Key Takeaway
Court grants summary judgment based on biomechanical engineer's conclusion that claimed injuries could not have resulted from the accident, shifting burden to plaintiff.
This article is part of our ongoing additional verification coverage, with 240 published articles analyzing additional verification issues across New York State. Attorney Jason Tenenbaum brings 24+ years of hands-on experience to this analysis, drawing from his work on more than 1,000 appeals, over 100,000 no-fault cases, and recovery of over $100 million for clients throughout Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx. For personalized legal advice about how these principles apply to your specific situation, contact our Long Island office at (516) 750-0595 for a free consultation.
Biomechanical Evidence Successfully Defeats No-Fault Claims
In no-fault insurance litigation, proving causation between an accident and claimed injuries is fundamental to any successful claim. While medical records and testimony typically form the backbone of causation arguments, this 2012 appellate decision demonstrates how biomechanical engineering analysis can serve as powerful evidence to defeat claims at the summary judgment stage.
The case of Andromeda Med. Care, P.C. v Utica Mut. Ins. Co. represents a significant development in New York No-Fault Insurance Law defense strategies. Insurance companies increasingly rely on expert biomechanical analysis to challenge the causal connection between accidents and alleged injuries. This case shows how such evidence, when properly presented through expert affidavits and comprehensive documentation, can establish a prima facie case for lack of causation—shifting the burden to the plaintiff to provide contrary evidence.
The decision is particularly noteworthy because it demonstrates how defendants can successfully use technical expert testimony to overcome what might otherwise appear to be straightforward injury claims, similar to other defense strategies we’ve seen in cases involving substantiated defenses.
Jason Tenenbaum’s Analysis:
Andromeda Med. Care, P.C. v Utica Mut. Ins. Co., 2012 NY Slip Op 50344(U)(App. Term 2d Dept. 2012)
This is the first time I have seen this outcome. Perhaps, my faith in biomechanical reports has changed.
“In support of its motion, defendant submitted an affidavit by its biomechanical engineer… The engineer concluded that the injuries of plaintiff’s assignors could not have arisen out of the accident in question, after he reviewed, among other things, the photographs of the vehicle involved in the accident, the medical records of plaintiff and other providers regarding their treatment of the assignors, and copies of the transcripts of plaintiff’s assignors’ testimony at their examinations under oath, all of which defendant attached to its moving papers.
As defendant established its entitlement to judgment as a matter of law by submitting proof in admissible form showing the lack of a causal connection between the accident and the injuries claimed by plaintiff’s assignors, the burden shifted to plaintiff to rebut defendant’s showing. Plaintiff, in its opposition papers, failed to do so. Defendant’s motion for summary judgment dismissing the complaint should therefore have been granted.”
(Rios dissented)
Key Takeaway
This decision establishes that comprehensive biomechanical analysis, when supported by vehicle photographs, medical records, and examination testimony, can create a prima facie case for lack of causation. Once defendants meet this burden, plaintiffs must provide substantive rebuttal evidence or face summary judgment dismissal of their no-fault claims.
Legal Update (February 2026): Since this 2012 decision, New York courts have continued to refine the standards for admissibility and sufficiency of biomechanical evidence in no-fault cases, with evolving precedents regarding expert qualifications and methodological requirements. Additionally, the New York No-Fault Law has undergone various regulatory amendments and fee schedule updates that may affect litigation strategies and procedural requirements. Practitioners should verify current case law developments and regulatory provisions when relying on biomechanical studies as defense evidence.
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Legal Context
Why This Matters for Your Case
New York law is among the most complex and nuanced in the country, with distinct procedural rules, substantive doctrines, and court systems that differ significantly from other jurisdictions. The Civil Practice Law and Rules (CPLR) governs every stage of civil litigation, from service of process through trial and appeal. The Appellate Division, Appellate Term, and Court of Appeals create a rich and ever-evolving body of case law that practitioners must follow.
Attorney Jason Tenenbaum has practiced across these areas for over 24 years, writing more than 1,000 appellate briefs and publishing over 2,353 legal articles that attorneys and clients rely on for guidance. The analysis in this article reflects real courtroom experience — from motion practice in Civil Court and Supreme Court to oral arguments before the Appellate Division — and a deep understanding of how New York courts actually apply the law in practice.
