The Future is Bright for Medical Necessity Summary Judgment Motions in New York

Key Takeaway

New York medical necessity summary judgment motions are evolving with stricter expert testimony standards, creating opportunities for skilled no-fault insurance attorneys.

In the evolving landscape of New York medical malpractice law, practitioners face increasingly complex challenges in establishing liability and proving causation. For attorneys practicing in Nassau County, Suffolk County, and throughout New York City, understanding the nuances of expert testimony requirements and summary judgment practice has become more critical than ever. Recent developments in appellate decisions are shaping the future of how courts evaluate medical expert opinions, with implications that extend beyond traditional medical malpractice into related areas of practice.

As a Long Island attorney who has handled numerous medical malpractice and no-fault insurance cases, I’ve observed firsthand how courts are becoming more stringent in their evaluation of expert testimony. This trend has significant implications not only for medical malpractice practitioners but also for those of us who handle personal injury protection (PIP) cases where medical necessity determinations play a crucial role.

The Changing Standards for Expert Medical Testimony

New York courts have always required that expert testimony be based on sufficient foundation and fall within the witness’s area of expertise. However, recent appellate decisions are clarifying and strengthening these requirements in ways that will benefit skilled practitioners who understand how to properly prepare and present expert testimony.

The trend toward more rigorous scrutiny of expert qualifications and opinions creates opportunities for attorneys who take the time to properly develop their cases. When opposing counsel fails to meet these heightened standards, summary judgment becomes not just possible, but probable.

Again, this is not necessarily a pure no-fault post. However, this is a no-fault post by analogy. I came across a doosy of a decision and order from the Appellate Division, Second Department. It kind of cuts both ways on two different issues. Hopefully you will see where I am going with this, after you see the excepts I am publishing.

**Geffner v North Shore Univ. Hosp.
**2008 NY Slip Op 10124 (2d Dept. 2008)

To support her allegations , the plaintiff submitted the expert affidavit of Charles Phillips, a physician certified in emergency medicine. Dr. Phillips’ affidavit was of no probative value, however, as it contained opinions outside his area of expertise and did not establish a foundation for his opinions (see Glazer v Choong-Hee Lee, 51 AD3d 970; Mustello v Berg, 44 AD3d 1018, 1018-1019; Behar v Coren, 21 AD3d 1045, 1046-1047)….”

“Finally, the plaintiff submitted the expert affirmations of Howard C. Adelman, a physician certified in clinical pathology and cytopathology, which alleged that the defendant doctors misdiagnosed the decedent as suffering from myelodysplastic syndrome, acute myeloid leukemia, and adenocarcinoma. Dr. Adelman’s affirmations were insufficient to raise a triable issue of fact with respect to the alleged misdiagnoses since they failed to address the evidence relied upon by North Shore’s experts in rendering their opinions that the diagnoses were correct (see Germaine v Yu, 49 AD3d 685, 687; Fhima v Maimonides Med. Ctr., 269 AD2d 559, 560).

What Geffner v North Shore University Hospital Teaches Us

The Geffner decision illustrates two critical failings that attorneys must avoid when opposing summary judgment motions in medical cases:

1. Expert Testimony Must Stay Within Areas of Expertise

The court’s rejection of Dr. Phillips’ affidavit because it “contained opinions outside his area of expertise” reinforces a fundamental principle: certification in one medical specialty does not automatically qualify a physician to render opinions in all areas of medicine. Emergency medicine physicians, while broadly trained, cannot necessarily opine on complex diagnostic issues in specialized fields without additional foundation.

This principle applies directly to no-fault insurance cases where medical necessity determinations are challenged. IME doctors who venture beyond their areas of specialization risk having their opinions excluded or given little weight by the court.

2. Failure to Address Opposing Expert Evidence

Perhaps even more significantly, the court found Dr. Adelman’s affirmations insufficient because they “failed to address the evidence relied upon by North Shore’s experts.” This requirement goes beyond simply offering a contrary opinion – the expert must engage with and respond to the specific evidence and reasoning presented by the opposing side.

Practical Applications for Long Island and NYC Medical Cases

These developments create significant opportunities for defense attorneys and challenging prospects for plaintiffs’ counsel. Here’s how these trends are likely to play out:

For Defense Counsel

The tightening standards for expert testimony make summary judgment motions more viable in cases where plaintiff’s experts:

Lack proper specialization for the specific medical issues involved
Fail to establish adequate foundation for their opinions
Don’t address the defendant’s expert evidence comprehensively
Rely on conclusory statements rather than detailed analysis

For Plaintiffs’ Counsel

Successfully opposing summary judgment now requires more careful attention to:

Selecting experts with precisely relevant specializations
Ensuring experts review all relevant medical records and depositions
Having experts specifically address and rebut defendant’s expert opinions
Providing detailed factual foundations for all expert conclusions

Implications for No-Fault Insurance Practice

While Geffner involves traditional medical malpractice, its principles have direct applications in no-fault insurance disputes, particularly those involving medical necessity determinations. Insurance companies frequently use Independent Medical Examinations (IMEs) to challenge the necessity of ongoing treatment.

