No-Fault Insurance
Got an IME notice from your insurer? Attendance isn't optional, and a bad report can cut off your No-Fault benefits.
If you’ve been injured in a car accident on Long Island, there’s a good chance you’ve heard the term “No-Fault insurance.” Most people know it pays medical bills after an accident, but that’s about where their understanding usually ends. Then, a few months into treatment, they receive a letter requiring them to appear for an IME. Suddenly they’re asking questions they’ve never had to think about before.
Do I have to go?
What happens if I miss it?
Can they really stop paying for my treatment?
After representing injured Long Islanders for more than three decades, I’ve answered these questions hundreds of times. The truth is that IMEs are simply part of the No-Fault process. If your treatment continues for more than a couple of months, you should expect the insurance company to schedule one. That doesn’t necessarily mean they think you’re lying or that your claim is in trouble. It simply means they’re exercising a right contained in your insurance policy.
Understanding how IMEs work before you walk into the examination can make the process a lot less stressful. In this article, I’ll explain what No-Fault insurance covers, why insurance companies require IMEs, what happens during the examination, what your rights are, and what options you have if your benefits are terminated.
If you were hurt in an accident and aren’t sure how No-Fault applies to your situation, we can walk you through your coverage, your deadlines, and your options. Schedule a free consultation with Palermo Law today.
New York has what is known as a No-Fault insurance system. Unlike many other states, your own automobile insurance company is generally responsible for paying your initial economic losses after a motor vehicle accident, regardless of who caused the crash.
The purpose of No-Fault is simple. It allows injured people to receive medical treatment and partial lost wages without waiting months or years for a lawsuit to be resolved. In theory, it gets benefits into the hands of injured people quickly while reducing the number of disputes over smaller accident claims.
In most cases, basic No-Fault coverage provides up to $50,000 in benefits. Those benefits may include payment of reasonable and necessary medical treatment related to the accident, a portion of your lost wages if your injuries prevent you from working, transportation expenses for medical appointments, and certain other necessary expenses permitted under the law.
Many people also purchase additional personal injury protection, commonly referred to as APIP, which increases the amount of available No-Fault benefits beyond the basic $50,000 policy limit.
One of the biggest misconceptions I hear is that No-Fault compensates people for everything they lose after an accident. It doesn’t.
No-Fault does not compensate you for your pain and suffering. It does not pay for the physical pain, emotional distress, inconvenience, or loss of enjoyment of life caused by your injuries. Those damages are pursued through a separate bodily injury claim against the at-fault driver, provided your injuries satisfy New York’s serious injury threshold.
That distinction is important because the IME we’re about to discuss only affects your No-Fault benefits. It does not determine whether you have a personal injury lawsuit or how much your lawsuit may ultimately be worth.
Every auto policy in New York includes a shared pool of coverage for injuries after an accident, regardless of fault. Basic coverage is $50,000 per person, per accident.
Reasonable and necessary medical expenses related to the accident, including doctor visits, imaging, and therapy.
A portion of your lost earnings if your injuries prevent you from working, subject to statutory limits.
Reasonable transportation expenses for getting to and from medical appointments related to your treatment.
Certain additional out-of-pocket expenses permitted under New York’s No-Fault law.
Plan Ahead
Serious injuries can easily cost more than the $50,000 basic limit, which is why many drivers add Additional Personal Injury Protection (APIP) to their policy in advance to raise their available No-Fault coverage.
IME stands for Independent Medical Examination.
Although that’s the name used throughout the insurance industry, many injured people question just how independent these examinations really are. The doctor performing the examination is selected by the insurance company and paid by the insurance company. Many of these physicians perform hundreds, if not thousands, of IMEs every year for insurance carriers.
That doesn’t automatically mean the doctor is biased or that every report will favor the insurance company. I’ve seen IME doctors write reports that support my clients’ injuries and recommend continued treatment. When that happens, I’m happy to use those reports later in the bodily injury claim because they come from a physician hired by an insurance company.
Unfortunately, I also see reports that conclude someone has fully recovered after an examination lasting only a few minutes. Those reports often differ dramatically from the opinions of the treating physicians who have been seeing my client for weeks or months.
From my perspective, that’s an important distinction.
A treating physician has the advantage of watching a patient’s recovery over time. They review MRI studies, monitor progress, evaluate how treatment is working, and adjust the treatment plan as necessary. An IME doctor, on the other hand, usually sees the patient only once. That single visit provides a much smaller snapshot of the person’s condition.
