and, through the examining doctor's affidavit, the assignor's failure to appear for the duly scheduled IMEs, warranting dismissal of those claims.
Quality Psychological Servs., P.C. v Metropolitan Cas. Ins. Co. (2013 NY Slip Op 50250(U)) Appellate Term, Second Department, February 19, 2013Insurer failed to prove the scheduling letters were mailed or properly addressedDenied the insurer summary judgment on its EUO no-show defense because it did not establish that the scheduling letters were mailed before the scheduled EUO dates.
Compas Med., P.C. v Praetorian Ins. Co. (2013 NY Slip Op 50249(U)) Appellate Term, Second Department, February 19, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved the IME scheduling letters were timely mailed and, through the examining doctors' affidavits, that the assignor failed to appear, entitling it to dismissal of those claims.
Flatlands Med., P.C. v State Farm Mut. Auto. Ins. Co. (2013 NY Slip Op 50071(U)) Appellate Term, Second Department, January 14, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld dismissal because the insurer proved timely mailing of the EUO letters and the provider's nonappearance, and the provider's objections to the requests should not have been considered since it never responded to them.
Eastern Star Acupuncture, P.C. v American Tr. Ins. Co. (2013 NY Slip Op 50059(U)) Appellate Term, Second Department, January 14, 2013Insurer failed to prove the nonappearance by someone with personal knowledge (also decides)Held the insurer proved mailing and nonappearance for two claims, but for one claim it offered no affidavit from anyone with personal knowledge that the assignor missed the earlier scheduled IMEs.
Brooklyn Hgts. Physical Therapy, P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 52406(U)) Appellate Term, Second Department, December 21, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the IME scheduling letters by its scheduler's standard-practice affidavit and the assignor's nonappearance by the intended examining chiropractor's affidavit, entitling it to summary judgment.
Essential Acupuncture Servs., P.C. v Ameriprise Auto & Home Ins. (2012 NY Slip Op 52404(U)) Appellate Term, Second Department, December 21, 2012Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer did not raise a triable issue on the EUO no-show defense because it failed to establish timely mailing of the EUO scheduling letters.
Parsons Med. Supply, Inc. v Utica Mut. Ins. Co. (2012 NY Slip Op 52397(U)) Appellate Term, Second Department, December 21, 2012Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer failed to demonstrate that its initial and follow-up EUO requests were timely sent under the regulations, so the no-show defense could not support summary judgment.
Essential Acupuncture Servs., P.C. v Amex Assur. Co. (2012 NY Slip Op 52259(U)) Appellate Term, Second Department, December 7, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely EUO scheduling letters and the provider's failure to appear for two properly scheduled EUOs, and refused to consider reasonableness because the provider never responded to the requests.
Morris Med., P.C. v Amex Assur. Co. (2012 NY Slip Op 52260(U)) Appellate Term, Second Department, December 7, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely EUO letters and nonappearance at both EUOs for six claims, and declined to consider the reasonableness of the requests because the provider never responded to them.
Arco Med. NY, P.C. v Lancer Ins. Co. (2012 NY Slip Op 52178(U)) Appellate Term, Second Department, November 26, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer showed timely mailed EUO letters and the principals' nonappearance, and that a follow-up sent within 10 days of the first missed EUO was not premature, defeating the provider's summary judgment.
W.H.O. Acupuncture, P.C. v Kemper Independence Ins. Co. (2012 NY Slip Op 52046(U)) Appellate Term, Second Department, October 18, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld dismissal on the IME no-show, rejecting the argument that the assignor need not respond to letters from a third party because the letters clearly stated they were sent on the insurer's behalf.
Infinity Health Prods., Ltd. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 51955(U)) Appellate Term, Second Department, October 16, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the IME scheduling letters and, via the examining physician's affirmation, the assignor's nonappearance; the provider's opposition raised no triable issue.
New Way Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 51954(U)) Appellate Term, Second Department, October 16, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the affidavit of the professional who was to perform the IMEs established the assignor's nonappearance, the only issue left for trial, so the insurer was entitled to dismissal of those causes of action.
Delta Diagnostic Radiology, P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 51953(U)) Appellate Term, Second Department, October 16, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the scheduler's affidavit and the examining doctors' affirmations established the assignor's failure to appear for duly scheduled IMEs, and counsel's affirmation in opposition raised no triable issue.
Rainbow Med. Care, P.C. v Kemper Ins. Co. (2012 NY Slip Op 51923(U)) Appellate Term, Second Department, October 5, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the IME scheduling letters and, through the chiropractor's affidavit, the assignor's nonappearance, entitling it to summary judgment.
All Boro Psychological Servs., P.C. v Hartford Ins. Co. (2012 NY Slip Op 51849(U)) Appellate Term, Second Department, September 19, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the EUO scheduling letters and that the provider failed to appear at either scheduled EUO, a condition precedent to liability.
Arco Med. N.Y., P.C. v Lancer Ins. Co. (2012 NY Slip Op 22278) Appellate Term, Second Department, September 19, 2012Proof on the no-show raises a question of fact; neither side wins the point as a matter of lawHeld the insurer raised a triable issue on later claims by showing timely EUO scheduling letters and two nonappearances, rejecting the lower court's reliance on the out-of-county location and on a willfulness requirement.
Jamaica Med. Supply, Inc. v Encompass Indem. Co. (2012 NY Slip Op 51825(U)) Appellate Term, Second Department, September 13, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailed EUO letters and the assignors' nonappearance, and refused to hear objections to the requests because neither the provider nor the assignors responded to them.
BLR Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 51770(U)) Appellate Term, Second Department, September 5, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Left in place the unchallenged finding that the insurer showed the assignor failed to appear for properly scheduled EUOs, and granted summary judgment once the denial was shown timely.
Royal Med. Supply, Inc. v Progressive Northeastern Ins. Co. (2012 NY Slip Op 51727(U)) Appellate Term, Second Department, August 31, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld the no-show defense because the insurer's proof of nonappearance at two EUOs timely scheduled after receipt of the claim was undisputed, making any gap regarding an earlier EUO date immaterial.
Atlantic Radiology Imaging, P.C. v NY Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 51725(U)) Appellate Term, Second Department, August 31, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the IME scheduling letters and, through the examiners' affirmations, the assignor's nonappearance, entitling it to summary judgment.
Brooklyn Hgts. Physical Therapy, P.C. v Liberty Mut. Fire Ins. Co. (2012 NY Slip Op 51712(U)) Appellate Term, Second Department, August 31, 2012Proof on the no-show raises a question of fact; neither side wins the point as a matter of lawHeld the insurer's proof of mailed IME letters, the assignor's nonappearance and timely denials raised a triable issue on the no-show defense, so the provider's summary judgment was vacated.
W.H.O. Acupuncture, P.C. v Travelers Home & Mar. Ins. Co. (2012 NY Slip Op 51707(U)) Appellate Term, Second Department, August 31, 2012Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the defense established for one claim, the letters properly mailed and from an agent acting for the insurer, but failed for two claims because the first IME was not scheduled within 30 days of receipt.
Quality Health Prods. v Hertz Claim Mgt. Corp (2012 NY Slip Op 51722(U)) Appellate Term, Second Department, August 31, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the IME nonappearances proved because the chiropractor and orthopedist stated on personal knowledge that the assignors failed to appear, so the acupuncturist's 'best of knowledge' wording did not matter.
Neomy Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 51653(U)) Appellate Term, Second Department, August 24, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the IME letters and, through the examiner's affidavit, the assignor's nonappearance; counsel's affirmation raised no triable issue.
Jamhil Med., P.C. v Clarendon Natl. Ins. Co. (2012 NY Slip Op 51644(U)) Appellate Term, Second Department, August 23, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the IME scheduling letters and, through the examiner's affidavit, the assignor's nonappearance, entitling it to summary judgment.
All Star Wellness Med., P.C. v Praetorian Ins. Co. (2012 NY Slip Op 51630(U)) Appellate Term, Second Department, August 7, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the vendor's mailing affidavit and the examining chiropractor's affidavit established mailing of the IME requests and the assignor's nonappearance, and the provider raised no triable issue.
Quality Psychological Servs., P.C. v Interboro Mut. Indem. Ins. Co. (2012 NY Slip Op 51628(U)) Appellate Term, Second Department, August 7, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the managing attorney's affirmation describing the firm's appearance-tracking practices proved the assignor failed to appear at both EUOs, and the letters were timely mailed.
Infinity Health Prods., Ltd. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 51497(U)) Appellate Term, Second Department, August 6, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedReversed the finding that the IME no-show defense was triable, holding the insurer proved timely mailing of the scheduling letters and, via the doctors' affidavits, the assignor's nonappearance.
Jamaica Dedicated Med. Care, P.C. v State Farm Mut. Auto. Ins. Co. (2012 NY Slip Op 51493(U)) Appellate Term, Second Department, August 6, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedAffirmed dismissal of the EUO no-show claims, holding the insurer's affidavits proved timely and proper mailing of the scheduling letters and rejecting the provider's remaining contentions.
Perfect Point Acupuncture, P.C. v Auto One Ins. Co. (2012 NY Slip Op 51486(U)) Appellate Term, Second Department, August 6, 2012Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer did not show it mailed the IME scheduling letters to the assignor, so it failed to prove a breach of the IME condition precedent and its cross motion should have been denied.
Dvs Chiropractic, P.C. v Interboro Ins. Co. (2012 NY Slip Op 51443(U)) Appellate Term, Second Department, July 18, 2012Claimant showed the nonappearance was excused or the request unreasonable or waivedHeld the insurer did not prove a failure to appear at both an initial and follow-up EUO because its own affidavit showed the initial EUO was twice rescheduled by mutual agreement before the scheduled dates.
J.M. Chiropractic Servs., PLLC v State Farm Mut. Ins. Co. (2012 NY Slip Op 51348(U)) Appellate Term, Second Department, July 13, 2012Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the motion to dismiss on the EUO no-show properly denied because the insurer did not prove the scheduling letters were timely mailed; it rejected any bold-font requirement for the letters.
All Boro Psychological Servs., P.C. v State Farm Mut. Auto. Ins. Co. (2012 NY Slip Op 51346(U)) Appellate Term, Second Department, July 13, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the EUO scheduling letters and, through the conducting attorney's affirmation, the provider's nonappearance at both EUOs; objections to the requests were not heard because the provider never responded to them.
Brooklyn Hgts. Physical Therapy, P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 51337(U)) Appellate Term, Second Department, July 12, 2012Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the IME no-show defense failed because the follow-up IME letter was not mailed within the regulatory time after the first nonappearance, so it did not toll the time to deny.
Five Boro Psychological Servs., P.C. v Praetorian Ins. Co. (2012 NY Slip Op 51336(U)) Appellate Term, Second Department, July 12, 2012Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer failed to establish nonappearance at two scheduled IMEs because it did not show as a matter of law that its rescheduling letter, sent after the assignor cancelled, was not a mutual rescheduling.
Mega Supplies Billing, Inc. v State Farm Mut. Auto. Ins. Co. (2012 NY Slip Op 51276(U)) Appellate Term, Second Department, June 27, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of the EUO letters and the provider's nonappearance at both EUOs, and rejected the argument that the insurer had to advise that a justified nonappearance would be excused.
Colonia Med., P.C. v State Farm Mut. Auto. Ins. Co. (2012 NY Slip Op 51273(U)) Appellate Term, Second Department, June 27, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailing of the EUO scheduling letters, rejecting the provider's challenge, and affirmed summary judgment on the EUO no-show defense.
Mega Supplies Billing, Inc. v State Farm Mut. Auto. Ins. Co. (2012 NY Slip Op 51269(U)) Appellate Term, Second Department, June 27, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the EUO letters; the provider's nonappearance challenge was raised first in a reply brief and its nonattendance had been conceded as not in dispute.
Tsatskis v State Farm Fire & Cas. Co. (2012 NY Slip Op 51268(U)) Appellate Term, Second Department, June 27, 2012Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the initial EUO request, sent more than 30 days after receipt of 13 claims, did not toll the insurer's time, while rejecting the argument that the insurer had to prove its policy contained an EUO endorsement.
VE Med. Care, P.C. v NY Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 51074(U)) Appellate Term, Second Department, June 11, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established prima facie mailing of the IME scheduling letters and, through the examining physicians' affirmations, the assignor's nonappearance; counsel's opposing affirmation raised no triable issue.
BR Clinton Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 51068(U)) Appellate Term, Second Department, June 11, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer entitled to summary judgment because its examining chiropractors' affidavits established the assignor's nonappearance at the scheduled IMEs and counsel's affirmation raised no triable issue.
