Pre-Claim Ime No Show Supports Denial, Even if for a Different Specialty Than Bill; Only One Pre-and Post-Claim No Shows Required for Denial: Prime Psychological Servs., Pc a/a/O Brent Horne V Elrac, Inc. (Courtside‪)‬

This case presents raises a new twist to this court's previous ruling that the notification requirements for verification requests, as contained in 11 NYCRR [section][section]65-3.5 and 3.6, do not apply to examinations under oath ("EUOs") and independent medical examinations ("IME") that are scheduled prior to the insurance company's receipt of claim forms ("pre claim EUO" or "pre-claim IME"). Here, the insurance company seeks summary judgment based upon the assignor's failure to appear at both a pre-claim IME and an IME noticed and scheduled subsequent to the insurance company receipt of a claim from the medical services provider which, under precedent, triggers strict regulatory time deadlines for compliance with verification requests. Plaintiff Prime Psychological Services, P.C., a medical services company, brought this action to be reimbursed in the amount of $1,036.41 for medical treatment it provided to its assignor Brent Horne. Defendant ELRAC, Inc. moves for summary judgment based upon its timely denial that the assignor failed to appear for two IMEs, one scheduled for a date prior to the defendant's receipt of the claim and another scheduled right after its receipt of the claim. Plaintiff opposes defendant's motion on the grounds that the IME request was unreasonable because the assignor was scheduled for a neurological IME while plaintiff presented a claim for psychological treatment. In the alternative, plaintiff alleges that defendant has not established a proper mailing of the denial and the IME notices.