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.
This article is part of our ongoing causation coverage, with 177 published articles analyzing causation 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.
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.
Related Articles
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
Causation in New York Personal Injury & No-Fault Law
Causation — proving that the defendant's negligence or the accident caused the plaintiff's injuries — is an essential element of every personal injury and no-fault claim. New York courts distinguish between proximate cause, intervening causes, and pre-existing conditions that may have been aggravated by an accident. The legal standards for establishing causation through medical evidence and the defenses available to challenge causal connection are analyzed in depth across these articles.
177 published articles in Causation
Keep Reading
More Causation Analysis
IME no-show is a policy defense triggering the hourly attorney fee provision
Learn how IME no-show defenses trigger hourly attorney fee provisions in NY no-fault insurance. Court rules failure to attend IME is policy defense.
May 22, 2021Contractual deemer
New York courts examine when out-of-state insurers can avoid no-fault coverage obligations through contractual deemer provisions and policy language analysis.
Apr 24, 2021Walking out of an EUO leads to a disclaimer and a whole lot more
Walking out of an EUO leads to disclaimer and coverage denial. Court rules insured who departed mid-examination breached policy conditions in NY no-fault case.
Jul 17, 2014MVAIC Claim Coverage: Understanding Qualified Person Status in New York No-Fault Cases
Learn MVAIC claim coverage requirements and qualified person status from Englington Medical case. Expert analysis for Long Island and NYC uninsured motorist accidents.
Jan 17, 2011MVAIC Claims in New York: Understanding Your Rights and Requirements
Expert legal guidance on MVAIC claims in NY. Learn requirements, deadlines & common pitfalls. Free consultation. Call 516-750-0595.
Oct 26, 20195102(d) examined at trial against MVAIC
Court ruling demonstrates that expert testimony on range of motion limitations and orthopedic tests can establish serious injury threshold under NY Insurance Law 5102(d).
Dec 15, 2016Common Questions
Frequently Asked Questions
How is causation established in New York personal injury cases?
Causation requires proof that the defendant's conduct was a substantial factor in causing the plaintiff's injuries. In motor vehicle and slip-and-fall cases, medical experts typically establish causation through review of the patient's medical history, diagnostic imaging, clinical examination findings, and the temporal relationship between the accident and the onset of symptoms. The plaintiff must also address any pre-existing conditions and demonstrate that the accident was a proximate cause of the current complaints.
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.
What happens if there's no valid insurance policy at the time of the accident?
If there is no valid no-fault policy covering the vehicle, the injured person can file a claim with MVAIC (Motor Vehicle Accident Indemnification Corporation), which serves as a safety net for people injured in accidents involving uninsured vehicles. MVAIC provides the same basic economic loss benefits as a standard no-fault policy, but the application process has strict requirements and deadlines.
What is policy voidance in no-fault insurance?
Policy voidance occurs when an insurer declares that the insurance policy is void ab initio (from the beginning) due to material misrepresentation on the application — such as listing a false garaging address or failing to disclose drivers. Under Insurance Law §3105, the misrepresentation must be material to the risk assumed by the insurer. If the policy is voided, the insurer has no obligation to pay any claims, though the burden of proving the misrepresentation falls on the insurer.
How does priority of coverage work in New York no-fault?
Under 11 NYCRR §65-3.12, no-fault benefits are paid by the insurer of the vehicle the injured person occupied. For pedestrians and non-occupants, the claim is made against the insurer of the vehicle that struck them. If multiple vehicles are involved, regulations establish a hierarchy of coverage. If no coverage is available, the injured person can apply to MVAIC. These priority rules determine which insurer bears financial responsibility and are frequently litigated.
Was this article helpful?
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 causation 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.