Yklik, Inc. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 51066(U)) Appellate Term, Second Department, June 11, 2012Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to establish its IME no-show defense because its affidavits conflicted on which company scheduled the IME and no one from the company it named attested that the IME was scheduled.
Concourse Chiropractic, PLLC v Fiduciary Ins. Co. of Am. (2012 NY Slip Op 51058(U)) Appellate Term, Second Department, June 11, 2012Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the EUO no-show defense failed because the second EUO request was mailed more than the permitted time after the first nonappearance, so it did not toll the time to deny.
Midwood Total Rehabilitation Med., P.C. v State Farm Mut. Auto. Ins. Co. (2012 NY Slip Op 50931(U)) Appellate Term, Second Department, May 15, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established mailing of the IME scheduling letters and, through the examiners' affirmations, the assignor's nonappearance; counsel's affirmation raised no triable issue.
Leica Supply, Inc. v Encompass Indem. Co. (2012 NY Slip Op 50890(U)) Appellate Term, Second Department, May 14, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailed EUO letters and nonappearance at both EUOs, and refused to hear objections to the requests because the provider never responded to them.
Mega Supplies Billing, Inc. v State Farm Fire & Cas. Co. (2012 NY Slip Op 51014(U)) Appellate Term, Second Department, May 14, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailed EUO scheduling letters and the provider's failure to appear at both EUOs, a condition precedent to liability, warranting dismissal.
BR Clinton Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 50880(U)) Appellate Term, Second Department, May 11, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailing of the IME scheduling letters through the scheduler's standard-practice affidavit and the assignor's nonappearance through the examining chiropractor's affidavit, and the provider raised no triable issue.
Eagle Surgical Supply, Inc. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 50772(U)) Appellate Term, Second Department, April 27, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld dismissal of claims on the EUO no-show, rejecting the provider's argument that the insurer had to prove the policy contained a provision entitling it to EUOs.
Axis Chiropractic, PLLC v Clarendon Natl. Ins. Co. (2012 NY Slip Op 50753(U)) Appellate Term, Second Department, April 25, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the IME scheduling letters and, through the orthopedist's affirmations, the assignors' nonappearance at the duly scheduled IMEs.
Quality Psychological Servs., P.C. v MVAIC (2012 NY Slip Op 50757(U)) Appellate Term, Second Department, April 25, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailing of the IME scheduling letters and, through the examiner's affidavit, the assignor's nonappearance, and the provider raised no issue of fact.
East-West Acupuncture v Safeco Ins. Co. of Ind. (2012 NY Slip Op 22095) Appellate Term, Second Department, April 4, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedAffirmed conditional summary judgment on the EUO no-show, finding the mailing procedures for the scheduling letters adequately shown and permitting a late certificate of conformity.
Viviane Etienne Med. Care, P.C. v State Farm Mut. Auto. Ins. Co. (2012 NY Slip Op 50579(U)) Appellate Term, Second Department, April 2, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of the EUO letters and, through the conducting attorney's affirmation, the provider's nonappearance at both EUOs; objections to the requests were not heard because the provider never responded.
East 75th St. Diagnostic Imaging, P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 50564(U)) Appellate Term, Second Department, March 28, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established mailing of the IME notices and, through the examining doctors' affidavits and affirmation, the assignor's nonappearance, entitling it to summary judgment.
Superior Oxygen & Ortho Supplies, Ltd. v Auto One Ins. Co. (2012 NY Slip Op 50348(U)) Appellate Term, Second Department, February 21, 2012Insurer failed to prove the scheduling letters were mailed or properly addressed (also decides)Held the EUO no-show defense failed because the insurer did not establish timely mailing of the EUO scheduling letters, so tolling and a timely denial were not shown.
Arco Med. NY, P.C. v Lancer Ins. Co. (2011 NY Slip Op 52384(U)) Appellate Term, Second Department, December 23, 2011Proof on the no-show raises a question of fact; neither side wins the point as a matter of lawHeld the insurer raised a triable issue on its EUO no-show defense for five claims by showing timely mailed initial and follow-up requests and the doctors' failure to appear at both scheduled EUOs.
Arco Med. NY, P.C. v Lancer Ins. Co. (2011 NY Slip Op 52383(U)) Appellate Term, Second Department, December 23, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Found the insurer properly requested the principals' EUOs and showed they failed to appear, but the defense failed on the denial.
ARCO Med. N.Y., P.C. v Lancer Ins. Co. (2011 NY Slip Op 52382(U)) Appellate Term, Second Department, December 23, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailed EUO requests within 15 days, a follow-up not premature because sent within 10 days of the first nonappearance, and the doctors' failure to appear at both EUOs.
Alrof, Inc. v Country Wide Ins. Co. (2011 NY Slip Op 52297(U)) Appellate Term, Second Department, December 19, 2011Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer's cross motion properly denied because it offered no admissible evidence from anyone with personal knowledge of the assignor's nonappearances at the IMEs.
Vega Chiropractic, P.C. v Kemper Independence Ins. Co. (2011 NY Slip Op 52291(U)) Appellate Term, Second Department, December 19, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedLeft summary judgment for the insurer in place on the IME no-show claims because the provider submitted insufficient evidence to raise an issue of fact that the scheduling of the three IMEs was unreasonable.
Neomy Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 52279(U)) Appellate Term, Second Department, December 16, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established mailing of the IME letters and, through the examining chiropractor's affidavit, the assignor's nonappearance; counsel's affirmation raised no triable issue.
Metrostar, Inc. v Electric Ins. Co. (2011 NY Slip Op 52277(U)) Appellate Term, Second Department, December 16, 2011Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the IME no-show defense unproved because the insurer's affidavits did not establish proper mailing of the scheduling letters.
Eastern Star Acupuncture, P.C. v American Tr. Ins. Co. (2011 NY Slip Op 52205(U)) Appellate Term, Second Department, December 5, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved for one claim that the IME requests were timely mailed and, by affidavit and affirmation, that the assignor failed to appear, entitling it to dismissal of that claim.
Park Slope Med. v Praetorian Ins. Co. (2011 NY Slip Op 52062(U)) Appellate Term, Second Department, November 4, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailing of the IME scheduling letters and, through the chiropractor's affidavit, the assignor's nonappearance at the duly scheduled IMEs.
Mega Supplies Billing, Inc. v State Farm Mut. Auto. Ins. Co. (2011 NY Slip Op 52023(U)) Appellate Term, Second Department, October 28, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld dismissal for the provider's failure to appear at two EUOs, rejecting the argument that the insurer had to prove its policy contained an EUO provision, since the post-2002 mandatory endorsement includes one.
Richmond Radiology, P.C. v American Tr. Ins. Co. (2011 NY Slip Op 52012(U)) Appellate Term, Second Department, October 27, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the affidavit of the investigator responsible for conducting the EUOs established that the assignor failed to appear for the scheduled EUOs, so summary judgment for the insurer was proper.
Padova Physical Rehab. Medicine, P.C. v Praetorian Ins. Co. (2011 NY Slip Op 51862(U)) Appellate Term, Second Department, October 14, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld, reversing a contrary finding, that the examining professionals' affirmations sufficiently established the assignor's nonappearance and that the IME notices had been timely mailed.
Proscan Imaging Buffalo v Clarendon Natl. Ins. Co. (2011 NY Slip Op 51855(U)) Appellate Term, Second Department, October 12, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld, reversing a contrary finding, that the chiropractor's affidavit sufficiently established the assignor's nonappearance and that the IME requests had been timely mailed.
Triangle R, Inc. v Clarendon Natl. Ins. Co. (2011 NY Slip Op 51854(U)) Appellate Term, Second Department, October 12, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailing of the IME requests and, through the doctor's and chiropractor's sworn statements, the assignor's nonappearance at the duly scheduled IMEs.
Parkway Imaging & Diagnostic, P.C. v Clarendon Natl. Ins. Co. (2011 NY Slip Op 51853(U)) Appellate Term, Second Department, October 12, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld, reversing a contrary finding, that the scheduling service's affidavit established timely mailing of the IME requests and the IME doctor's affirmation established the assignor's nonappearance; counsel's opposition raised no triable issue.
Five Boro Psychological Servs., P.C. v State Farm Mut. Auto. Ins. Co. (2011 NY Slip Op 51846(U)) Appellate Term, Second Department, October 11, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved its EUO no-show defense through office-practice proof of mailing and an affirmation of the attorney conducting the EUOs, and rejected the requirement that scheduling letters conspicuously highlight their contents.
Fiutek v Clarendon Natl. Ins. Co. (2011 NY Slip Op 51840(U)) Appellate Term, Second Department, October 11, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved the IME no-show elements through the scheduling service's office-practice mailing affidavit and the examining professional's affidavit of nonappearance, reversing a finding of triable issues.
Delta Diagnostic Radiology, P.C. v Autoone Ins. Co. (2011 NY Slip Op 51839(U)) Appellate Term, Second Department, October 11, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved the IME no-show defense through the scheduler's mailing affidavit and the chiropractor's affidavit that the assignor failed to appear.
Vincent Med. Servs., P.C. v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 51718(U)) Appellate Term, Second Department, September 16, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved the IME no-show defense with the scheduler's mailing affidavit and the examiner's affidavit of nonappearance, so its cross motion should have been granted.
Shoreline Healing Acupuncture Group, P.C. v American Tr. Ins. Co. (2011 NY Slip Op 51531(U)) Appellate Term, Second Department, August 4, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved the IME no-show defense through the scheduler's mailing affidavit and the chiropractor's affidavit of the assignors' nonappearance.
Alrof, Inc. v Nationwide Ins. Co. (2011 NY Slip Op 51451(U)) Appellate Term, Second Department, July 28, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved the IME no-show defense through the mailing company's affidavit and the examining doctor's receptionist's affidavit of nonappearance.
Corona Hgts. Med., P.C. v Lancer Ins. Co. (2011 NY Slip Op 51293(U)) Appellate Term, Second Department, July 5, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved the provider's EUO no-show through timely mailed scheduling letters and proof of nonappearance, entitling it to dismissal of the claims.
Manhattan Med. Imaging, P.C. v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 51230(U)) Appellate Term, Second Department, June 30, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held the scheduler's affidavit proved the IME notices were sent and the examining doctor's affidavit proved the assignor's two nonappearances.
East Coast Acupuncture, P.C. v Clarendon Natl. Ins. Co. (2011 NY Slip Op 51229(U)) Appellate Term, Second Department, June 30, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's unopposed papers proved mailing of the IME letters and the assignor's failure to attend, reversing a finding of credibility issues as to those claims.
All Borough Group Med. Supply, Inc. v Utica Mut. Ins. Co. (2011 NY Slip Op 50949(U)) Appellate Term, Second Department, May 23, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved the IME no-show defense through the scheduler's mailing affidavit and an affidavit from the examining psychologist's office establishing nonappearance.
LDE Med. Servs., P.C. v Interboro Ins. Co. (2011 NY Slip Op 50946(U)) Appellate Term, Second Department, May 23, 2011Insurer failed to prove the nonappearance by someone with personal knowledgeHeld a pre-claim IME letter was not a nullity, but the insurer failed to prove the nonappearances because its moving papers had no one with personal knowledge and the doctors' affirmations came improperly in reply.
Crescent Radiology, PLLC v American Tr. Ins. Co. (2011 NY Slip Op 50622(U)) Appellate Term, Second Department, April 6, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved the EUO no-show defense and rejected the objective-justification objection because the papers showed the basis for the EUO and the claimant never responded to the request.
All County, LLC v Unitrin Advantage Ins. Co. (2011 NY Slip Op 50621(U)) Appellate Term, Second Department, April 6, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved the IME no-show defense and that the objective-justification requirement of 65-3.5 (e) applies only to EUOs, not to IME requests.
Urban Radiology, P.C. v Clarendon Natl. Ins. Co. (2011 NY Slip Op 50601(U)) Appellate Term, Second Department, April 5, 2011Insurer failed to prove the scheduling letters were mailed or properly addressedDenied the insurer summary judgment on the EUO no-show defense because it did not prove that the initial and follow-up EUO requests were mailed.
Tri-Mount Acupuncture, P.C. v N.Y. Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 50335(U)) Appellate Term, Second Department, March 2, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer made its prima facie no-show showing through the scheduler's mailing affidavit and the examiners' statements of nonappearance, and counsel's reply affirmation raised no triable issue.
GLM Med., P.C. v State Farm Mut. Auto. Ins. Co. (2011 NY Slip Op 50194(U)) Appellate Term, Second Department, February 14, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailed EUO letters and, through the attorney who was to conduct them, the provider's nonappearance, and that the letters need not highlight the time and place in bold or larger font.
