Key Takeaway
NY court declines partial summary judgment in no-fault case, finding triable issues of fact regarding medical necessity of services despite defendant's cross-motion.
Court Declines Partial Summary Judgment in Medical Necessity Dispute
In no-fault insurance litigation, parties frequently seek summary judgment to resolve disputes without trial. However, courts will only grant such motions when there are no genuine issues of material fact requiring resolution by a jury or judge. The recent Appellate Term decision in Pollenex Services, Inc. v. GEICO General Insurance Co. demonstrates how factual disputes over medical necessity can derail even well-crafted summary judgment motions.
This case involved a healthcare provider’s claim against an insurer for reimbursement of medical services. The defendant insurer filed a cross-motion for summary judgment seeking dismissal of the entire complaint, while the plaintiff requested partial summary judgment and asked the court to limit the trial issues under CPLR 3212. The Appellate Term’s decision highlights the critical importance of establishing clear factual records when seeking summary disposition in no-fault cases, particularly when medical necessity remains in dispute.
Jason Tenenbaum’s Analysis:
Pollenex Servs., Inc. v GEICO Gen. Ins. Co., 2014 NY Slip Op 50953(U)(App. Term 2d Dept. 2014)
“Upon a review of the record, we find that there is a triable issue of fact regarding the medical necessity of the services at issue. Accordingly, the order, insofar as appealed from, is reversed and defendant’s cross motion for summary judgment dismissing the complaint is denied. We decline plaintiff’s request to limit the issues for trial (see CPLR 3212 ).”
Key Takeaway
When factual disputes exist regarding medical necessity in no-fault cases, courts will deny summary judgment motions from both parties. The Appellate Term emphasized that genuine issues of material fact must be resolved at trial, and refused to limit trial issues even when requested by the plaintiff. This underscores the importance of developing comprehensive factual records before seeking summary judgment relief in medical necessity disputes.
Legal Update (February 2026): Since this 2014 post, CPLR 3212 summary judgment procedures may have been modified through legislative amendments or court rule changes, and standards for medical necessity determinations in no-fault cases may have evolved through subsequent appellate decisions. Practitioners should verify current summary judgment motion requirements and recent precedents regarding factual disputes over medical necessity before relying on the procedural analysis discussed in this post.
