Key Takeaway
Court rejects insurance company's confused medical expert testimony in no-fault case, showing that unopposed evidence must still meet basic quality standards.
In New York no-fault insurance disputes, insurance companies frequently rely on medical experts to challenge the necessity of treatments and diagnostic tests. However, as this case demonstrates, simply presenting expert testimony is not enough — the testimony must be coherent, well-founded, and demonstrate actual knowledge of the patient’s condition.
When insurance carriers attempt to deny coverage for medical services, they bear the burden of proving that the treatment was not medically necessary. This typically involves medical necessity reversals through expert testimony that challenges the appropriateness of the care provided. However, the quality and credibility of that expert testimony remains subject to judicial scrutiny.
The case of Webster Ave Med. Pavilion, PC v Allstate Ins. Co. illustrates a critical principle: even when medical expert testimony goes unopposed by the opposing party, courts retain the authority to reject testimony that lacks foundation or reflects the expert’s own admitted ignorance about the patient’s condition. This protection is particularly important for MRI facilities and other medical providers facing challenges to their diagnostic services.
Jason Tenenbaum’s Analysis:
Webster Ave Med. Pavilion, PC v Allstate Ins. Co., 2014 NY Slip Op 50393(U)(App. Term 1st Dept. 2014)
“The trial court was entitled to reject the sparse and confusing opinion testimony offered by defendant’s medical expert — which reflected the expert’s confessed lack of knowledge as to the assignor’s medical condition at the time of testing — even though the expert’s testimony was unopposed”
Key Takeaway
This decision reinforces that insurance companies cannot simply present any medical expert testimony to defeat no-fault claims. The expert must demonstrate actual knowledge of the patient’s condition and provide clear, well-reasoned opinions. Courts will reject confused or inadequately supported testimony even when it goes unchallenged, ensuring that New York no-fault insurance law protections remain meaningful for legitimate medical providers and their patients.
Legal Update (February 2026): Since this 2014 post, New York’s no-fault regulations have undergone several revisions that may affect medical necessity standards, expert testimony requirements, and procedural rules for insurance carrier denials. Additionally, fee schedules and documentation requirements for MRI facilities and other diagnostic providers have been updated multiple times. Practitioners should verify current regulatory provisions and recent case law developments when handling medical necessity disputes.