ARCO Med. NY, P.C. v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 50184(U)) Appellate Term, Second Department, February 14, 2011Insurer failed to prove the scheduling letters were mailed or properly addressedAffirmed denial of the insurer's no-show motion because its affidavits did not establish mailing of the IME scheduling letters by the vendor's standard practice or by personal mailing.
Allstate Social Work & Psychological Servs., PLLC v Utica Mut. Ins. Co. (2011 NY Slip Op 21010) Appellate Term, Second Department, January 10, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedUpheld the IME no-show defense, rejecting the objection that IMEs must be conducted by physicians because a psychologist could properly examine assignors who received psychological treatment.
Trimed Med. Supply, Inc. v ELRAC, Inc. (2010 NY Slip Op 52057(U)) Appellate Term, Second Department, November 26, 2010Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld that the affidavit of the doctor who was to perform the IMEs established the assignor's nonappearance at the doctor's office, located at the address in the scheduling letters.
Lde Med. Servs., P.C. v Encompass Ins. (2010 NY Slip Op 51845(U)) Appellate Term, Second Department, October 20, 2010Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the affirmation of the associate at the law firm conducting the EUOs set forth facts sufficient to show the assignor failed to appear for duly scheduled EUOs, so the provider's summary judgment was vacated.
St. Vincent Med. Care, P.C. v Clarendon Natl. Ins. Co. (2010 NY Slip Op 51728(U)) Appellate Term, Second Department, October 1, 2010Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the scheduler's affidavit proved mailing of the IME notices and the examining doctor's affidavit proved the assignor's nonappearance, entitling the insurer to judgment on three causes of action.
Points of Health Acupuncture, P.C. v Lancer Ins. Co. (2010 NY Slip Op 51455(U)) Appellate Term, Second Department, August 12, 2010Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved the EUO no-show defense through the law firm's mailing practice and counsel's account of the provider's nonappearance at the firm's office.
Points of Health Acupuncture, P.C. v Lancer Ins. Co. (2010 NY Slip Op 51338(U)) Appellate Term, Second Department, July 22, 2010Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established the no-show defense for three claims through counsel's detailed affirmation of the firm's mailing practice for the EUO letters and facts showing the provider failed to appear at the scheduled EUOs.
Infinity Health Prods., Ltd. v Progressive Ins. Co. (2010 NY Slip Op 51334(U)) Appellate Term, Second Department, July 22, 2010Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the EUO no-show defense failed to raise a triable issue because the insurer did not establish that the EUO scheduling letters were timely mailed.
Eagle Surgical Supply, Inc. v Utica Mut. Ins. Co. (2010 NY Slip Op 51057(U)) Appellate Term, Second Department, June 11, 2010Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedRejected the argument that EUO scheduling letters sent by the insurer's counsel were nullities, since they told the assignor counsel acted for the insurer, and upheld the finding of two missed EUOs.
Five Boro Psychological Servs., P.C. v Progressive Northeastern Ins. Co. (2010 NY Slip Op 50991(U)) Appellate Term, Second Department, June 4, 2010Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established that its retained law firm properly mailed the EUO scheduling notices and that the assignor failed to appear, the attorney's rescheduling contacts showing he acted for the assignor.
Central Radiology Servs., P.C. v MVAIC (2010 NY Slip Op 50887(U)) Appellate Term, Second Department, May 13, 2010Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the IME defense failed because the letters relied on were confirmations addressed to the insurer, with only a carbon copy to the assignor, and so were not proper IME requests tolling the insurer's time.
Crotona Hgts. Med., P.C. v Farm Family Cas. Ins. Co. (2010 NY Slip Op 50716(U)) Appellate Term, Second Department, April 16, 2010Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the affirmation of the partner at the law firm retained to conduct the EUO established the provider's nonappearance for duly scheduled EUOs, which with the unappealed mailing findings warranted dismissal.
Riu Chiropractic, P.C. v AutoOne Ins. Co. (2010 NY Slip Op 50653(U)) Appellate Term, Second Department, April 9, 2010Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer made its prima facie case on the IME no-show defense through an affidavit showing the scheduling letters were timely mailed per office practice and the examining physician's affirmation of nonappearance.
St. Vincent Med. Care, P.C. v Travelers Ins. Co. (2010 NY Slip Op 50446(U)) Appellate Term, Second Department, March 10, 2010Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the EUO scheduling letters, mailed 52 days after the bills were received, were untimely under the verification rules and did not toll the time to pay or deny.
Park Slope Med. & Surgical Supply, Inc. v Chubb Group of Ins. (2010 NY Slip Op 50151(U)) Appellate Term, Second Department, January 29, 2010Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer's opposing affidavits were insufficient to show the assignor had not appeared for the IMEs, so it raised no triable issue against the provider's motion.
Canarsie Family Med. Practice, PLLC v American Tr. Ins. Co. (2010 NY Slip Op 50070(U)) Appellate Term, Second Department, January 12, 2010Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer's papers failed to establish that the assignor did not appear for the IMEs, so it neither won summary judgment nor raised a triable issue, and the provider was awarded those claims.
Radiology Today, P.C. v GEICO Ins. Co. (2009 NY Slip Op 52208(U)) Appellate Term, Second Department, October 23, 2009Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved its IME no-show defense: the scheduling service's affidavit showed proper mailing of the notices and the examiners' affidavits showed the assignor's nonappearance.
A.B. Med. Servs., PLLC v American Tr. Ins. Co. (2009 NY Slip Op 52067(U)) Appellate Term, Second Department, October 6, 2009Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established mailing of the EUO notices and the assignor's nonappearance, and rejected arguments that the notices were defective and the EUO unnecessary.
DVS Chiropractic, P.C. v Mercury Cas. Co. (2009 NY Slip Op 51887(U)) Appellate Term, Second Department, September 1, 2009Insurer failed to prove the scheduling letters were mailed or properly addressedDenied summary judgment on the IME no-show because the insurer did not prove timely mailing of the scheduling letters under a standard office practice.
Vega Chiropractic, P.C. v Clarendon Natl. Ins. Co. (2009 NY Slip Op 52536(U)) Appellate Term, Second Department, August 31, 2009Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established that the assignor failed to attend the scheduled IMEs and that the scheduling letters were timely sent under a standard office mailing practice.
W & Z Acupuncture, P.C. v Amex Assur. Co. (2009 NY Slip Op 51732(U)) Appellate Term, Second Department, July 31, 2009Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld that the affirmation of a partner in the law firm retained to conduct the EUOs alleged facts sufficient to establish the provider's owner failed to appear for duly scheduled EUOs.
Inwood Hill Med., P.C. v Progressive Cas. Ins. Co. (2009 NY Slip Op 51397(U)) Appellate Term, Second Department, June 29, 2009Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer's cross motion should have been denied because it did not establish by admissible proof that the assignor failed to appear for the EUOs and IMEs.
Careplus Med. Supply, Inc. v AutoOne Ins. Co. (2009 NY Slip Op 51372(U)) Appellate Term, Second Department, June 29, 2009Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to prove mailing of the IME scheduling letters and also failed to establish the assignors' nonappearance, so it raised no triable issue on its no-show defense.
Advanced Med., P.C. v Utica Mut. Ins. Co. (2009 NY Slip Op 51023(U)) Appellate Term, Second Department, May 22, 2009Insurer failed to prove the scheduling letters were mailed or properly addressed (also decides)Held the EUO no-show defense unavailable because the insurer did not establish that the EUO scheduling letters were timely mailed.
A.B. Med. Servs., PLLC v Country-Wide Ins. Co. (2009 NY Slip Op 50583(U)) Appellate Term, Second Department, April 1, 2009Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to prove proper mailing of the IME scheduling letters, so its no-show defense failed and the providers were granted summary judgment on those claims.
RLC Med., P.C. v Allstate Prop. & Cas. Ins. Co. (2009 NY Slip Op 52691(U)) Appellate Term, Second Department, March 19, 2009Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer failed to raise a triable issue on its EUO no-show denials because its own opposition papers alleged the assignor had appeared at the EUO.
Audobon Physical Med & Rehab, P.C. v GEICO Ins. Co. (2009 NY Slip Op 50456(U)) Appellate Term, Second Department, March 16, 2009Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the scheduling company manager's affidavit insufficient to show the IME requests were mailed or that the assignor failed to appear, so the insurer raised no triable issue.
Daras v GEICO Ins. Co. (2009 NY Slip Op 50438(U)) Appellate Term, Second Department, March 10, 2009Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to establish by admissible proof that the IME requests were timely mailed and that the assignor failed to appear, so the provider's motion should have been granted.
Great Wall Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2009 NY Slip Op 50294(U)) Appellate Term, Second Department, February 20, 2009Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the EUO no-show defense established because the policy had an EUO endorsement, letters sent to the provider's attorney were effective, post-2003 EUOs needed only a reasonable date rather than 30 days, and the owner did not appear.
Richard Morgan Do, P.C. v State Farm Mut. Auto. Ins.Co. (2009 NY Slip Op 50242(U)) Appellate Term, Second Department, February 13, 2009Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the IME scheduling company employee's affidavit sufficiently established that the initial and follow-up IME requests were mailed to the assignor, sustaining the no-show defense.
Great Wall Acupuncture, P.C. v New York Central Mutual Insurance Company (2009 NY Slip Op 50224(U)) Appellate Term, Second Department, February 10, 2009Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the EUO no-show defense failed because the insurer did not timely request the EUO after receiving the bills under the verification rules, so its time to deny was not tolled.
All Mental Care Medicine, P.C. v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 52588(U)) Appellate Term, Second Department, December 31, 2008Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to establish by admissible proof that the IME requests were timely mailed and that the assignor failed to appear, so the provider was entitled to summary judgment.
Tuncel v Progressive Cas. Ins. Co. (2008 NY Slip Op 52455(U)) Appellate Term, Second Department, December 3, 2008Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the affidavit of the chiropractor who was to examine the assignor established the nonappearance at her office, which was at the address in the IME scheduling letters, rejecting the provider's address objection.
Post Traumatic Med. Care, P.C. v Progressive Cas. Ins. Co. (2008 NY Slip Op 51954(U)) Appellate Term, Second Department, September 29, 2008Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer raised no triable issue on its IME no-show defense because it submitted no admissible evidence from anyone with personal knowledge of the assignors' nonappearances.
Eagle Surgical Supply, Inc. v Progressive Cas. Ins. Co. (2008 NY Slip Op 28342) Appellate Term, Second Department, September 10, 2008Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved its EUO no-show defense: the policy endorsement authorized EUOs, letters were timely mailed, the 30-day scheduling rule no longer applied to EUOs after the 2002 amendment, the date was reasonable, and the assignor failed to appear.
Crossbridge Diagnostic Radiology, P.C. v Progressive Ins. Co. (2008 NY Slip Op 51761(U)) Appellate Term, Second Department, August 19, 2008Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer's affidavit insufficient to establish the assignor's nonappearance at the scheduled EUOs, so it raised no triable issue and the provider was granted summary judgment on that claim.
Quality Health Prods., P.C. v Progressive Ins. Co. (2008 NY Slip Op 51757(U)) Appellate Term, Second Department, August 19, 2008Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the IME no-show defense failed for two claims because the insurer offered no proof in admissible form that the assignor failed to appear, even though the scheduling requests were shown to have been mailed.
Vista Surgical Supplies, Inc. v Autoone Ins. Co. (2008 NY Slip Op 51460(U)) Appellate Term, Second Department, July 8, 2008Insurer failed to prove the nonappearance by someone with personal knowledgeDenied summary judgment on one claim because the insurer offered no proof from anyone with personal knowledge of the assignor's failure to appear for the two IMEs.
Midisland Med., PLLC v New York Cent. Mut. Ins. Co. (2007 NY Slip Op 51983(U)) Appellate Term, Second Department, September 4, 2007Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer raised no triable issue on its IME no-show defense because it submitted no affidavit from anyone with personal knowledge of the assignor's failure to appear.
Triboro Chiropractic & Acupuncture, PLLC v New York Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 51175(U)) Appellate Term, Second Department, June 8, 2007Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer's affidavit insufficient to establish either the mailing of the IME notices or the assignor's nonappearance, so its motion was properly denied.
First Help Acupuncture, P.C. v Progressive Northeastern Ins. Co. (2007 NY Slip Op 51167(U)) Appellate Term, Second Department, June 5, 2007Insurer failed to prove the nonappearance by someone with personal knowledge (also decides)Held the insurer failed to raise a triable issue on its IME no-show defense for one assignor's bills because it submitted no affidavit from anyone with personal knowledge of the failure to appear.
