An insurer's medical exam came early; notice to the provider came late. A New York court said the later date decided it.
On July 9, 2026, New York's Appellate Division, First Department, unanimously upheld a $3,568.50 no-fault award against American Transit Insurance Company, with costs.
The money went to a chiropractor who had treated one of the insurer's covered patients. American Transit tried to have the arbitration award thrown out, arguing it had properly ended the chiropractor's no-fault benefits on March 12, 2023. The insurer leaned on an independent medical examination, or IME - an outside medical review of whether more treatment was needed. A nonparty chiropractor had issued that report on February 21, 2023, concluding the patient needed no further chiropractic care.
The court was not persuaded. What mattered, the judges said, was not the day American Transit chose to stop paying, but the day the provider learned the benefits were being cut off. That was May 1, 2023. And the insurer never answered the provider's argument about that May 1 date - an argument the first arbitrator had already accepted.
American Transit also left another point unanswered. The arbitrator had relied on an opinion letter from the New York State Insurance Department Office of General Counsel, which said an IME does not take effect until the insurer sends the provider a timely denial based on the exam. The insurer never rebutted that. Because it failed to knock down the reasoning behind the arbitrators' decisions, the court found no basis to call them irrational, arbitrary, or contrary to settled law.
Timing undid the insurer on the verification question, too. American Transit said the verification requests it sent between July 2022 and July 2023 had paused the 30-day window it had to pay or deny the bills. But except for one request dated July 17, 2023, the insurer did not dispute that the provider had turned over the verifications it asked for - which put it back on the 30-day clock.
As for that July 17 request, the arbitrator found it asked for material the provider had already supplied, since the provider's final verification arrived in May 2023. So it no longer stopped the clock, and American Transit did not challenge that finding either.
The insurer was right on one point: the court found its petition was filed on time, disagreeing with the lower court, which had treated it as late. But that changed nothing. The award stands.