Ultimately, the insurance company uses the IME doctor’s report to decide whether it will continue paying No-Fault benefits.
People often assume they’ve done something wrong when an IME notice arrives in the mail.
Most of the time, that’s simply not true.
Insurance companies routinely schedule IMEs whenever treatment continues beyond the initial stages of recovery. In my experience, once treatment lasts approximately two to three months, clients should begin expecting that an IME notice may arrive.
That timeline isn’t fixed. Some people receive an IME earlier, particularly if they’re undergoing extensive treatment or expensive procedures. Others may not receive one until much later. Every insurance company has its own internal procedures for reviewing ongoing claims.
If your injuries involve different parts of the body, you may also be scheduled to see different specialists.
For example, someone recovering from neck and back injuries may be examined by an orthopedic surgeon. A person suffering from post-concussion symptoms may be scheduled with a neurologist. If psychological injuries are being treated, the insurance company may request an examination by a psychologist or psychiatrist.
I’ve also seen clients attend multiple IMEs over the life of a claim. Again, that’s simply part of the No-Fault process.
The important thing is not to panic when you receive the notice. In most cases, it is an expected step in a claim involving ongoing treatment.
One thing I always explain to clients is that attending an IME is not optional if you want to keep your no-fault benefits intact.
When you purchase automobile insurance in New York and make a claim for No-Fault benefits, your policy requires you to cooperate with the insurance company’s investigation of that claim. That cooperation includes appearing for properly scheduled IMEs.
Ignoring the appointment because you don’t think it’s fair is usually a mistake.
Likewise, deciding not to attend because your own doctor already knows you’re injured is not a valid excuse.
Whether you agree with the process or not, failing to comply with your policy’s requirements can jeopardize your No-Fault benefits.
Fortunately, that doesn’t mean you’re powerless. You still have important rights throughout the process, and understanding those rights can make a significant difference if the insurance company later decides to terminate your benefits.
Most No-Fault IMEs are conducted in a doctor’s office selected by the insurance company. The notice you receive will tell you the date, time, location, and the specialty of the physician who will be performing the examination.
The office may or may not be close to your home. In my experience, most insurance companies try to schedule examinations within a reasonable distance, whether you live in Suffolk County or Nassau County, although some locations are certainly more convenient than others.
The notice should also explain what claim the examination relates to and provide enough information for you to identify the accident involved.
Whenever a client receives an IME notice, I recommend reading it carefully. Make sure you know where you’re going, allow yourself extra travel time, and arrive early. Running late or showing up at the wrong office creates unnecessary problems that are easily avoided.
Yes.
Many people assume they’ll attend one examination and that’s the end of it. Unfortunately, that’s not always how the process works.
If your treatment continues for an extended period of time, the insurance company may request additional IMEs. Likewise, if you’re treating different injuries, you may be examined by more than one specialist.
For example, someone receiving treatment for orthopedic injuries and post-concussion symptoms may be asked to see both an orthopedic surgeon and a neurologist. If psychological treatment is being provided following the accident, an examination with a psychologist or psychiatrist may also be requested.
I’ve represented clients who attended several IMEs over the course of a single claim. While that can certainly become frustrating, it is permitted under most No-Fault policies so long as the requests are reasonable.
Again, I always tell my clients not to view additional IMEs as a sign that something has gone wrong with their case. Long-term treatment often results in additional reviews by the insurance company.
Life happens.
People get sick.
Cars break down.
Family emergencies arise.
Most insurance companies will permit an IME to be rescheduled if there is a legitimate reason, particularly if you notify them before the appointment.
The key is communication.
If you know you cannot attend, contact your attorney immediately. If you’re not represented, contact the insurance company as soon as possible. Waiting until after you’ve missed the appointment makes the situation much more difficult.
I also recommend keeping documentation if the reason for the rescheduling is something significant. For example, if you were hospitalized or experienced another medical emergency, those records may become important if there is ever a dispute over why you failed to appear.
Simply deciding you don’t want to attend the examination is not a valid reason for rescheduling.
This is probably the question I’m asked most often.
The answer is simple.
Missing an IME can have serious consequences.
Under New York’s No-Fault system, appearing for properly scheduled IMEs is considered part of your obligation to cooperate with your insurance company. If you fail to appear without a valid excuse, the carrier may deny future No-Fault benefits.
Generally speaking, insurance companies don’t terminate benefits after a single missed appointment. In many cases, they schedule a second examination before issuing a denial. However, you should never assume you’ll automatically receive another opportunity.