Psychological Practice, P.C. v State Farm Fire & Cas. Co. (2007 NY Slip Op 27165) Appellate Term, Second Department, April 26, 2007Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer failed to submit admissible proof that the assignor did not appear for the IMEs, so it raised no triable issue and its cross motion on that ground failed.
Mega Supply & Billing, Inc. v AIU Ins. Co. (2007 NY Slip Op 50687(U)) Appellate Term, Second Department, April 2, 2007Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to raise a triable issue on its EUO no-show defense because its affidavit did not establish mailing of the scheduling letters, so the provider's motion was granted.
Impulse Chiropractic, P.C. v Kemper Ins. Co. (2007 NY Slip Op 50665(U)) Appellate Term, Second Department, March 28, 2007Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer raised no triable issue on its IME no-show defense because no one with personal knowledge attested to mailing of the scheduling notices or to the assignor's nonappearances.
Wei Wei Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2007 NY Slip Op 50394(U)) Appellate Term, Second Department, March 5, 2007Insurer failed to prove the scheduling letters were mailed or properly addressedRejected the EUO no-show defense because only an attorney without personal knowledge asserted that EUO requests were sent and the insured failed to appear, so the mailings were not established.
Great Wall Acupuncture v Utica Mut. Ins. Co. (2007 NY Slip Op 50389(U)) Appellate Term, Second Department, March 2, 2007Insurer failed to prove the scheduling letters were mailed or properly addressedRejected the IME no-show defense because the insurer did not prove the IME requests were mailed and, in any event, offered no one with personal knowledge of the nonappearances.
Vega Chiropractic, P.C. v Eveready Ins. Co. (2007 NY Slip Op 50363(U)) Appellate Term, Second Department, February 26, 2007Proof on the no-show raises a question of fact; neither side wins the point as a matter of lawHeld the insurer's proof that it mailed pre-claim IME notices and a timely follow-up, and that the assignor received both and failed to appear, sufficed to defeat the provider's summary judgment motion.
Fair Price Med. Supply Corp. v New York Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 50357(U)) Appellate Term, Second Department, February 16, 2007Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer's cross motion should have been denied because it offered no affidavit from anyone with personal knowledge that the assignor failed to appear for the two IMEs.
Chi Acupuncture, P.C. v Kemper Auto & Home Ins. Co. (2007 NY Slip Op 50352(U)) Appellate Term, Second Department, February 14, 2007Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer failed to prove its pre-claim IME no-show defense because, although it established mailing of the scheduling letters, it offered no admissible evidence from anyone with personal knowledge of the nonappearances.
Celtic Med. P.C. v New York Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 27057) Appellate Term, Second Department, February 6, 2007Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailing of IME requests and follow-ups within the regulatory periods and unchallenged nonappearance, and that the record did not support an issue of fact about the reason for nonappearance.
Vista Surgical Supplies, Inc. v New York Cent. Ins. Co. (2007 NY Slip Op 50165(U)) Appellate Term, Second Department, January 31, 2007Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the IME no-show defense raised no triable issue because the examiner, who was not responsible for scheduling or mailing IME notices, could prove neither the mailing of the letters nor the assignor's nonappearance.
Vitality Chiropractic, P.C. v Kemper Ins. Co. (2006 NY Slip Op 26536) Appellate Term, Second Department, December 11, 2006Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the insurer established the nonappearance for the timely denied claims, but no follow-up request after the July IMEs was made, and mutually rescheduled IMEs were not follow-ups, so no toll arose for one claim.
AVA Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 52256(U)) Appellate Term, Second Department, November 15, 2006Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the IME no-show defense failed because the insurer's affidavit did not establish mailing of the IME request letters, lacking personal knowledge or a sufficiently detailed description of office mailing practice.
Vega Chiropractic, P.C. v Eveready Ins. Co. (2006 NY Slip Op 52239(U)) Appellate Term, Second Department, November 2, 2006Proof on the no-show raises a question of fact; neither side wins the point as a matter of lawHeld the insurer's opposition, showing the assignor was sent and received pre-claim IME requests, called to say she would not appear, and was timely denied, raised a triable issue defeating the provider's summary judgment motion.
Vega Chiropractic, P.C. v Eveready Ins. Co. (2006 NY Slip Op 52238(U)) Appellate Term, Second Department, November 2, 2006Proof on the no-show raises a question of fact; neither side wins the point as a matter of lawHeld the insurer's opposition, showing pre-claim IME requests were sent to and received by the assignor, a call that she would not appear, and timely denials on that ground, rebutted the presumption of medical necessity and raised a triable issue.
Triboro Chiropractic & Acupuncture P.L.L.C v Allstate Ins. Co. (2006 NY Slip Op 51740(U)) Appellate Term, Second Department, September 14, 2006Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the pre-claim IME no-show raised no triable issue because the insurer failed to prove the IME request letters were mailed.
A.B. Med. Servs. PLLC v Peerless Ins. Co. (2006 NY Slip Op 26318) Appellate Term, Second Department, July 26, 2006Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the IME no-show denials did not rebut the provider's showing because the insurer proved mailing of only a single IME request and no follow-up as 11 NYCRR 65-3.6(b) requires.
Bronxborough Med., P.C. v New Hampshire Ins. Co. (2006 NY Slip Op 51354(U)) Appellate Term, Second Department, July 7, 2006Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the IME no-show defense raised no triable issue because the insurer's conclusory affidavit, made without personal knowledge, did not describe a standard practice for addressing and mailing the IME requests.
Amaze Med. Supply Inc. v Allstate Ins. Co. (2006 NY Slip Op 50909(U)) Appellate Term, Second Department, May 17, 2006Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's proof of mailed IME request letters and the record showing the assignor failed to appear for the pre-claim IME defeated the provider's summary judgment motion.
Amaze Med. Supply Inc. v General Assur. Co. (2006 NY Slip Op 50910(U)) Appellate Term, Second Department, May 17, 2006Proof on the no-show raises a question of fact; neither side wins the point as a matter of lawHeld the insurer's affidavit of standard IME mailing practice and the assignor's nonattendance raised a triable issue, since the provider offered no excuse for the nonappearance and did not show the requests unreasonable.
Rigid Med. of Flatbush, P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 50582(U)) Appellate Term, Second Department, April 6, 2006Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the EUO no-show defense failed because the policy was not shown to authorize EUOs, the EUO notices were not proved mailed, and compliance with the follow-up requirements was not shown.
Star Med. Servs. P.C. v Utica Mut. Ins. Co. (2006 NY Slip Op 50505(U)) Appellate Term, Second Department, March 27, 2006Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the EUO no-show defense failed because the insurer did not prove its policy contained an endorsement authorizing EUOs, so the requests did not toll the time to deny.
A.B. Med. Servs. PLLC v Prudential Prop. & Cas. Ins. Co. (2006 NY Slip Op 50504(U)) Appellate Term, Second Department, March 27, 2006Insurer failed to prove the scheduling letters were mailed or properly addressed (also decides)Held the EUO and IME no-show defenses failed for two assignors because the insurer offered no proof it mailed the scheduling requests; for a third, conceded nonattendance left triable issues of excuse and propriety of the requests.
A.B. Med. Servs. PLLC v Allstate Ins. Co. (2006 NY Slip Op 50474(U)) Appellate Term, Second Department, March 27, 2006Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the EUO no-show could not support denial because the insurer failed to establish that the policy contained the revised endorsement authorizing EUOs.
Star Med. Servs., P.C. v Allstate Ins. Co. (2006 NYSlipOp 50344(U)) Appellate Term, Second Department, March 7, 2006Insurer failed to prove the scheduling letters were mailed or properly addressedRejected the EUO no-show defense because the insurer did not send the EUO demand to the assignor at his proper address, and sending it to the assignor's attorney did not toll the time to pay or deny.
Amaze Med. Supply Inc. v General Assur. Co. (2006 NY Slip Op 50307(U)) Appellate Term, Second Department, February 27, 2006Proof on the no-show raises a question of fact; neither side wins the point as a matter of lawHeld the insurer's supervisor affidavit proved standard-practice mailing of the pre-claim IME notices and, with the assignor's stated nonattendance, rebutted the presumption of medical necessity and raised a triable issue defeating the provider's motion.
Star Med. Servs., P.C. v Allstate Ins. Co. (2006 NY Slip Op 50245(U)) Appellate Term, Second Department, February 14, 2006Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the EUO no-show denials ineffective because the insurer did not show the policy's no-fault endorsement authorized EUOs and did not follow the required follow-up verification procedures.
Star Med. Servs. P.C. v Allstate Ins. Co. (2006 NY Slip Op 50129(U)) Appellate Term, Second Department, February 1, 2006Insurer failed to prove the scheduling letters were mailed or properly addressedRejected the EUO no-show defense for one assignor because the insurer did not prove the EUO letters were mailed, and also did not show in admissible form that its policy contained an EUO endorsement.
A.B. Med. Servs. PLLC v Liberty Mut. Ins. Co. (2005 NY Slip Op 51902(U)) Appellate Term, Second Department, November 21, 2005Insurer failed to prove the scheduling letters were mailed or properly addressed (also decides)Held the IME no-show defense raised no triable issue because the insurer offered no competent proof that it mailed the IME scheduling requests and otherwise failed to address the defense.
Ocean Diagnostic Imaging, P.C. v Utica Mut. Ins. Co. (2005 NY Slip Op 51747(U)) Appellate Term, Second Department, October 21, 2005Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the assignor had no duty to appear because the initial EUO request was untimely and did not schedule the EUO within the prescribed time, making later rescheduling irrelevant.
A.B. Med. Servs. PLLC v Utica Mut. Ins. Co. (2005 NY Slip Op 25456) Appellate Term, Second Department, October 21, 2005Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the IME defense failed for most claims because one scheduled IME was unproved and no follow-up request followed the conceded November nonappearance, so verification protocols were not exhausted.
A.B. Med. Servs. PLLC v American Tr. Ins. Co. (2005 NYSlipOp 51316(U)) Appellate Term, Second Department, August 17, 2005Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the pre-claim IME no-show opposition insufficient because there was no competent proof the IME notices were mailed to one assignor and the insurer admitted none were mailed to the other.
Amaze Med. Supply Inc. v State Farm Mut. Auto. Ins. Co. (2005 NYSlipOp 51315(U)) Appellate Term, Second Department, August 17, 2005Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the pre-claim IME no-show did not rebut the provider's case because the insurer's affiants neither showed personal knowledge of mailing the IME requests nor described a standard mailing practice.
A.B. Med. Servs. PLLC v USAA Gen. Indem. Co. (2005 NY Slip Op 25297) Appellate Term, Second Department, July 21, 2005Claimant showed the nonappearance was excused or the request unreasonable or waivedHeld the assignors' unrebutted affidavit showed a valid excuse for nonattendance because the insurer cancelled one rescheduled IME and refused a good-faith request to reschedule the other.
Ocean Diagnostic Imaging P.C. v New York Cent. Mut. Fire Ins. Co. (2005 NY Slip Op 51772(U)) Appellate Term, Second Department, July 7, 2005Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the pre-claim IME no-show defense failed because the scheduler's and manager's affidavits neither showed personal knowledge of actual mailing nor described a standard office mailing procedure.
Summit Psychological, P.C. v General Assur. Co. (2005 NY Slip Op 25263) Appellate Term, Second Department, June 28, 2005Insurer failed to prove the scheduling letters were mailed or properly addressed (also decides)Held, as an alternative ground, that the claims examiner's affidavit did not establish mailing of the IME requests because it lacked personal knowledge of mailing and any description of standard office mailing procedure.
Amaze Med. Supply Inc. v General Assur. Co. (2005 NY Slip Op 50960(U)) Appellate Term, Second Department, June 9, 2005Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the IME no-show opposition insufficient because the attorney's conclusory allegations lacked personal knowledge and no standard practice for addressing and mailing the IME requests was described.
S & M Supply Inc. v State Farm Mut. Auto. Ins. Co. (2005 NYSlipOp 50747(U)) Appellate Term, Second Department, May 19, 2005Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the insurer not entitled to summary judgment on its defense based on the assignor's nonattendance at scheduled EUOs, citing prior Appellate Term authority without stating the ground.
Gpm Chiropractic, P.C. v State Farm Mut. Ins. Co. (2005 NYSlipOp 50744(U)) Appellate Term, Second Department, May 19, 2005Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the insurer not entitled to summary judgment on the assignor's nonattendance at scheduled EUOs, for a December 2000 accident, stating no reason beyond citations to prior Appellate Term authority.
Ocean Diagnostic Imaging P.C. v Lumbermens Mut. Cas. Co. (2005 NY Slip Op 50743(U)) Appellate Term, Second Department, May 19, 2005Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the IME no-show defense failed because counsel lacked personal knowledge and the claims specialist did not address the IME letters' mailing; alternatively the insurer made no required follow-up requests.
