Summary
This Appellate Division, First Department decision reverses a trial court's denial of an insurer's motion for summary judgment regarding no-fault automobile insurance benefits. The court held that the insured claimant's failure to attend properly noticed independent medical examinations (IMEs) foreclosed coverage under the policy. The opinion clarifies that notice requirements for verification requests do not apply when IME notices are sent prior to claim receipt, and that such failures constitute a blanket coverage defense not requiring a timely disclaimer.
Topics
Practice areas
Questions Presented
- Whether a claimant's failure to attend properly noticed independent medical examinations forecloses coverage and obligates the insurer to pay no‑fault benefits.
- Whether the insurer must establish a timely disclaimer of coverage when the claimant fails to attend the examinations.
Holdings
- Plaintiffs are entitled to summary judgment because the claimant's failure to attend properly noticed IMEs is a coverage defense that forecloses coverage.
Key quotations
“Moreover, the failure to attend a properly noticed examination is a "coverage defense [that] appl[ies] to any claims, and is not determined on a bill by bill basis".”
Factual background
The underlying accident occurred on June 2, 2021. The insurer sent two properly noticed independent medical examination (IME) notices to the claimant, who failed to appear for either examination. The providers argued the IMEs were untimely, but the insurer contended the notices satisfied the statutory requirements.
Procedural history
The Supreme Court, New York County denied the plaintiffs' motion for summary judgment on the issue of no‑fault benefits. The plaintiffs appealed, and the Appellate Division, First Department reversed the lower court's denial, granting summary judgment in favor of the plaintiffs.