Under the standards articulated in Geffner, IME reports that venture beyond the examining physician’s area of expertise or fail to address the treating physician’s specific findings and reasoning may be vulnerable to successful challenges.

Challenging IME Reports

When challenging IME reports in no-fault cases, consider whether:

The IME physician has relevant specialization for the specific conditions at issue
The IME report addresses the treating physician’s findings and reasoning
The IME physician had access to all relevant medical records
The conclusions are supported by adequate factual foundation

Strategic Considerations for Motion Practice

The Geffner decision suggests that courts are becoming more analytical in their review of expert testimony. This creates opportunities for skilled attorneys to achieve summary judgment in cases that might previously have proceeded to trial.

Timing and Preparation

Successful summary judgment motions in medical cases require early and thorough preparation. Defense attorneys should:

Carefully review opposing expert qualifications early in discovery
Identify areas where opposing experts may lack proper foundation
Ensure their own experts comprehensively address all plaintiff allegations
Prepare detailed factual records to support expert opinions

Frequently Asked Questions

How do these standards apply to IME reports in no-fault cases?

IME physicians must stay within their areas of expertise when rendering medical necessity opinions. An orthopedist, for example, may not be qualified to opine on psychological treatment needs without additional foundation.

What constitutes sufficient foundation for expert medical opinions?

Experts must demonstrate they have reviewed relevant medical records, understand the specific facts of the case, and base their opinions on established medical principles. Conclusory statements without supporting analysis are insufficient.

Can an expert opinion be rejected solely for lack of specialization?

Yes, if the expert ventures into areas outside their board certification or demonstrated expertise without establishing adequate foundation for their knowledge in those areas.

How should attorneys respond to summary judgment motions in medical cases?

Opposition must include expert affidavits that specifically address and rebut the moving party’s expert evidence, not just offer contrary conclusions.

Do these standards apply to cases in Nassau and Suffolk County courts?

Yes, these are statewide standards that apply in all New York courts, including local trial courts throughout Long Island and New York City.

Looking Forward: The Evolving Landscape

The trend toward more rigorous scrutiny of expert testimony represents a maturation of New York’s approach to medical litigation. Courts are recognizing that not all expert opinions are created equal, and that the quality of expert testimony should be carefully evaluated before cases proceed to trial.

For practitioners in medical malpractice, personal injury, and no-fault insurance cases, this evolution requires a higher level of preparation and attention to detail. The attorneys who adapt to these higher standards will find themselves with significant advantages in motion practice and case outcomes.

Building Stronger Cases

Success in this environment requires:

Careful selection of experts with precisely relevant qualifications
Thorough preparation of expert witnesses
Comprehensive factual development
Strategic use of summary judgment motions
Attention to opposing expert vulnerabilities

Need Experienced Medical Litigation Counsel?

Whether you’re dealing with a complex medical malpractice case, challenging an IME report in a no-fault dispute, or facing a summary judgment motion, the evolving standards for expert testimony require experienced legal representation. Our firm has extensive experience handling medical litigation throughout Nassau County, Suffolk County, and New York City.

We understand the nuances of expert testimony requirements and can help you navigate these increasingly complex procedural requirements. Don’t let inadequate expert preparation derail your case or allow improperly supported opposing expert opinions to go unchallenged.

Contact us today at 516-750-0595 to discuss your medical litigation needs. We provide thorough, knowledgeable representation that takes full advantage of the current legal landscape to achieve the best possible outcomes for our clients.

The information in this post is provided for educational purposes only and should not be construed as legal advice. Every case is unique, and the outcome of your case will depend on the specific facts and circumstances involved.

Legal Update (February 2026): Since this 2008 post, New York’s approach to medical expert testimony and summary judgment standards has continued to evolve through appellate decisions and potential amendments to CPLR provisions governing expert disclosure and foundation requirements. Additionally, no-fault insurance regulations and medical necessity standards may have been updated through Department of Financial Services rule changes. Practitioners should verify current expert testimony requirements, summary judgment standards, and any recent appellate decisions that may have modified the landscape discussed in this analysis.

Filed under: Evidence Experts Medical Necessity Sufficiency of medical evidence Sufficienty of medical opposition

The Future is Bright for Medical Necessity Summary Judgment Motions in New York