D.A.V. Chiropractic P.C. v American Tr. Ins. Co. (2005 NYSlipOp 50609(U)) Appellate Term, Second Department, April 22, 2005Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of the pre-claim IME letters and the provider offered no excuse for the nonappearance or showing the requests were unreasonable, but under the then rule this only raised a triable issue of medical necessity, so both motions were denied.
A.B. Med. Servs. PLLC v Electric Ins. Co. (2005 NYSlipOp 50542(U)) Appellate Term, Second Department, April 13, 2005Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld that the assignor's selective attendance showed he received all the scheduled IME requests and that his unexcused nonappearance, shown by the scheduler's letter and the denials, sufficed to defeat the providers' summary judgment motion.
King's Med. Supply Inc. v Kemper Auto & Home Ins. Co. (2005 NYSlipOp 50450(U)) Appellate Term, Second Department, March 31, 2005Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the post-claim IME no-show denial lacked merit as a matter of law because the insurer never sent the required follow-up IME request after the first nonappearance, abandoning the request.
Careplus Med. Supply Inc. v General Assur. Co. (2005 NY Slip Op 50429(U)) Appellate Term, Second Department, March 31, 2005Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the IME no-show defense to the timely denied claims failed because the insurer gave no competent proof that the IME notices were mailed to the assignors themselves.
Ocean Diagnostic Imaging P.C. v General Assur. Co. (2005 NY Slip Op 50435(U)) Appellate Term, Second Department, March 31, 2005Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the IME no-show defense failed because the insurer did not prove mailing of the IME notices by personal knowledge or standard office practice, and vendor affidavits outside the record could not be considered.
Fair Price Med. Supply Corp. v General Assur. Co. (2005 NY Slip Op 50256(U)) Appellate Term, Second Department, March 2, 2005Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the IME no-show opposition insufficient because the conclusory affidavit lacked personal knowledge and did not describe the office practice for addressing and mailing the IME requests.
Ocean Diagnostic Imaging P.C. v State Farm Mut. Auto. Ins. Co. (2005 NY Slip Op 25336) Appellate Term, Second Department, March 1, 2005Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the EUO no-show opposition meritless because the claim predated the regulation authorizing EUOs and the insurer did not prove it issued the revised endorsement.
Triboro Chiropractic v New York Cent. Mut. Fire Ins. Co. (2005 NY Slip Op 50110(U)) Appellate Term, Second Department, February 2, 2005Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held the insurer's proof of the assignor's nonappearance at pre-claim IMEs, unanswered by any excuse or showing the requests were unreasonable, defeated the provider's motion on the timely denied claims, though it rebutted only medical necessity rather than being a defense.
S&M Supply Inc. v Peerless Ins. Co. (2004 NY Slip Op 51683(U)) Appellate Term, Second Department, December 22, 2004Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held it uncontroverted that the assignor failed to attend a reasonable pre-claim IME request and that the provider showed neither an excuse nor unreasonableness.
A.B. Med. Servs. PLLC v USAA Cas. Ins. Co. (2004 NY Slip Op 51682(U)) Appellate Term, Second Department, December 22, 2004Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the pre-claim IME no-show defense to two claims failed because the insurer offered only counsel's affirmation, with no proof of actual mailing or standard office mailing practice for the IME letters.
Amaze Med. Supply Inc. v New York Cent. Mut. Ins. Co. (2004 NY Slip Op 51680(U)) Appellate Term, Second Department, December 22, 2004Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of reasonable pre-claim IME requests and the assignor's nonappearance, with no excuse offered, but under the then rule this only rebutted the presumption of medical necessity, raising a triable issue, so both motions were denied.
Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co. (2004 NY Slip Op 24527) Appellate Term, Second Department, December 22, 2004Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held the assignor's failure to attend a pre-claim IME was uncontroverted and the request's reasonableness unchallenged, so the insurer's proof defeated the provider's summary judgment though it did not warrant dismissal.
King's Med. Supply Inc. v New York Cent. Mut. Fire Ins. Co. (2004 NY Slip Op 51550(U)) Appellate Term, Second Department, December 8, 2004Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld a single missed post-claim IME gave no valid basis to deny because the insurer did not exhaust the follow-up protocol by sending a second request, so it showed no meritorious defense to vacate its default.
Star Med. Servs. P.C. v Eagle Ins. Co. (2004 NY Slip Op 24482) Appellate Term, Second Department, December 1, 2004Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the EUO no-show could not support the denial because the insurer failed to show that the policy contained the revised endorsement authorizing EUOs.
S & M Supply Inc. v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 51250(U)) Appellate Term, Second Department, October 20, 2004Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held, alternatively, that the insurer failed to prove its EUO requests were timely or that the regulations provided for EUOs when the claims were filed.
A.B. Med. Servs. PLLC v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 51031(U)) Appellate Term, Second Department, September 17, 2004Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Rejected the EUO non-cooperation defense because no regulation authorized EUOs when the claims were filed and the liability-policy cooperation clause could not qualify the mandatory no-fault endorsement.
S & M Supply Inc. v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 50693(U)) Appellate Term, Second Department, June 30, 2004Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the EUO requests ineffective because the insurer did not show the policy endorsement authorized EUOs and its first requests were neither sent within 15 business days nor scheduled within 30 days of receipt of the verification forms.
S & M Supply, Inc. v Nationwide Mut. Ins. Co. (2004 NY Slip Op 50557(U)) Appellate Term, Second Department, June 3, 2004Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the EUO no-show defense failed because the regulation in effect when the claim was submitted did not require EUOs, so the requests did not toll the time to deny.
A.B. Med. Servs. v Travelers Prop. Cas. Corp. (2004 NY Slip Op 50517(U)) Appellate Term, Second Department, May 25, 2004Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Noted the insurer could not assert the EUO no-show defense because the applicable regulation did not require claimants to submit to examinations under oath.
King'S Med. Supply v Progressive Ins. (2004 NY Slip Op 50311(U)) Appellate Term, Second Department, April 14, 2004Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the EUO no-show defense failed because, when the claims were filed, the regulations did not authorize EUOs as verification and the policy's cooperation clause could not supply that right.
Adam'S Med. Supplies v Windsor Group Ins. Co. (2004 NY Slip Op 50310(U)) Appellate Term, Second Department, April 14, 2004Proof on the no-show raises a question of fact; neither side wins the point as a matter of lawHeld the insurer's showing that the assignor never appeared for medical examinations raised a triable issue but did not entitle it to summary judgment dismissing the complaint.
King'S Med. Supply v Kemper Auto & Home Ins. Co. (2004 NY Slip Op 50401(U)) Appellate Term, Second Department, February 18, 2004Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the EUO no-show was no defense because the regulations in effect when the claim was submitted did not require the injured person to submit to an EUO, and a policy cooperation clause could not supply that requirement.
Amstel Chiropractic v Omni Indem. Co. (2004 NY Slip Op 50088(U)) Appellate Term, Second Department, January 27, 2004Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the EUO no-show could not raise a triable issue because the insurance regulations in effect at the time contained no authorization for examinations under oath.
A.B. Med. Servs. PLLC Royalton Chiropractic P.C. v Lumbermens Mut. Cas. Co. (2003 NY Slip Op 51393(U)) Appellate Term, Second Department, October 21, 2003Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the EUO no-show defense unavailable because the 2001 regulation then governing required submission only to medical examinations, not EUOs, so the EUO request did not toll the time to deny.

Trial courts in the First Department (40 decisions)

SCOB, LLC v Liberty Mut. Ins. Co. (2026 NY Slip Op 51484(U)) Civil Court of the City of New York, New York County, July 13, 2026Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the IME no-show defense unproved because the scheduling letters went to an address differing from the NF-2, and the examining doctor's affirmation of nonappearance omitted the full CPLR 2106 penalty-of-perjury language.
KBJ Med. Practice, P.C. v Lancer Ins. Co. (2025 NY Slip Op 50277(U)) Civil Court of the City of New York, Bronx County, March 3, 2025Insurer failed to prove the scheduling letters were mailed or properly addressedFound nonappearance proved by a certified transcript, but denied judgment on the EUO no-show because the insurer's mailing proof was boilerplate and contradictory, leaving mailing for trial.
Fyzio PT, PLLC v Ocean Harbor Cas. Ins. Co. (2025 NY Slip Op 50103(U)) Civil Court of the City of New York, Bronx County, January 13, 2025Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer failed to prove the EUO and IME nonappearances because the claims manager's conclusory affidavit showed no personal knowledge or procedure for recording them, though mailing was proved.
Kim v State Farm Ins. Co. (2024 NY Slip Op 51364(U)) Civil Court of the City of New York, New York County, June 10, 2024Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer did not establish compliance with the regulations because its form EUO letters, sent for several claimants, stated no specific objective justification tied to this claim, so its summary judgment motion was denied.
State Farm Fire & Cas. Co. v Blackburn (2023 NY Slip Op 50745(U)) Supreme Court, New York County, July 13, 2023Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved EUO letters mailed within 15 business days, two nonappearances by each claimant and a sufficient objective justification, rejecting the providers' justification, address and prematurity objections.
Country-Wide Ins. Co. v Henderson (2022 NY Slip Op 51304(U)) Supreme Court, New York County, December 21, 2022Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsDenied the insurer summary judgment because its conclusory, inconsistent EUO justifications did not show a specific objective justification under 65-3.5 (e), and the motion was premature under CPLR 3212 (f) pending discovery of that reason.
Country-Wide Ins. Co. v Duff (2022 NY Slip Op 51289(U)) Supreme Court, New York County, December 20, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely IME requests measured from receipt of NF-3 bills and two unexcused nonappearances; it need not show request timeliness for each provider's bill, and the bills were adequately authenticated.
American Tr. Ins. Co. v Graves (2022 NY Slip Op 51273(U)) Supreme Court, New York County, December 14, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held, for default-judgment purposes, that the insurer showed it timely requested and scheduled IMEs under 65-3.5 and that the claimant twice failed without good cause to appear.

Show all 40 decisions

State Farm Mut. Auto. Ins. Co. v Emote Med. Servs., P.C. (2022 NY Slip Op 50818(U)) Supreme Court, New York County, August 24, 2022Insurer failed to prove the scheduling letters were mailed or properly addressedDenied a default declaration on EUO no-shows because the verified complaint conclusorily alleged timely requests without proof that they were addressed and mailed, omitted bill-receipt dates, and did not address possible justification requests.
American Tr. Ins. Co. v Ferguson (2022 NY Slip Op 50757(U)) Supreme Court, New York County, August 15, 2022Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsDenied the insurer a default judgment because it did not show that the IME requests went out before any NF-3 was received, within 15 business days of receipt, or that the IMEs were scheduled within 30 days.
American Tr. Ins. Co. v Lopez (2022 NY Slip Op 50218(U)) Supreme Court, New York County, March 22, 2022Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer could not show its IME requests were timely under the 15-business-day and 30-day rules because it produced none of the providers' verification forms and did not claim pre-claim scheduling.
American Tr. Ins. Co. v Rivera (2022 NY Slip Op 50180(U)) Supreme Court, New York County, March 8, 2022Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the IME physician's unsigned, inconsistently notarized affidavit incompetent proof of nonappearance, and also found the IME requests and the follow-up after the nonappearance not shown timely under the regulations.
American Tr. Ins. Co. v Reyes (2022 NY Slip Op 50013(U)) Supreme Court, New York County, January 10, 2022Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer failed to establish compliance with the IME time frames because the IME was set 33 days after the request and its papers did not show when it received the claims or verification forms.
Kemper Independence Ins. Co. v Accurate Monitoring, LLC (2021 NY Slip Op 21253) Supreme Court, New York County, September 23, 2021Claimant showed the nonappearance was excused or the request unreasonable or waivedHeld the provider's nonappearance could not support denial because the insurer categorically refused the provider's request for the specific objective justification for the EUO, making the rescheduled request unreasonable.
Park Ave. Chiropractic & Health Care PC v Maya Assur. Co. (2021 NY Slip Op 50804(U)) Civil Court of the City of New York, Bronx County, August 18, 2021Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailed EUO notices and two nonappearances, and the provider's objection, written after the first EUO date and absent for the second, was a nullity that did not excuse the nonappearance.
Alsaad Med., P.C. v State Farm Mut. Auto. Ins. Co. (2021 NY Slip Op50532(U)) Civil Court of the City of New York, Bronx County, June 8, 2021Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved two timely EUO requests mailed under a described office practice and nonappearance through the attorney-partner's affidavit, rejecting objections to the notices' document demands as inadmissible and first raised in opposition.
