Sorry for the delay. After looking through the plugin code, there is a has_post_thumbnail option. I came up with this that I’m sure could be written better, I’m still learning.
// Check for Plugin
if (class_exists('MultiPostThumbnails')) {
// Set Thumbnail
$thumb = MultiPostThumbnails::the_post_thumbnail(get_post_type(), 'preview-image');
$has_thumb = MultiPostThumbnails::has_post_thumbnail(get_post_type(), 'preview-image', strval(get_the_ID()));
// Thumbnail exist? Else show Not Found
if ($has_thumb) : echo $thumb; else : echo '<img src="'. get_bloginfo('template_directory') . '/img/default_thumb.jpg" />'; endif;
// Plugin not found.
} else {
echo "MultiPostThumbnails Not Found.";
}