The Sigalov Firm PLLC specializes in the collection and arbitration of no-fault medical claims
IME no-shows are a frequent problem for medical providers seeking reimbursement. Injured persons are expected to present themselves for an examination at the time and place of the insurance carrier’s choosing.
It takes two no-shows, to the same IME specialist, for an insurer to sustain a denial based on failure to attend IMEs. An IME scheduling letter is treated as a verification request; therefore, all the rules that apply to verification requests apply to IME request letters as well. Furthermore, the regulations state that an injured party must attend an IME: “when, and as often as, the insurer may reasonably require.” If the injured person fails to attend two IME requests, it entitles the no-fault insurer to deny benefits retroactively to the date of loss.
However, there are cases where a failure to attend an IME may be excused
All the usual legitimate reasons why a persons may fail to attend the appointment may be adequate. A conflicting appointment with a treating doctor, a wedding, or an illness are all legitimate excuses.
Furthermore, the insurance carrier must show evidence that requests for such IMEs were mailed to the injured person. If the insurance carrier is able to prove that the IME requests were properly mailed, the insurer must then present evidence that the injured party actually failed to attend the IME in both instances. We know how to discredit an insurance carrier’s evidence and frequently win because the carrier failed to carry its burden to show with certainty that both IME requests had been sent and that the injured party had failed to attend.