Country-Wide Ins. Co. v Ware (2021 NY Slip Op 50506(U)) Supreme Court, New York County, May 28, 2021Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved two timely requested and scheduled IMEs and nonappearances, since the request needed to fall within 15 business days of any provider's NF-3, not the first bill received.
Liberty Mut. Ins. Co. v Carranza (2021 NY Slip Op 50284(U)) Supreme Court, New York County, April 7, 2021Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsDenied the insurer's default judgment because, with no bills or verification forms and only a conclusory claims affidavit, it failed to show the EUO/IME requests were made within 15 business days and IMEs scheduled within 30 days.
Country-Wide Ins. Co. v Delacruz (2021 NY Slip Op 21019) Supreme Court, New York County, February 4, 2021Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsDenied summary judgment because, for one provider, the insurer did not show the EUO request met the 15-business-day time frame, and for the others the motion was premature without disclosure of the EUO's objective justification, which was not waived.
American Tr. Ins. Co. v Romero-Richiez (2020 NY Slip Op 51181(U)) Supreme Court, New York County, October 9, 2020Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsDenied the insurer summary judgment because it showed neither that the IME requests met the 65-3.5 (b) and (d) time frames nor that they preceded receipt of any claim, rejecting its argument that general-need IMEs are exempt.
American Tr. Ins. Co. v Martinez (2020 NY Slip Op 50930(U)) Supreme Court, New York County, August 21, 2020Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer failed its prima facie burden because its documents did not show when it received the verification forms, so compliance with the 30-day IME scheduling rule of 65-3.5 (d) was unproved.
American Tr. Ins. Co. v Wildex (2020 NY Slip Op 50929(U)) Supreme Court, New York County, August 21, 2020Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer failed its prima facie burden because the first IME was scheduled 43 days after the scheduling notice, so compliance with the 30-day rule of 65-3.5 (d) was not shown.
American Tr. Ins. Co. v Bookman (2020 NY Slip Op 50607(U)) Supreme Court, New York County, May 27, 2020Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer failed to establish compliance with 11 NYCRR 65-3.5 because nothing showed when verification forms were sent or returned, so the EUO request's timeliness was unproved; summary judgment and default judgment were denied.
Unitrin Advantage Ins. Co. v Dowd (2020 NY Slip Op 50594(U)) Supreme Court, New York County, May 21, 2020Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the EUO requests untimely under the 15-business-day rule for the first claim, so that claim could not be denied for the no-show, but timely and proper for the later claim, which was defeated.
Liberty Mut. Ins. Co. v Martin (2020 NY Slip Op 50511(U)) Supreme Court, New York County, May 4, 2020Insurer failed to prove the scheduling letters were mailed or properly addressed (also decides)Held the insurer did not show the EUO scheduling letters were mailed, because the affidavits of service were unsigned, undated and unnotarized, nor that its requests met the 65-3.5 time frames.
American Tr. Ins. Co. v Hayes (2020 NY Slip Op 50462(U)) Supreme Court, New York County, April 14, 2020Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer failed to establish compliance with 11 NYCRR 65-3.5 because the record did not show when verification forms were sent or received back, leaving the IME request's timeliness unproved; summary and default judgment were denied.
Tian Shan Acupuncture PC v Global Liberty Ins. Co. (2019 NY Slip Op 50728(U)) Civil Court of the City of New York, Bronx County, May 14, 2019Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely initial and follow-up IME requests, mailed notices, and nonappearance through the examining doctor's first-hand affirmation, rejecting the claim that the affirmation was conclusory and declining to consider the reasonableness of the notice periods.
State Farm Mut. Auto. Ins. Co. v Sweetwater Chiropractic, P.C. (2018 NY Slip Op 51177(U)) Supreme Court, New York County, August 6, 2018Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsDenied the insurer summary judgment because its investigator's affidavit gave no specific objective justification for the EUOs on these claims, leaving issues on whether they were properly requested and warranting discovery.
Global Liberty Ins. Co. of N.Y. v Otero (2018 NY Slip Op 51025(U)) Supreme Court, Bronx County, June 15, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved two mailed IME notices, timely scheduling within 30 days of the first bill, and nonappearance through the IME physician who was present, rejecting the provider's admissibility, timing, mailing and address objections.
Country-Wide Ins. Co. v Gotham Med., P.C. (2015 NY Slip Op25387) Supreme Court, New York County, November 20, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the provider's owner, who appeared but on counsel's direction refused to answer relevant questions about his probation and the treatment, materially breached the EUO condition, barring recovery.
New Capital Supply, Inc. v State Farm Mut. Auto. Ins. Co. (2014 NY Slip Op 24277) Civil Court of the City of New York, New York County, August 14, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's attorney, present at the office on both EUO dates and responsible for conducting them, had personal knowledge of the provider's nonappearance, and that a provider who never responded to the requests could not obtain discovery on their reasonableness.
Medcare Supply Inc. v Travelers Prop. Cas. Co. of Am. (2014 NY Slip Op 51421(U)) Civil Court of the City of New York, New York County, August 13, 2014Insurer failed to prove the nonappearance by someone with personal knowledgeHeld that although the EUO letters were proved mailed, the assigned attorney's conclusory affirmation, never stating he was present on the scheduled dates, did not prove the assignor's nonappearance.
Repwest Ins. Co. v Advantage Radiology, P.C. (2014 NY Slip Op 50016(U)) Supreme Court, New York County, January 13, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved two or three mailed EUO requests per claimant and their nonappearance through an attorney who personally waited, rejecting the providers' unsupported claim that improper document demands made the requests defective.
American Tr. Ins. Co. v Miranda (2013 NY Slip Op 52277(U)) Supreme Court, New York County, December 12, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer's scheduling letters, mail-room manager testimony and proof of two IME nonappearances went unrebutted by the attorney's affirmation, and the claimed need for discovery was unsupported.
American Tr. Ins. Co. v Curry (2013 NY Slip Op 23470) Supreme Court, New York County, October 8, 2013Insurer failed to prove the nonappearance by someone with personal knowledgeDenied default and summary declaratory judgment because no witness attested to the claimant's EUO nonappearances, the SIU director's recital of unproduced records being hearsay, and the insurer showed no specific objective justification for the EUO.
American Tr. Ins. Co. v Rodriguez (2013 NY Slip Op 51630(U)) Supreme Court, New York County, October 7, 2013Insurer failed to prove the nonappearance by someone with personal knowledgeDenied summary declaratory judgment because only an attorney's affirmation without personal knowledge described the policy and the EUO nonappearance, and the mailing affidavits did not establish that the claimant breached the policy.
New Century Med. Diagnostics, P.C. v Utica Mut. Ins. Co. (2013 NY Slip Op 23204) Civil Court of the City of New York, New York County, June 24, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the provider's undisputed failure to produce anyone at two EUOs justified the denial, rejecting its argument that the notices were defective for demanding a specific individual, since it could have produced any knowledgeable person.
Hastava & Aleman Assoc., P.C. v State Farm Mut. Auto Ins. Co. (2009 NY Slip Op 51818(U)) Civil Court of the City of New York, Bronx County, July 2, 2009Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved the provider failed to appear for two EUOs authorized by the mandatory endorsement, without producing the policy, and that the scheduling letters were mailed by certified mail.
Unitrin Advantage Ins. Co. v Carothers (2007 NY Slip Op 52100(U)) Supreme Court, New York County, August 20, 2007Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsDismissed the insurer's no-coverage complaint because it alleged no objective standards showing the EUOs were reasonably required and no willful noncooperation, where the provider sought only reimbursement of lost wages and travel.
Lumbermens Mut. Cas. Co. v Inwood Hill Med., P.C. (2005 NY Slip Op 51101(U)) Supreme Court, New York County, July 12, 2005Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Found the EUO scheduling letters and timely follow-ups properly mailed and the assignors' nonappearance uncontested, but treated the no-shows as only rebutting the presumption of medical necessity, so insurer judgment was denied.

Trial courts in the Second Department (88 decisions)

Medical Supply of NY Corp. v State Farm (2026 NY Slip Op 51163(U)) Civil Court of the City of New York, Kings County, July 28, 2026Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of the scheduling letters and nonappearance at two duly scheduled EUOs, and the provider's rebuttal affidavits from an unrelated matter failed to raise an issue of fact.
Clinton Med. Off. P.C. v Progressive Max Ins. Co. (2026 NY Slip Op 26094) Civil Court of the City of New York, Richmond County, June 22, 2026Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held the insurer showed it mailed two EUO notices and that the assignor failed to appear, which the provider did not dispute, so the dispute turned only on the sufficiency of the denials.
Terra Chiropractic, P.C. v Country-Wide Ins. Co. (2026 NY Slip Op 50953(U)) Civil Court of the City of New York, Kings County, June 17, 2026Insurer failed to prove the nonappearance by someone with personal knowledgeHeld at trial that the insurer proved mailing of the EUO letters but not, through anyone with personal knowledge, the assignor's two nonappearances, because the EUO statement on the record was not admitted for its truth.
New York Heritage Med Serv, PLLC v Nationwide Affinity Ins. Co. of Am. (2026 NY Slip Op 50099(U)) Civil Court of the City of New York, Kings County, January 28, 2026Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved the provider's EUO nonappearances after timely notices, rejecting the excuse of a day-before request to reschedule because a reschedule must be agreed upon and cannot be unilateral.
Palms P.T., P.C. v State Farm Fire & Cas. Co. (2025 NY Slip Op 50706(U)) Civil Court of the City of New York, Kings County, May 2, 2025Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved two EUO no-shows, counting only the dates scheduled after the pandemic reopening order and finding it made best efforts to comply under the totality of the circumstances.
Medical Supply of NY Servs. Inc. v State Farm Mut. Auto Ins. Co. (2025 NY Slip Op 50301(U)) Civil Court of the City of New York, Richmond County, February 21, 2025Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer failed to prove the EUO nonappearance because its attorney's affirmation said only that he placed a default statement on the record, not that he was present at the scheduled time, and the transcript lacked a foundation.
Flatbush Acupuncture P.C. v Repwest Ins. Co. (2025 NY Slip Op 25032) Civil Court of the City of New York, Queens County, February 13, 2025Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established the assignor's failure to appear for two scheduled EUOs and, following Second Department law, was not required to give the provider a specific objective justification for the EUO requests.
Precision Acupuncture P.C. v State Farm Mut. Auto. Ins. Co. (2025 NY Slip Op 50021(U)) Civil Court of the City of New York, Kings County, January 14, 2025Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Found the insurer established timely mailed EUO scheduling letters and the provider's failure to appear for both scheduled EUOs.

Show all 88 decisions

AVK RX Inc v Progressive Advanced Ins. Co. (2024 NY Slip Op 51521(U)) Civil Court of the City of New York, Richmond County, November 8, 2024Insurer failed to prove the scheduling letters were mailed or properly addressedDenied the insurer summary judgment on the IME no-show defense because it failed to prove a standard office practice ensuring proper addressing and mailing of the IME notices or any business record of mailing.
Avamed Supply Inc v GEICO (2024 NY Slip Op 50688(U)) Civil Court of the City of New York, Richmond County, June 10, 2024Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the EUO no-show defense unproved because the second scheduling letter was mailed fifteen days after the first nonappearance, outside the regulatory follow-up period.
NYRX Pharm. Inc. v Mid-Century Ins. Co. (2023 NY Slip Op51094(U)) Civil Court of the City of New York, Kings County, October 11, 2023Proof on the no-show raises a question of fact; neither side wins the point as a matter of law (also decides)Held a triable issue of fact existed on the alleged EUO no-shows because the record was inconsistent about whether the proper insurer was Farmers or Mid-Century.
MLG Med. P.C. v Nationwide Mut. Ins. Co. (2023 NY Slip Op 23199) Civil Court of the City of New York, Queens County, June 30, 2023Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held the insurer showed timely mailed scheduling letters and the assignor's nonappearance on all four dates; the provider did not dispute receipt or nonappearance and had responded to the letters objecting to location while professing willingness to attend.
American Tr. Ins. Co. v NextStep Healing, Inc. (2023 NY Slip Op 50521(U)) Supreme Court, Kings County, May 28, 2023Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held, in the alternative on Article 75 review, that the arbitrator rationally rejected the EUO no-show defense because the insurer never explained the months-long gap between the initial and follow-up EUO requests.
State Farm Fire & Cas. Co. v R.L. (2023 NY Slip Op 50497(U)) Supreme Court, Nassau County, April 21, 2023Proof on the no-show raises a question of fact; neither side wins the point as a matter of law (also decides)Held the providers raised disputed factual issues about the insurer's compliance with EUO regulations that the insurer did not address, defeating likelihood of success on its EUO no-show claims.
