IME No-Show Lawyer in NY

Lawyer signing a book

An Independent Medical Exam (IME) is one of the ways that an insurer tries to limit their liability on treatment that a patient receives after the IME. 

When an insurance company orders an IME, the insurer’s doctor is responsible for conducting an objective examination of the injured person. The results of the IME are then used to help the insurance carrier determine whether the injured person is entitled to receive additional care under No-Fault benefits. 

A common issue we see is that the patient misses two appointments with the same specialty. If the injured person indeed misses two IME appointments with the same specialist, the insurance company is likely to deny all additional benefits. Indeed, the insurer may even deny all claims retroactively.

As a practitioner attempting to recover a debt for services already provided, you may find that insurers use missed IMEs to avoid paying for care. This is a common issue that the New York No-Fault Attorneys at The Sigalov Firm PLLC have encountered. Our team is prepared to help you maximize recovery in missed IME cases.

The team of attorneys at The Sigalov Firm, PLLC have decades of experience representing medical professionals and facilities trying to recover debts for services rendered under New York’s No-Fault system. We know how to deal with insurance companies and their tactics. 

Do the Reasons Behind an IME No-Show Matter?

The reasons for a no-show typically do not matter. What matters is whether the patient or the patient’s attorney had communicated with the insurance carrier about the patient’s inability to attend an IME appointment. If a patient had timely communicated with the insurer and worked in good faith to reschedule the IME, that would be a valid excuse.  

Regardless of the “why,” after two no-shows, an insurance company will typically deny an IME to the claimant all the way back to the date of the accident. This leaves the medical facility currently treating them unable to collect payments for services already rendered and those scheduled for future dates. 

Insurance Denial Based on IME No-Shows

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.

How to Recover Medical Bills After a No-Show Claim Denial

There are cases where there is documentary evidence (i.e. emails) showing that the injured person tried to reschedule their IME in good-faith but was ignored by the carrier. However, this is seldom the case and most of the time we must rely on technicalities to prevail in IME no-show cases. 

The burden of proof to show that the injured person failed to attend an IME is on the insurance carrier. The insurer must show evidence that requests for such IMEs were properly mailed to the injured, at the right address, and they must further show that the injured did not attend at the scheduled time. We are often able to prevail by showing that the carrier’s IME process was somehow deficient. 

Contact the Sigalov Firm for a Free Consultation

If your claim has been denied because your patient missed their IME appointments, call us today at (347) 489-7830. You may also visit the contact form to schedule a consultation with one of our experienced No-Fault insurance attorneys

Your best course of action depends on the specific situation. We know how to discredit an insurance carrier’s evidence and often win because the carrier failed to carry its burden to show that both IME requests had been sent and the injured party had failed to attend.