Applicant v. Allstate Insurance Company (8/11/2010)
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The requirement that a patient attend a physical examination at a carrier’s request is set forth in 11 NYCRR. 65.3.5. A claimant is entitled to two opportunities to appear at said examination (an “IME”), and the scheduling of an exam is referred to as a verification request. 11 NYCRR 65.3.5(d). When the claimant fails to comply with the original request, Section 65.3.5(e)(2) requires that the carrier follow-up by either telephone or by mail to schedule a second exam. The insurance carrier is also required to place Applicant’s counsel on notice of the scheduling of the second physical examination. See Prime Psychological Services, P.C. v. Nationwide, 24 Misc.3d 230, 234-235 (Civ. Court 2009).

AR Physical Therapy & PTA PLLC v. Geico Insurance Company (8/12/2010)
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The insurance carrier denied coverage on the basis that the patient failed to attend independent medical examinations. However, the carrier failed to submit any evidence to show that the appointment letters were even mailed properly, thus, regardless of the reasons for the patient’s failure to appear, the lack of evidence provided by the carrier requires the arbitrator to award the benefits.

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