Glispy v Ameriprise Ins. Co. (2023 NY Slip Op 50338(U)) Civil Court of the City of New York, Kings County, April 13, 2023Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer established timely mailing of the EUO scheduling letters and the assignor's nonappearance through counsel's affidavits and on-the-record statements, and the provider raised no triable issue.
Sloan v Nationwide Mut. Ins. Co. (2022 NY Slip Op 50997(U)) Civil Court of the City of New York, Queens County, October 13, 2022Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the insurer's first EUO request untimely because it was sent beyond 15 business days after receipt of the bill, and a delay letter that merely said verification would be sought did not toll.
Fine Needle Acupuncture P.C. v State Farm Mut. Auto. Ins. Co. (2022 NY Slip Op 50873(U)) Civil Court of the City of New York, Queens County, September 16, 2022Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held the provider's nonappearance at the EUOs established by collateral estoppel from the Supreme Court's finding in the insurer's declaratory action, where the request and its justification were not challenged.
Life Equip., Inc v Mid-Century Ins Co (2022 NY Slip Op 50877(U)) Civil Court of the City of New York, Kings County, August 9, 2022Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to prove its IME no-show defense because the scheduling letters were not shown mailed, and the examiner's affidavit lacked personal knowledge of nonappearance and was unsupported by the business records.
Chiropractic Exam Works, P.C. v Sentry Cas. Co. (2021 NY Slip Op 51125(U)) Civil Court of the City of New York, Queens County, November 30, 2021Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsDenied the EUO defense because the insurer, having already repudiated liability, could not demand EUOs, and in any event its first EUO letter was sent long after 30 days from receipt of the claim.
Jiang Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2021 NY Slip Op 50945(U)) District Court of Suffolk County, Fourth District, September 23, 2021Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the IME no-show defense failed because, although notices were mailed and the assignor did not appear, the IMEs were not scheduled within 30 days of receipt of the claims, making the scheduling letters nullities.
FJL Med. Servs. PC v Nationwide Ins. (2021 NY Slip Op 21214) Civil Court of the City of New York, Kings County, July 28, 2021Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved four scheduled EUOs and nonappearances, and the provider's delay requests, fee demand and a transcript time error raised no triable issue or excuse.
MSB Physical Therapy, P.C. v Nationwide Ins. (2021 NY Slip Op 50750(U)) Civil Court of the City of New York, Kings County, July 13, 2021Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held the insurer proved the provider's EUO nonappearances through certified transcripts and attorney affidavits, and rejected objections about objective reasons, two-to-three-month adjournment requests, inconvenience and demanded up-front $1,500 reimbursement.
New York Core Chiropractic, P.C. v Ameriprise Ins. Co. (2021 NY Slip Op 50599(U)) Civil Court of the City of New York, Queens County, June 24, 2021Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved three mailed EUO requests and three nonappearances; a two-business-day-late initial request within 30 days still tolled, and no stated objective basis or reply to objections was required.
Advanced Recovery v Allstate Ins. Co. (2021 NY Slip Op 21148) Civil Court of the City of New York, Queens County, May 27, 2021Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved the IME no-show because the scheduler's practice affidavit showed the letters were mailed and the examining chiropractors' affidavits, though sworn years later without stating a basis for recollection, were not conclusory.
Parisien v Travelers Ins. Co. (2021 NY Slip Op 50396(U)) Civil Court of the City of New York, Kings County, April 30, 2021Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of the pre-claim EUO letters and two nonappearances by certified transcripts, rejecting arguments on objective justification, willfulness, and bad-faith requests for two-to-three-month adjournments and up-front fees.
NY Wellness Med. P.C. v Ameriprise Ins. Co. (2021 NY Slip Op 50382(U)) Civil Court of the City of New York, Queens County, April 29, 2021Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved the provider's EUO no-show through timely mailed initial and follow-up letters and transcripts showing nonappearance; objections about unstated reasons, Mallela and a flat $1,000 fee did not toll the duty or raise issues.
Kings County Physicians Group v Nationwide Ins. Co. (2021 NY Slip Op 50337(U)) Civil Court of the City of New York, Queens County, April 16, 2021Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved its EUO no-show defense: letters were proved mailed, follow-ups were timely, and transcripts showed nonappearance at the initial and two continued EUOs, with no evidence of a mutually agreed rescheduling.
Sayyed DC, P.C. v Ameriprise Ins. Co. (2021 NY Slip Op 50311(U)) Civil Court of the City of New York, Queens County, April 13, 2021Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailed EUO requests, a timely follow-up after the first nonappearance, and two nonappearances by transcripts, rejecting arguments that it had to answer objections or give objective reasons for the EUO.
Blackman Pelham Med., P.C. v MVAIC (2020 NY Slip Op 51406(U)) Civil Court of the City of New York, Kings County, November 18, 2020Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the IME requests void because the first IME was scheduled more than a year after the bills were received, violating the 30-day time frame of 11 NYCRR 65-3.5 (d).
Longevity Med. Supply, Inc. v Progressive Ins. Co. (2020 NY Slip Op 20137) Civil Court of the City of New York, Kings County, June 17, 2020Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the IME no-show defense unproved because the scheduler's affidavit did not show personal knowledge or when letters were generated, and nonappearance affidavits were conclusory or hearsay.
New Chiropractic Care, P.C. v Nationwide Ins. Co. of N.Y. (2020 NY Slip Op 50652(U)) Civil Court of the City of New York, Kings County, June 1, 2020Insurer failed to prove the scheduling letters were mailed or properly addressed (also decides)Held the EUO no-show proved for most bills (letters mailed, Melville location reasonably convenient, nonappearance shown by attending attorney), but rejected the IME no-show because the scheduler's affidavit did not establish mailing and the doctor's affidavit was conclusory.
Krasner Chiropractic, P.C. v IDS Prop. & Cas. Ins. Co. (2019 NY Slip Op 29382) Civil Court of the City of New York, Richmond County, November 12, 2019Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer's EUO requests to the provider untimely because they were made after the claims had been denied, and no rule lets an insurer unilaterally reconsider denied claims to seek further verification.
Sama Physical Therapy v MVAIC (2019 NY Slip Op 29218) Civil Court of the City of New York, Queens County, July 15, 2019Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld that the EUO requests failed because they were sent more than two years after receipt of the bills, outside the 15-business-day period of 11 NYCRR 65-3.5 (b), so the defense could not be asserted.
Island Life Chiropractic Pain Care PLLC v Amica Mut. Ins. Co. (2019 NY Slip Op 51589(U)) Civil Court of the City of New York, Kings County, May 17, 2019Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the insurer failed to prove mailing because the attached notices came from another law firm and sought the EUO of the provider's employee, not the assignor; nonappearance was also unproved by counsel's conclusory affirmation.
Prompt Med. Supply, Inc. v Metropolitan Group Prop. & Cas. Ins (2019 NY Slip Op 51594(U)) Civil Court of the City of New York, Kings County, March 28, 2019Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the EUO scheduling letters inadmissible for lack of a CPLR 4518 foundation and, in any event, not shown properly addressed and mailed, so the no-show defense failed.
Dowd v Allstate Ins. Co. (2019 NY Slip Op 50648(U)) Civil Court of the City of New York, Queens County, March 11, 2019Insurer failed to prove the scheduling letters were mailed or properly addressedDenied the insurer summary judgment because it failed to prove that the IME scheduling letters were properly addressed and mailed to the assignor.
Body Acupuncture Care, P.C. v Erie Ins. Co. of N.Y. (2018 NY Slip Op 51362(U)) Civil Court of the City of New York, Kings County, July 6, 2018Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer failed to establish its IME no-show defense because the IME notice did not plainly tell the assignor of the right to reimbursement of lost earnings and travel expenses, reciting the regulation in tiny, confusing print.
Active Care Med. Supply, Corp. v American Tr. Ins. Co. (2018 NY Slip Op 51408(U)) Civil Court of the City of New York, Kings County, May 17, 2018Insurer failed to prove the nonappearance by someone with personal knowledgeHeld the insurer failed to prove the EUO nonappearance because its attorney's affirmation addressed the wrong date and rested on an unspecified file review without explaining his recollection seven years later.
Neuro Rehab Med. Servs. of S.I., P.C. v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 50671(U)) District Court of Suffolk County, Third District, May 4, 2018Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved two properly mailed EUO demands, nonappearance through the attorney assigned to conduct the EUOs, and sufficient reasons for the EUO, and the provider waived objections by not responding.
Active Care Med. Supply Corp. v ELRAC Inc. (2017 NY Slip Op 51968(U)) Civil Court of the City of New York, Kings County, November 17, 2017Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsAfter trial, found the scheduling letters mailed but held the defense failed because the first EUO should have been rescheduled once the insurer learned the assignor could not attend, so only one no-show occurred and no required follow-up was sent.
Shirom Acupuncture, P.C. v Country-wide Ins. Co. (2017 NY Slip Op 51412(U)) District Court of Suffolk County, Third District, October 16, 2017Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Left standing as rational an arbitrator's finding that EUO requests first mailed four and a half years after the claim were untimely and a nullity, so the no-show did not defeat the claim.
Pierre J. Renelique MD, P.C. v Travelers Ins. Co. (2017 NY Slip Op 51047(U)) Civil Court of the City of New York, Kings County, July 31, 2017Insurer failed to prove the nonappearance by someone with personal knowledgeFound at trial that the scheduling letters were timely mailed but that the insurer's witness, relying only on the file and office procedures, lacked personal knowledge of the assignor's failures to appear.
American Chiropractic Care, P.C. v GEICO Ins. (2017 NY Slip Op 27272) Civil Court of the City of New York, Kings County, July 20, 2017Proof on the no-show raises a question of fact; neither side wins the point as a matter of lawAdhered on reargument to holding that, although the insurer showed mailing and nonappearance, a triable issue existed whether it had a good-faith basis for the provider EUO, because the provider timely asked for a reason and the insurer refused any.
Central Park Physical Medicine & Rehab., P.C. v Travelers Indem. Co. of Conn. (2017 NY Slip Op 51354(U)) District Court of Suffolk County, Fourth District, June 27, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved properly mailed EUO letters and nonappearance through the attorney present at both EUOs, and rejected objections about reasonableness, notice to counsel and late requests to reschedule.
Z.M.S. & Y. Acupuncture, P.C. v Geico Gen. Ins. Co. (2017 NY Slip Op 27189) Civil Court of the City of New York, Kings County, May 26, 2017Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved its EUO no-show defense: letters were properly mailed, counsel present at all four EUOs attested to nonappearance, and the one-day-late follow-up was a technical defect excused under 11 NYCRR 65-3.5 (p).
Sure Way NY, Inc. v Travelers Ins. Co. (2016 NY Slip Op 26413) Civil Court of the City of New York, Kings County, December 8, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the EUO request to the provider timely because new information from the assignor's EUO started a new 15-business-day period, met here, and the insurer proved mailing of the letters and two nonappearances.
Charles Deng Acupuncture, P.C. v Titan Ins. Co. (2016 NY Slip Op 26211) Civil Court of the City of New York, Kings County, June 30, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedFound at trial that the insurer proved timely mailing of the EUO letters and, admitting certified EUO no-show transcripts as business records, that the providers failed to appear at least twice.
Avalon Radiology, P.C. v Ameriprise Ins. Co. (2016 NY Slip Op 26182) District Court of Suffolk County, Third District, June 8, 2016Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the EUO requests noncompliant with 11 NYCRR 65-3.5 (e) because the insurer refused the provider's timely request for the specific objective justification, so it did not show two failures to appear for properly scheduled EUOs.
NY Rehab Pain Mgt. & Med. Servs., PC v State Farm Auto Ins. Co. (2016 NY Slip Op 50821(U)) Supreme Court, Nassau County, May 24, 2016Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of the EUO letters and, through its attorney's affidavit, the provider's two nonappearances, and rejected the provider's belated good-cause objection and its appearance in another case as no excuse.
Matter of New Century Acupuncture P.C. v Country Wide Ins. Co. (2015 NY Slip Op 50919(U)) District Court of Suffolk County, Third District, June 18, 2015Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Left standing on article 75 review the arbitral finding that the insurer sent two EUO requests and the provider failed to appear, holding the finding implicit in the award and properly reviewed by the master arbitrator.
Electrodiagnostic & Physical Med PC v Maya Assur. Co. (2014 NY Slip Op 51500(U)) District Court of Nassau County, First District, October 17, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held the insurer made a prima facie showing that the EUO scheduling letters were timely mailed, the dates and places were reasonable and the assignor failed to appear, but the defense was barred by an arbitration award.