Every missed appointment creates unnecessary risk.
If you accidentally miss an examination, don’t ignore it. Contact your attorney immediately. Sometimes the situation can still be addressed before the insurance company takes further action.
The worst thing you can do is simply throw the notice aside and hope it goes away.
One of the biggest surprises for many clients is how short the examination can be.
Unlike your treating physician, who may have been seeing you regularly for months, the IME doctor usually meets you only once.
You’ll typically be asked about the accident, your injuries, your current complaints, your medical history, and the treatment you’ve received since the collision.
The doctor may ask whether you’re working, whether you’re still attending physical therapy, whether you’ve undergone injections or surgery, and whether your symptoms have improved since the accident.
After asking questions, the doctor usually performs a physical examination.
Depending upon the nature of your injuries, this may include measuring your range of motion, checking muscle strength, evaluating reflexes, testing sensation, or performing other orthopedic or neurological tests.
Some examinations are fairly thorough. Others are surprisingly brief.
That’s one of the criticisms many attorneys have of the IME process. I’ve seen examinations that lasted only a few minutes. It’s difficult to believe any physician can fully evaluate months of treatment and ongoing complaints during such a short encounter.
By comparison, your treating physician has often seen you dozens of times, reviewed your MRI studies, monitored your progress, adjusted your treatment, and watched your recovery unfold over time.
In my opinion, that relationship provides a much more complete picture of your injuries than a single examination ever could.
This is actually one of the easiest parts of the process.
Be honest.
Answer the questions truthfully.
Don’t exaggerate your symptoms.
At the same time, don’t minimize them either.
If something hurts, say so.
If it doesn’t, don’t pretend that it does.
I also tell clients not to argue with the doctor or try to convince them that they’re injured. The examination isn’t a debate. Your job is simply to answer the questions honestly and cooperate with the examination.
Another practical tip is to avoid guessing.
If you don’t remember the exact date of a medical appointment or the name of a medication, it’s perfectly acceptable to say you don’t remember.
Finally, remember that your conduct before and after the examination may also be observed. Whether you’re walking from the parking lot, getting in and out of your vehicle, or sitting in the waiting room, assume you’re being watched.
That doesn’t mean you should become paranoid. It simply means you should act naturally and honestly throughout the process.
Once the examination is over, your part is usually finished. The IME doctor prepares a written report for the insurance company summarizing your medical history, the examination findings, and the doctor’s opinions regarding your condition.
That report can have a significant impact on your No-Fault claim. If the doctor concludes that additional treatment remains medically necessary, your No-Fault benefits will generally continue. If the doctor concludes that further treatment is no longer necessary or that you have recovered from your accident-related injuries, the insurance company may rely on that report to terminate future No-Fault benefits.
It is important to understand what the IME report does and does not do. A negative IME does not erase your injuries, and it does not determine whether you have a personal injury lawsuit. It is one piece of evidence that may affect your No-Fault benefits and may later become relevant in your bodily injury case.
Many people believe they have no rights once the insurance company schedules an IME. That’s simply not true.
While your policy requires you to attend a properly scheduled examination, you also have rights throughout the process. You are entitled to reasonable notice of the examination, to know where you are expected to appear, and to know what type of physician will be conducting the examination.
After the examination is completed, you are entitled to obtain a copy of the doctor’s report. If you are represented by an attorney, your attorney should request it and review it with you.
I always tell clients to keep every letter they receive from the insurance company. Those notices can become important if there is ever a dispute about scheduling or a later denial of benefits.
This is another area that causes confusion. The physician performing your IME is not there to provide treatment. They are not establishing a doctor-patient relationship, prescribing medication, recommending surgery, or directing your recovery.
Their role is much narrower. They are there to examine you and provide an opinion to the insurance company about whether your current treatment remains medically necessary and related to the accident.
Your treating physician is focused on helping you recover. The IME doctor is evaluating you for the insurance company. Understanding that distinction helps set realistic expectations before you walk into the examination room.
Your doctor
Hired by the insurance company
Why it matters: If an IME report conflicts with your treating physician’s findings, that conflict — not the IME alone — is often what your case comes down to.
A denial of No-Fault benefits can be frustrating, but it does not necessarily mean your medical treatment has to stop.
Depending on the circumstances, your medical provider may challenge the denial through No-Fault arbitration or litigation if it believes the IME report is incorrect. Many providers routinely pursue these claims when they believe treatment remained medically necessary.
