Amato v. State Farm Ins. Co.
| Decision Date | 13 October 2010 |
| Citation | 30 Misc.3d 238,910 N.Y.S.2d 637 |
| Parties | Richard E. AMATO D.C., a/a/o Sandra J. Burrell, Plaintiff, v. STATE FARM INSURANCE COMPANY, Defendant. |
| Court | New York District Court |
30 Misc.3d 238
Richard E. AMATO D.C., a/a/o Sandra J. Burrell, Plaintiff,
v.
STATE FARM INSURANCE COMPANY, Defendant.
District Court, Nassau County, New York.
First District.
Oct. 13, 2010.
Abrams, Fensterman, et al., for Plaintiff.
Lawrence Rogak, LLC, for Defendant.
FRED J. HIRSH, J.
This action raises issues regarding the extent to which a no-fault insurance carrier may rely upon the results of an Independent Medical Examination ("IME") to deny payment for medical treatment provided after the IME.
Plaintiff sues to recover first party no-fault benefits for chiropractic care provided to Sandra Burrell ("Burrell") during the period January 3, 2006 through January 30, 2007.
Burrell was injured in a motor vehicle accident that occurred on February 16, 2005. State Farm Insurance Company ("State Farm") provided no-fault insurance benefits to Burrell for medical treatment received for injuries sustained in this accident.
Burrell received chiropractic treatment for the injuries she sustained in the accident from Richard E. Amato, D.C. ("Dr. Amato"). Burrell assigned her right to receive first party no-fault benefits for her chiropractic care to Dr. Amato.
State Farm requested Burrell submit to an IME to be conducted by Todd Aordkian, D.C. ("Dr. Aordkian"). The IME was conducted on September 8, 2005.
Dr. Aordkian's examination found the range of motion of Burrell's cervical and lumbar spine to be essentially normal. The only objective finding he made was decreased sensation along the right leg.
In addition to conducting an IME, Dr. Aordkian also reviewed medical records of the doctors who had provided treatment to Burrell prior to the IME and report of a cervical MRI dated April 30, 2005.
Dr. Aordkian's diagnosis was a resolved cervical and lumbar sprain. Dr. Aordkian issued a report dated September 16, 2005 in which he concluded Burrell needed no further chiropractic treatment for the injuries arising from the February 16,2005 automobile accident.
Dr. Aordkian testified a trial Burrell's condition would not improve even if she received additional chiropractic treatment.
Burrell received additional chiropractic treatment from Dr. Amato during the period January 3, 2006 through January 30, 2007.
Dr. Amato submitted the bills for this treatment to State Farm. State Farm denied payment of the bills for this treatment
Dr. Aordkian testified he had not seen any medical reports or records relating the treatment Burrell received from Dr. Amato from January 3, 2006 through January 30, 2007. He did not know what Burrell's condition was when she received this treatment or whether her condition had worsened after he conducted the IME.
The parties stipulated to the timely submission of the bills for the treatment and the timely issuance of denials. The parties stipulated into evidence the bills, the report of the Independent Medical Examination performed by Dr. Aordkian and the medical reports and records reviewed by Dr. Aordkian when he conducted the IME.
DISCUSSION
The No-Fault regulations permit an insurer to demand the injured party to submit to an IME "... as often as, the company may reasonably require it." 11 NYCRR 65-1.1. An applicant for no-fault benefits is not to be treated as an adversary. 11 NYCRR 65-3.2(b). The basic goal of an insurer in processing no-fault claims is "... the prompt and fair payment to all automobile accident victims." 11 NYCRR 65-3.2(a).
The purpose of an IME is to assist the carrier in determining the extent of the claimant's injuries and the claimant's need for continuing medical treatment. See, Rowe v. Wahnow, 26 Misc.3d 8, 11, 12, 891 N.Y.S.2d 584 [App. Term, 1st Dept.2009, (McKeon, P.J. dissenting) ].
The purpose of the no-fault statute is to insure prompt payment of medical claims regardless of fault. Fair Price Medical Supply Corp. v. Travelers Indemnity Co., supra; and
In order to meet this purpose, an insurer must pay a deny a claim within 30 days of receipt. 11 NYCRR 65-3.8(a). An insurer may toll or extend its time to pay a claim by timely demanding an IME, an Examination Under Oath or verification. Hospital for Joint Diseases v. New York Central Mutual Fire Ins. Co., 44 A.D.3d 903, 844 N.Y.S.2d 371 (2nd Dept.2007); 11 NYCRR 65-3.5(c); and 11 NYCRR 65-3.8(a)(1).
A no-fault insurance carrier is precluded from...
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