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Malella and priority of coverage discovery disallowed
Medical Necessity

Malella and priority of coverage discovery disallowed

By Jason Tenenbaum 2 min read

Key Takeaway

Court rejects insurer's discovery attempts to find primary coverage and investigate fraudulent incorporation in NY no-fault case, ruling demands improper.

This article is part of our ongoing medical necessity coverage, with 171 published articles analyzing medical necessity 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.

Pomona Med. Diagnostic P.C. v Adirondack Ins. Co., 2012 NY Slip Op 51165(U)(App. Term 1st Dept. 2012)

Defendant appeared to work under a novel theory that it could use discovery to figure out who is primary and, in the alternative, to find out if Plaintiff was fraudulentally incorporated.  Defendant’s attempt to obtain discovery on the first score was a loser, on the law.  Defendant’s attempt to obtain discovery on the second score was a loser, on the law.

“The defendant insurer’s motion to strike the notice of trial and compel discovery should have been denied. Insofar as defendant sought discovery pertaining to its affirmative defense that another insurance carrier was primarily liable, the information was immaterial and, in result, the demands were palpably improper (see Duhe v Midence, 1 AD3d 279 ), since defendant cannot properly rely on this defense as a basis to deny plaintiff’s no-fault claim (see 11 NYCRR 65-3.12; M.N. Denatal Diagnostics, PC v Government Empl. Ins. Co., 81 AD3d 541 ). Nor has defendant set forth any case-specific allegations in support of its defense that plaintiff was fraudulently incorporated so as to justify discovery on this issue (cf. One Beacon Ins. Group, LLC v Midland Med. Care, PC, 54 AD3d 738 ). Defendant “will not be allowed to use pretrial discovery as a fishing expedition when they cannot set forth a reliable factual basis for what amounts to, at best, mere suspicions” (Devore v Pfizer Inc., 58 AD3d 138, 144 , lv denied 12 NY3d 703 ).”


Legal Update (February 2026): Since this 2012 decision, New York’s no-fault regulations under 11 NYCRR Part 65 have undergone multiple amendments, including updates to priority of coverage provisions and discovery limitations in no-fault litigation. Additionally, appellate courts have continued to refine the standards for when discovery may be permitted regarding fraudulent incorporation defenses and priority disputes. Practitioners should verify current regulatory provisions and recent case law developments when addressing similar coverage priority and discovery issues.

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

Medical Necessity Disputes in No-Fault Insurance

Medical necessity is the most common basis for no-fault claim denials in New York. Insurers hire peer reviewers to opine that treatment was not medically necessary, shifting the burden to providers and claimants to demonstrate otherwise. The legal standards for establishing and rebutting medical necessity — including the sufficiency of peer review reports, the qualifications of reviewing physicians, and the evidentiary burdens at arbitration and trial — are the subject of extensive case law. These articles provide detailed analysis of medical necessity litigation strategies and court decisions.

171 published articles in Medical Necessity

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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 medical necessity 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.

Jason Tenenbaum, Personal Injury Attorney serving Long Island, Nassau County and Suffolk County

Reviewed & Verified By

Jason Tenenbaum, Esq.

Jason Tenenbaum is a personal injury attorney serving Long Island, Nassau & Suffolk Counties, and New York City. Admitted to practice in NY, NJ, FL, TX, GA, MI, and Federal courts, Jason is one of the few attorneys who writes his own appeals and tries his own cases. Since 2002, he has authored over 2,353 articles on no-fault insurance law, personal injury, and employment law — a resource other attorneys rely on to stay current on New York appellate decisions.

Education
Syracuse University College of Law
Experience
24+ Years
Articles
2,353+ Published
Licensed In
7 States + Federal

Discussion

Comments (9)

Archived from the original blog discussion.

MS
mitchell s. lustig
The Court is correct with regard to discovery regarding priority of payment. Under the priority of payment regulations, the first insurer to receive the claim is obligted to pay and then can seek recovery in inter-company priorty of payment arbitration under section 5015(b) of the Insurance Law. The purpose behind the priorty of payment regulation is to provide quick efficient compensation to the injured party and allow the insurers an opportunity to fight it out later amongst themselves.
LR
Larry Rogak
I agree with Mitch. Priority of payment is neither a defense nor a discovery issue.
KL
Kurt Lundgren
“case specific allegations”. Does this put an end to the boilerplate verification requests issued to providers and knee jerk motions to vacate notices of trial?
J
JT Author
This has to be one of the most stinging defeats for the carriers on the corporate discovery type issues that I have seen in years. Just amazing how the carrier in this case on really bad facts created awful law.
CA
Captain America
Finally someone said “Enough” to knee jerk discovery.
KL
Kurt Lundgren
Its aweful when the court gets it right.
LR
Larry Rogak
Does anyone think this decision deviates from the existing standard of requiring a “founded belief” in order to do Malella discovery? I don’t.
DJ
Damin J. Toell
There’s a “founded belief” standard to get Mallela discovery?
CA
Captain America
As Martin Sheen told Colonel Kurtz in Apocalypse Now: “Frankly I do not see any method.” Well frankly I do not see an Malella standard save one … ask insurance company and the insurance Gods a.k.a. the Courts of New York State — will make sure you receive so you can delay and screw people up. How easy it is to be a defense attorney for an insurance company. Demand every friggin thing on every case and make the cost of discovery exceed the value of the case. In the future I plan to make the insurance companies pay for every copy — 50 cents a page for material and time — that I make. I want the check in hand and deposited and cleared before I send the discovery. And in support of my demand I will state: “We gave them this a million times.”

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