You may also be able to continue treatment through private health insurance, Medicare, or Medicaid if those options are available. Every situation is different, so it is important to discuss your options with your attorney and your medical providers.
One thing I never want clients to do is assume that a denial letter means they should simply stop treating. There are often other options.
After handling car accident cases for more than 30 years, I’ve come to expect IMEs in almost every claim involving ongoing treatment. I prepare every client for them because I don’t want anyone to be surprised when that notice arrives in the mail. It’s simply part of the No-Fault process.
Do I think the system is perfect? No, not by a long shot.
The reality is that insurance companies hire these doctors over and over again. That naturally raises questions about impartiality. At the same time, on occasion I’ve also seen IME doctors write reports that fully support my clients’ injuries and recommend continued treatment. When that happens, I have no hesitation using those reports later because they come from the insurance company’s own doctor.
The reports I really struggle with are the ones that conclude someone has fully recovered after a very brief examination. In my opinion, those findings should always be weighed against the treating physician’s opinions. The treating doctor has followed the patient’s progress over weeks or months, reviewed diagnostic imaging, adjusted treatment, and watched the recovery firsthand. That relationship almost always provides a more complete picture than a one-time examination.
If there’s one thing I’ve learned after representing injured people for more than three decades, it’s that preparation makes a tremendous difference. Clients who understand the IME process before they attend are usually far less anxious because they know what to expect.
I tell every client the same thing. Tell the truth. Don’t exaggerate. Don’t minimize your symptoms. Cooperate with the examination. Then let your attorney handle the legal issues that follow.
Most IMEs come and go without creating major problems. Even when No-Fault benefits are terminated, there are often ways to challenge that decision or continue treatment through other available resources. The most important thing is not to let fear of the unknown cause you to make a mistake that could have been avoided.
A No-Fault IME is a medical examination requested by your automobile insurance company while it is still paying your No-Fault benefits. Its purpose is to determine whether your treatment remains medically necessary and related to the accident. It is not treatment, and the examining doctor does not become your treating physician.
Generally, yes. Your No-Fault policy requires you to cooperate with reasonable requests for an IME. Failing to appear without a valid excuse can place your future No-Fault benefits at risk, so it is important to attend the exam or promptly reschedule it if you cannot make it.
Most insurance companies schedule a No-Fault IME after two to three months of ongoing treatment, though the exact timing varies. In my experience representing injured people across Long Island, some clients are examined sooner, particularly with extensive treatment, while others wait longer. Every insurer follows its own internal review schedule.
A No-Fault IME typically has two parts: a discussion of your accident, injuries, symptoms, and treatment history, followed by a physical examination. Depending on your injuries, the doctor may test your range of motion, muscle strength, reflexes, or sensation. Most exams last only a few minutes to half an hour.
Yes. If you have a legitimate conflict, contact your attorney or the insurance company as soon as possible to reschedule. Do not simply miss the appointment. Addressing the issue before the scheduled examination is almost always better than trying to explain a missed appointment after the fact.
A denial does not mean you must stop treating. Your medical provider may challenge the decision through No-Fault arbitration or litigation, and you may be able to continue treatment through private health insurance, Medicare, or Medicaid. Discuss your options with your attorney and providers before changing your course of care.
Yes. You are generally entitled to request and receive a copy of the IME report from the insurance company. Reviewing it with your attorney helps you understand the doctor's findings and determine whether the report actually supports the insurer's decision to reduce or terminate your No-Fault benefits.
No. A negative IME primarily affects your No-Fault benefits, not your right to sue the at-fault driver. It does not determine whether your injuries meet New York's serious injury threshold or how much your bodily injury case may be worth. It is simply one piece of evidence among many considered.
Not entirely, despite the name. IME stands for Independent Medical Examination, but the examining doctor is selected and paid by the insurance company, not by you. Some reports genuinely support injured clients, while others do not. In my experience, the treating physician usually has a more complete understanding of a patient's condition because they've followed the recovery over time.
It's a good idea, especially if you've suffered significant injuries. An experienced attorney can explain what to expect, answer your questions, review the IME report afterward, and advise you if the insurance company later relies on that report to terminate your No-Fault benefits.
The information provided in this blog is for general informational purposes only and reflects the opinions of the author. It is not legal advice and does not create an attorney-client relationship. Every case is different, and results depend on the specific facts and applicable law. You should not act or rely on any information in this blog without first seeking advice from a qualified attorney regarding your individual situation.
