Key Takeaway
New York court ruling confirms insurance medical experts don't need to review all plaintiff records to establish prima facie case for lack of serious injury.
Understanding Medical Expert Requirements in No-Fault Cases
In New York’s no-fault insurance system, establishing whether an injury meets the “serious injury” threshold under Insurance Law § 5102(d) often hinges on competing medical expert opinions. A common defense strategy involves challenging the plaintiff’s injuries by arguing they don’t rise to the statutory serious injury standard. However, plaintiffs frequently counter by claiming the defense expert’s opinion is inadequate because they didn’t review certain medical records like MRIs or EMG studies.
The Brand v Evangelista decision provides important clarity on what constitutes a sufficient prima facie showing by defense experts. This ruling has significant implications for both personal injury cases and medical necessity determinations in no-fault disputes, areas where similar expert witness standards apply.
Jason Tenenbaum’s Analysis:
Brand v Evangelista, 103 AD3d 539 (1st Dept. 2013)
“efendant’s physicians required to review plaintiff’s medical records, since they detailed the specific tests they used in their personal examination of plaintiff, which revealed full range of motion (see Fuentes v Sanchez, 91 AD3d 418, 419 ; Zhijian Yang v Alston, 73 AD3d 562 ).
…is physicians did not tender any recent quantified range-of-motion measurements to demonstrate any limitations he may have had from his herniated discs, or following his second back surgery.
Point of this case is that the line: “well you did not look at the MRI’s or EMG’s” should not be fatal to an insurance carrier’s expert who opines on the lack of medical necessity, lack of causal relationship or non existence of a statutory serious injury.
Key Takeaway
Defense medical experts can establish a prima facie case for lack of serious injury without reviewing all plaintiff medical records, provided they conduct thorough physical examinations and document specific objective findings. This principle applies equally to medical necessity reversals where similar expert testimony standards govern insurance coverage decisions.
Legal Update (February 2026): Since this 2013 post, New York courts have continued to refine standards for medical expert testimony in serious injury determinations, and Insurance Law § 5102(d) has been subject to ongoing judicial interpretation that may affect the sufficiency requirements for prima facie showings. Practitioners should verify current case law developments and any regulatory updates that may have modified expert witness standards or medical record review requirements in no-fault serious injury cases.