About This Topic
Additional Verification in No-Fault Claims
Under New York's no-fault regulations, insurers may request additional verification of a claim within specified time limits. The timeliness, scope, and reasonableness of verification requests — and the consequences of a claimant's failure to respond — are among the most litigated issues in no-fault practice. These articles examine the regulatory framework for verification requests, court decisions on compliance, and the interplay between verification delays and claim determination deadlines.
240 published articles in Additional Verification
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Feb 15, 2013Common Questions
Frequently Asked Questions
What is additional verification in no-fault insurance?
Additional verification is a request by the insurer for more information to process a no-fault claim, authorized under 11 NYCRR §65-3.5. When the insurer sends a verification request, the 30-day clock for claim processing is tolled (paused) until the requested information is received. This is a common insurer tactic to delay payment — but the verification request must be timely and relevant to be valid.
How long does an insurer have to request additional verification?
Under the no-fault regulations, the insurer must request initial verification within 15 business days of receiving the claim. Follow-up verification requests must be made within 10 business days of receiving a response to the prior request. If the insurer fails to meet these deadlines, the verification request is invalid and cannot be used to toll the claim processing period.
What types of additional verification can a no-fault insurer request?
Under 11 NYCRR §65-3.5, insurers may request medical records, provider licensing documentation, proof of treatment rendered, tax returns or financial records (in certain fraud investigations), authorization for release of medical records, and signed NF-3 verification forms. The verification request must be relevant to the claim and not overly burdensome. Requests for information not reasonably related to claim processing may be challenged as improper.
What happens if I don't respond to a no-fault verification request?
Failure to respond to a timely and proper verification request can result in denial of your no-fault claim. Under 11 NYCRR §65-3.5(o), if the requested verification is not provided within 120 calendar days of the initial request, the claim is deemed denied. The 120-day period runs from the date of the original request. However, if the verification request itself was untimely or improper, the denial based on non-response may be challenged.
What are common coverage defenses in no-fault insurance?
Common coverage defenses include policy voidance due to material misrepresentation on the insurance application, lapse in coverage, the vehicle not being covered under the policy, staged accident allegations, and the applicability of policy exclusions. Coverage issues are often treated as conditions precedent, meaning the insurer bears the burden of proving the defense. Unlike medical necessity denials, coverage defenses go to whether any benefits are owed at all.
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About the Author
Jason Tenenbaum, Esq.
Jason Tenenbaum is the founding attorney of the Law Office of Jason Tenenbaum, P.C., headquartered at 326 Walt Whitman Road, Suite C, Huntington Station, New York 11746. With over 24 years of experience since founding the firm in 2002, Jason has written more than 1,000 appeals, handled over 100,000 no-fault insurance cases, and recovered over $100 million for clients across Long Island, Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, the Bronx, and Staten Island. He is one of the few attorneys in the state who both writes his own appellate briefs and tries his own cases.
Jason is admitted to practice in New York, New Jersey, Florida, Texas, Georgia, and Michigan state courts, as well as multiple federal courts. His 2,353+ published legal articles analyzing New York case law, procedural developments, and litigation strategy make him one of the most prolific legal commentators in the state. He earned his Juris Doctor from Syracuse University College of Law.
Disclaimer: This article is published by the Law Office of Jason Tenenbaum, P.C. for informational and educational purposes only. It does not constitute legal advice, and no attorney-client relationship is formed by reading this content. The legal principles discussed may not apply to your specific situation, and the law may have changed since this article was last updated.
New York law varies by jurisdiction — court decisions in one Appellate Division department may not be followed in another, and local court rules in Nassau County Supreme Court differ from those in Suffolk County Supreme Court, Kings County Civil Court, or Queens County Supreme Court. The Appellate Division, Second Department (which covers Long Island, Brooklyn, Queens, and Staten Island) and the Appellate Term (which hears appeals from lower courts) each have distinct procedural requirements and precedents that affect litigation strategy.
If you need legal help with a additional verification matter, contact our office at (516) 750-0595 for a free consultation. We serve clients throughout Long Island (Huntington, Babylon, Islip, Brookhaven, Smithtown, Riverhead, Southampton, East Hampton), Nassau County (Hempstead, Garden City, Mineola, Great Neck, Manhasset, Freeport, Long Beach, Rockville Centre, Valley Stream, Westbury, Hicksville, Massapequa), Suffolk County (Hauppauge, Deer Park, Bay Shore, Central Islip, Patchogue, Brentwood), Queens, Brooklyn, Manhattan, the Bronx, Staten Island, and Westchester County. Prior results do not guarantee a similar outcome.