Objected to inadmissible proof spells doom

In New York no-fault litigation, evidentiary precision can mean the difference between victory and defeat. Healthcare providers pursuing unpaid no-fault benefits must satisfy strict evidentiary requirements when opposing insurance carriers’ medical necessity defenses. A single procedural misstep—such as submitting an unsworn medical report—can prove fatal to an otherwise meritorious claim.

The Second Department Appellate Term’s decision in Medical Associates, P.C. v Interboro Insurance Co. demonstrates how technical compliance with evidence rules determines case outcomes. When plaintiffs attempt to create fact questions using inadmissible evidence, courts will grant summary judgment to defendants even if the underlying facts might support the plaintiff’s position. This strict approach serves important policy objectives: it maintains the integrity of the summary judgment process and ensures that only properly authenticated evidence influences judicial determinations.

Understanding these evidentiary requirements is essential for no-fault practitioners. CPLR 2106 governs the admissibility of medical affidavits and reports, establishing specific requirements for how medical opinions must be presented to the court. Similarly, hearsay rules determine what types of documentary evidence may be considered when evaluating peer review reports and medical records. Failure to comply with these technical requirements results in exclusion of the evidence, often dooming the party’s case.

Case Background

Medical Associates, P.C. brought suit against Interboro Insurance Company seeking payment for medical services provided to an injured patient. Interboro moved for summary judgment, submitting a peer review report concluding that the treatments were not medically necessary. The peer review physician opined that, assuming the facts documented in the patient’s medical records were accurate, the treatment provided exceeded what was medically required.

In opposition, Medical Associates submitted a medical report from the treating physician defending the medical necessity of the services. However, this report was not sworn—it lacked the verification required under CPLR 2106 to make it admissible evidence. Interboro objected to the unsworn report’s admissibility. The trial court initially denied the summary judgment motion, but on appeal, the Appellate Term reversed.

Jason Tenenbaum’s Analysis

Medical Assoc., P.C. v Interboro Ins. Co., 2012 NY Slip Op 50392(U)(App. Term 2d Dept. 2012).

I wrote the reply that got this case dismissed on appeal. I am not sure if I wrote the appeal. The Court said the following:

“Triable issue of fact not raised because:

“In opposition, plaintiff proffered an unsworn medical report (see CPLR 2106; Pan Chiropractic, P.C. v Mercury Ins. Co., 24 Misc 3d 136, 2009 NY Slip Op 51495 ; cf. Continental Med., P.C. v Mercury Cas. Co., 22 Misc 3d 134, 2009 NY Slip Op 50234 ).”

And a hearsay bonus here:

“The purpose of the peer review report submitted by defendant was not to attempt to prove that plaintiff’s assignor was injured as documented in her medical records, or that she was treated as set forth in those records, but to establish that, assuming the facts set forth therein were true, the treatment allegedly provided by plaintiff was not medically necessary (Urban Radiology, P.C. v Tri-State Consumer Ins. Co., 27 Misc 3d 140, 2010 NY Slip Op 50987 ). Consequently, defendant was not required to demonstrate that the records fell within an exception to the rule against hearsay (id.). Thus, the Civil Court should have granted the branch of defendant’s motion seeking summary judgment dismissing the complaint.”

Legal Significance

The Medical Associates decision establishes two critical evidentiary principles that continue to shape no-fault litigation. First, it reinforces the absolute requirement that medical reports and affidavits comply with CPLR 2106’s verification requirements. This statute mandates that medical opinions submitted in summary judgment proceedings must be properly sworn or affirmed. Unsworn reports, regardless of their substantive merit, cannot be considered by courts evaluating summary judgment motions.

This requirement serves multiple purposes. Sworn verification ensures that the affiant understands they face potential perjury consequences for false statements, thereby enhancing reliability. It also provides a procedural safeguard against submission of reports that physicians did not actually author or review. In the high-volume world of no-fault litigation, where medical reports are sometimes generated with minimal physician involvement, the verification requirement ensures meaningful physician oversight.

Second, the decision clarifies an important distinction regarding hearsay and peer review reports. Defense counsel often face plaintiffs’ arguments that peer review reports constitute inadmissible hearsay because they rely on medical records generated by other providers. Medical Associates rejects this argument by recognizing that peer reviewers use medical records as assumptions rather than facts to be proven. The peer reviewer’s conclusion—that treatment was not necessary—is offered for its truth, but the underlying medical records are not. This analytical framework allows peer review reports to serve their intended function without running afoul of hearsay rules.

The court’s reasoning draws on well-established precedent from Urban Radiology, P.C. v Tri-State Consumer Insurance Co., which comprehensively analyzed the role of medical records in peer review analysis. By treating medical records as hypothetical assumptions rather than facts requiring proof, courts enable peer reviewers to perform their evaluative function without needing to authenticate every underlying document.

Practical Implications

For healthcare providers and plaintiffs’ attorneys, Medical Associates delivers a harsh but clear message: technical compliance with evidence rules is not optional. Before submitting any medical report or affidavit in opposition to summary judgment, counsel must verify that the document complies with CPLR 2106. This means checking for proper notarization, ensuring the physician has sworn to or affirmed the contents, and confirming that all required procedural formalities have been satisfied.

The stakes are particularly high because of the summary judgment context. When a defendant establishes prima facie entitlement to judgment through a properly supported peer review report, the plaintiff bears the burden of raising a triable issue of fact. Inadmissible evidence cannot satisfy this burden, meaning that submission of an unsworn report is effectively equivalent to submitting no opposition at all. Plaintiffs who fail to meet these technical requirements will watch their cases dismissed on appeal even if the trial court initially ruled in their favor.

Defense counsel, conversely, should carefully review plaintiffs’ opposition papers for compliance with evidentiary requirements. Objecting to unsworn medical reports or other inadmissible evidence can turn seemingly close cases into clear victories on appeal. The reply brief becomes crucial in this regard—it provides the opportunity to highlight evidentiary deficiencies and cite controlling precedent like Medical Associates.

The decision also counsels defense lawyers to properly frame their peer review reports. By explicitly stating that the peer reviewer assumes the accuracy of medical records without vouching for their truth, defense counsel can avoid hearsay objections. The peer reviewer’s role is to evaluate medical necessity based on documented facts, not to authenticate those facts. Maintaining this analytical distinction strengthens the peer review report’s admissibility and effectiveness.

For all practitioners, Medical Associates underscores the importance of understanding evidence law in no-fault litigation. Cases are won and lost not only on substantive medical issues but also on procedural compliance with technical evidentiary requirements. Counsel who neglect these requirements do their clients a grave disservice, potentially sacrificing meritorious claims or defenses to procedural defaults.

Related Articles

• Civil Court Decisions in No-Fault Insurance: When Legal Reasoning Goes Wrong
• Understanding Article 10 Evidentiary Issues: Expert Witness Testimony and Hearsay Rules in New York Courts
• Understanding Medical Necessity Defense Failures in New York No-Fault Insurance Cases
• Expert Qualification Standards in New York No-Fault Cases: Understanding Professional Sufficiency Requirements
• New York No-Fault Insurance Law

Legal Update (February 2026): Since this 2012 decision, CPLR 2106 requirements for medical affidavits and the standards for admissibility of peer review reports in no-fault cases may have been subject to regulatory amendments or evolving case law interpretations. Practitioners should verify current provisions regarding unsworn medical reports and hearsay exceptions in medical necessity determinations, as procedural requirements and evidentiary standards in no-fault litigation continue to develop.