Key Takeaway
Court dismisses no-fault claim when medical provider's bare-bones affidavit fails to rebut insurer's causation defense with factual basis or address contrary expert findings.
In New York’s no-fault insurance system, medical providers frequently assign their rights to collect benefits from patients and pursue claims directly against insurance companies. When insurers deny these claims based on lack of medical necessity or causation, the burden shifts in summary judgment proceedings. While insurers must initially demonstrate their defense with expert medical evidence, providers must then respond with substantive proof to create a genuine issue of fact.
The quality of rebuttal evidence becomes crucial in these disputes. Courts consistently require more than conclusory statements from medical experts — they demand detailed factual foundations that directly address the insurer’s specific challenges. This principle applies whether the case involves causation issues or other coverage disputes in the no-fault context.
Jason Tenenbaum’s Analysis:
Shahid Mian, M.D., P.C. v Interboro Ins. Co., 2013 NY Slip Op 50589(U)(App. Term. 1st Dept. 2013)
“In opposition to the defendant-insurer’s prima facie showing that the assignor’s treated medical condition was not causally related to the underlying motor vehicle accident (see Mount Sinai Hosp. v Triboro Coach, 263 AD2d 11, 19-20 ), plaintiff failed to raise a material issue requiring a trial of its claim for assigned no-fault first-party benefits. The bare bones affidavit filed by plaintiff’s principal, an orthopedist who performed the surgical procedure giving rise to this no-fault action, was insufficient to defeat summary judgment. The affiant failed to set forth a factual basis for his single-sentence conclusion on the critical causation issue, and did not address, let alone rebut, the contrary findings made by defendant’s medical experts.”
This was my case. The defense was based upon a radiological review and a peer review, based upon the radiological review and plaintiff’s medical records. For those that remember Stephen Fealy v. State Farm, the affidavit, in rebuttal in this case, was better than the affidavit in rebuttal case. Note my comment in Amherst Medical Supply, where the court evaluated these cases under a 5102(d) prism.
Key Takeaway
This case demonstrates that medical providers cannot defeat summary judgment with conclusory expert opinions. When insurers present detailed medical evidence challenging causation, providers must respond with substantive factual analysis that directly addresses the insurer’s expert findings. Bare-bones affidavits lacking specific medical reasoning will consistently fail to create triable issues of fact in no-fault litigation.
Legal Update (February 2026): Since this 2013 post, New York’s no-fault insurance regulations under Insurance Law § 5102 and accompanying regulatory provisions may have been amended, particularly regarding medical necessity standards, causation requirements, and evidentiary procedures for provider reimbursement disputes. Practitioners should verify current regulatory language and recent appellate decisions when addressing burden-shifting in summary judgment motions for no-fault benefits claims.