Prestige Med. P.C. v Travelers Home & Mar. Ins. Co. (2014 NY Slip Op 24317) Civil Court of the City of New York, Kings County, October 5, 2014Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the provider's EUO request, sent four business days late, did not defeat the defense but only shortened the time to deny, and granted the insurer summary judgment on the provider's two EUO no-shows.
Rutland Med., P.C. v State Farm Ins. Co. (2014 NY Slip Op 24298) Civil Court of the City of New York, Kings County, October 1, 2014Proof on the no-show raises a question of fact; neither side wins the point as a matter of lawHeld that the provider's timely, specific written objections to the reasonableness of the EUO requests, apparently unanswered, raised a triable issue on whether its nonappearance was excusable despite proof of mailing and nonappearance.
Hempstead Regional Chiropractic, PC v Allstate Ins. Co. (2014 NY Slip Op 24259) District Court of Nassau County, First District, September 8, 2014Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsDenied the insurer summary judgment because the assignor's attorney timely objected to the EUO and the insurer offered no objective basis for requesting it, though an IME cutoff did not itself bar the request.
Boulevard Multispec Med., P.C. v Tri-State Consumer Ins. Co. (2014 NY Slip Op 24080) District Court of Nassau County, First District, March 26, 2014Claimant showed the nonappearance was excused or the request unreasonable or waivedHeld the psychiatric IME no-show could not defeat claims for chiropractic, physical therapy and functional testing because the missed examination bore no relationship to the treatment at issue.
Natural Therapy Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2013 NYSlip Op 51935(U)) Civil Court of the City of New York, Kings County, November 21, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of the EUO scheduling letters and, through the attorney present on both dates, the provider's nonappearance, and refused to consider reasonableness objections the provider never raised before suit.
Matter of Boro Chiropractic P.C. v State Farm Fire & Cas. Co. (2013 NY Slip Op 50791(U)) Civil Court of the City of New York, Kings County, May 17, 2013Insurer failed to prove the nonappearance by someone with personal knowledge (also decides)Reinstated the arbitrator's finding that the insurer's letter briefs did not establish the EUO nonappearance, holding the master arbitrator irrationally shifted to the provider the burden of proving attendance.
LK Health Care Prods. Inc v GEICO Gen. Ins. Co. (2013 NY Slip Op 50810(U)) Civil Court of the City of New York, Kings County, May 9, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer need not answer a provider's letter objecting to and refusing an EUO, and its SIU manager's affidavit justified the request, so the provider's nonappearance defeated the claim.
Diagnostic Radiographic Imaging, P.C. v GEICO (2013 NY Slip Op 52247(U)) Civil Court of the City of New York, Kings County, May 8, 2013Claimant showed the nonappearance was excused or the request unreasonable or waivedHeld after trial that the insurer unreasonably refused to reschedule the IMEs after the pregnant claimant's good-faith request for a short adjournment, so her nonappearance was excused and the defense failed.
Jersey Rehab PA, P.C. v IDS Prop. Cas. Ins. Co. (2013 NY Slip Op 50652(U)) District Court of Nassau County, First District, April 26, 2013Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsDenied the insurer summary judgment because its IME letters did not tell the assignor he would be reimbursed for lost earnings and transportation, as 65-3.5 (e) requires, making the IME demands defective despite proof of nonappearance.
Quality Psychological Servs., P.C. v Hartford Ins. Co. (2013 NY Slip Op 50045(U)) Civil Court of the City of New York, Kings County, January 15, 2013Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved timely mailed EUO requests and follow-up within regulatory time frames, nonappearance through the attorney present on both dates, and justification for the EUO; the provider waived objections to location by not objecting.
GBI Acupuncture, P.C. v Esurance Ins. Co. (2012 NY Slip Op 52423(U)) Civil Court of the City of New York, Kings County, December 26, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved properly mailed EUO notices to the assignor and her attorney and repeated nonappearances, rejecting challenges to affidavit form, the paralegal's knowledge and spacing of the letters, with no excuse offered.
Back to Back Chiropractor, P.C. v State Farm Mut. Auto. Ins. Co. (2012 NY Slip Op 51088(U)) District Court of Suffolk County, Third District, June 15, 2012Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held the insurer proved that EUO notices were twice mailed under standard office practice and that the provider did not appear on either date, so a condition precedent to coverage was unmet.
Lender Med. Supply, Inc. v Hartford Ins. Co. (2012 NY Slip Op 50903(U)) Civil Court of the City of New York, Kings County, May 1, 2012Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer could not rely on the no-show because the pre-claim EUO was adjourned on consent and, after the claim arrived, it sent no follow-up request after the single post-claim nonappearance.
Concourse Chiropractic, PLLC v State Farm Mut. Ins. Co. (2012 NY Slip Op 50676(U)) District Court of Nassau County, First District, April 16, 2012Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the EUO no-show defense failed because the EUO notice was palpably improper: it demanded corporate ownership and financial documents seven days in advance, which the regulations do not authorize as part of an EUO.
Tarnoff Chiropractic, P.C. v GEICO Ins. Co. (2012 NY Slip Op 50670(U)) District Court of Nassau County, First District, April 12, 2012Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsDenied the insurer summary judgment on the EUO no-show because it showed only an unfounded suspicion of a staged accident, so it lacked an objective justification for the EUO request, which was therefore improper.
Chiropractic Back Care of Queens Vil., P.C. v ELRAC, Inc. (2011 NY Slip Op 50544(U)) District Court of Nassau County, First District, April 1, 2011Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of both IME letters through its scheduler's practice affidavit and nonappearance through the examining physician's affidavit, with no challenge to receipt or timeliness of the letters.
Dynamic Med. Imaging, P.C. v State Farm Mut. Auto. Ins. Co. (2010 NY Slip Op 20285) District Court of Nassau County, First District, July 15, 2010Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the insurer could not rely on the provider's failure to appear for EUOs because the EUO letters improperly demanded advance production of corporate ownership and financial documents, which the regulations do not authorize, so summary judgment was denied.
Gegerson v State Farm Ins. Co. (2010 NY Slip Op 50604(U)) District Court of Nassau County, Second District, April 8, 2010Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer entitled to dismissal for the provider's EUO default because its investigator's proof gave an objective justification, receipt was undisputed, and the follow-up request was timely measured from 30 days after the original request.
Perfect Point Acupuncture, P.C. v Auto One Ins. Co. (2010 NY Slip Op 50010(U)) Civil Court of the City of New York, Kings County, January 6, 2010Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of both IME letters and the assignor's nonappearance, rejecting the argument that a follow-up sent 17 days after the first letter forfeited the toll.
Prime Psychological Servs., PC v ELRAC, Inc. (2009 NY Slip Op 52579(U)) Civil Court of the City of New York, Richmond County, December 4, 2009Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing and nonappearance for a pre-claim IME, needing no follow-up because 65-3.6 time frames do not govern pre-claim exams, and rejected the claim that a neurological IME was unreasonable for psychological treatment.
Prime Psychological Servs., P.C. v Nationwide Prop. & Cas. Ins. Co. (2009 NY Slip Op 29100) Civil Court of the City of New York, Richmond County, March 5, 2009Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the 65-3.6 (b) requirement to notify the applicant's attorney of a follow-up did not apply to pre-claim EUOs, so the insurer proved properly mailed EUO requests and the assignor's nonappearance.
Five Boro Psychological Servs., P.C. v AutoOne Ins. Co. (2008 NY Slip Op28510) Civil Court of the City of New York, Kings County, December 8, 2008Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the IME request valid though before a psychologist and the doctor's nonappearance proof sufficient, but the requests were untimely and failed to toll the time, so the no-show defense failed.
A.B. Med. Servs. PLLC v GEICO Gen. Ins. Co. (2008 NY Slip Op 52641(U)) Nassau District Court, November 24, 2008Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (also decides)Held the insurer timely requested the provider's EUO and the provider failed to appear, rejecting as unauthorized his conditions of a separate paid day for each of 21 patients, which amounted to a refusal to provide verification.
Allstate Social Work & Psychological Servs., PLLC v Utica Mut. Ins. Co. (2008 NY Slip Op 28494) Civil Court of the City of New York, Kings County, November 5, 2008Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the insurer proved mailing of initial and follow-up IME requests and the assignors' nonappearances, rejecting the argument that psychological IMEs by a non-physician psychologist were not authorized by the endorsement.
All-Boro Med. Supplies, Inc. v Progressive Northeastern Ins. Co. (2008 NY Slip Op 28207) Civil Court of the City of New York, Kings County, May 27, 2008Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the EUO no-show was not a valid ground for denial because, after receiving the claim, the insurer did not reschedule the pre-claim EUO within 30 days of receipt.
KOI Med. Acupuncture v State Farm Ins. Co. (2007 NY Slip Op 51705(U)) Nassau District Court, September 10, 2007Insurer failed to prove the scheduling letters were mailed or properly addressed (also decides)Held the EUO no-show defense failed because the insurer did not show its policy contained the EUO endorsement and offered no competent proof that the EUO scheduling letters were mailed to the assignor.
Tsai Chao v Country-Wide Ins. Co. (2006 NY Slip Op 50794(U)) Nassau District Court, May 3, 2006Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the IME no-show defense failed because the insurer offered no admissible proof that the IME notice was properly mailed; its affidavit did not say how or when it was sent.
A.B. Med. Servs. PLLC v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 26131) Civil Court of the City of New York, Kings County, March 7, 2006Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the IME no-show defense failed because the insurer did not prove the IME requests were timely mailed and, in any event, did not show a timely follow-up request.
Foster Diagnostic Imaging, P.C. v General Assur. Co. (2005 NY Slip Op 25431) Civil Court, Kings County, October 17, 2005Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld at trial that the scheduler's mailing testimony and its computer notes, admissible as business records despite unnamed sources, proved the examinations were scheduled and the assignors never appeared; no excuse was offered.
Vital Points Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2005 NY Slip Op 50267(U)) Civil Court of the City of New York, Kings County, March 3, 2005Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the denials based on the assignor's failure to attend IMEs ineffective because the insurer did not send a follow-up request within 10 days as the verification regulations require for IME requests.
A.B. Med. Servs. PLLC v New York Cent. Mut. Fire Ins. Co. (2004 NY Slip Op 51847(U)) Civil Court of the City of New York, Kings County, November 10, 2004Insurer failed to prove the scheduling letters were mailed or properly addressedHeld the IME no-show defense failed because no one with personal knowledge attested to mailing the scheduling letters or to a standard mailing practice, and the insurer also did not follow up as the regulations require.
Star Med. Servs., P.C. v Allstate Ins. Co. (2004 NY Slip Op 51280(U)) Civil Court of the City of New York, Kings County, October 27, 2004Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the no-show defense failed because, after the assignor missed the only scheduled EUO, the insurer sent no follow-up request as the regulations require, so its time to deny was not tolled.
Star Med. Servs., P.C. v Allstate Ins. Co. (2004 NY Slip Op 24410) Civil Court, Kings County, October 25, 2004Insurer failed to prove the scheduling letters were mailed or properly addressedRejected the EUO no-show defense because both scheduling letters went to a wrong address and notice to the assignor's personal-injury attorney was not notice to the assignor.
Ocean Diagnostic Imaging P.C. v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 24356) Civil Court of the City of New York, Kings County, September 24, 2004Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejectedHeld the EUO regulation applied to a claim filed after its effective date under a policy issued after September 2001, so the assignor's undisputed failure to attend two EUOs defeated the provider's summary judgment motion.
Andrew Lopedote, D.C. v General Assur. Co. (2004 NY Slip Op 50593(U)) Civil Court, Kings County, June 21, 2004Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the IME no-show denial invalid because the IME requests were sent to the assignor and counsel before the claim was submitted, not to the provider within the regulatory verification period, so the provider won summary judgment.
Ocean Diagnostic Imaging v Utica Mut. Ins. Co. (2004 NY Slip Op 50203(U)) District Court of Nassau County, Third District, March 29, 2004Insurer did not show its requests met the regulatory timing, follow-up or justification requirements (also decides)Held the IME requests did not toll the time to deny because the first IME was scheduled more than 30 days after receipt of the claim and no timely requests were documented.
New York Craniofacial Care v Lumbermen's Mut. Cas. Co. (2004 NY Slip Op 24025) Civil Court of the City of New York, Queens County, January 22, 2004Insurer did not show its requests met the regulatory timing, follow-up or justification requirementsHeld the EUO no-show defense failed because the regulations in force before April 2002 required no EUO, so appearance was not a condition precedent. Two missed EUOs were not willful noncooperation, and the policy's EUO clause was not shown to be part of the no-fault endorsement.

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