“All in one” debacle is not good law

Donoso v Motor Veh. Acc. Indem. Corp., 118 AD3d 461 (1st Dept. 2014)

This came out a few months ago and I meant to post it.  There was a case in 2014 where Judge Ciaffa (District, Nassau County) held that stipulated post-IME treatment notes were sufficient to rebut the testimony of an IME physician and to prove that the services were medically necessary.  Literally, one month after All in One was published, the First Department published Donoso which says otherwise.

Here are the facts and the law:

“Plaintiff claims that she suffered permanent consequential and significant limitations of use of her lumbar spine as a result of an accident involving a motor vehicle (see Insurance Law § 5102 ). At trial, she testified that she was knocked over by a car and thereafter suffered back pain and injuries for which she received physical therapy and epidural injections, and that she underwent surgery four years later. Ambulance and emergency room records admitted into evidence show that the then 65-year-old plaintiff complained of back pain following the accident, and medical records of the treatment about which plaintiff testified show, inter alia, that the surgical procedure was a laminectomy to address spinal stenosis. Plaintiff did not call any treating physician or medical expert to testify.

Defendant moved for a directed verdict at the close of plaintiff’s evidence, arguing that plaintiff could not prove causation without a doctor’s testimony (see CPLR 4401). Contrary to plaintiff’s contention, since defendant’s argument constituted a challenge to the sufficiency of the evidence, and indeed plaintiff opposed defendant’s motion on the ground that her medical records were sufficient, the issue whether plaintiff established prima facie that she suffered a serious injury causally related to the motor vehicle accident is preserved for review (see Geraci v Probst, 15 NY3d 336, 342 ).

Plaintiff presented no evidence of a causal connection between the motor vehicle accident and her lumbar condition. The medical records do not contain an opinion given by a physician that there was a causal connection between the accident and plaintiff’s disc herniation or the spinal stenosis for which she underwent surgery four years later. Indeed, the impression of one of plaintiff’s treating physicians, according to his medical records, was “egenerative disc disease of the lumbar spine.” However, if the records had contained an opinion, the trial court could not have considered them, because the opining physician was not available for cross-examination (see Rickert v Diaz, 112 AD3d 451 ; **2 Daniels v Simon, 99 AD3d 658, 660 ). Thus, defendant was correct that plaintiff could not prove causation without a doctor’s testimony, and its motion should have been granted because “there no rational process by which the fact trier could base a finding in favor of ” (see Szczerbiak v Pilat, 90 NY2d 553, 556 ; see e.g. Ciocca v Park, 21 AD3d 671 , affd 5 NY3d 835 ).”

What’s the lesson of the story?  You must have an expert opine that the service was medically necessary.  I hope GEICO appealed All in one, but I am not holding my breath.

Related Articles

• Understanding Medical Necessity Denials: Escaping the Four Corners Rule in Long Island No-Fault Cases
• Why Conclusory Affidavits Fail: Building Strong Opposition to Medical Necessity Summary Judgment Motions
• Medical Necessity in No-Fault Insurance: Understanding the First Department’s Victory for Insurance Carriers
• A prima facie case of medical necessity?
• New York No-Fault Insurance Law

Legal Update (February 2026): Since this post’s publication in 2014, Insurance Law § 5102 may have been subject to regulatory amendments or interpretive guidance affecting medical necessity standards and expert testimony requirements. Additionally, procedural rules under CPLR 4401 regarding directed verdict motions in no-fault cases may have evolved through subsequent appellate decisions. Practitioners should verify current provisions and recent case law developments when addressing medical necessity proofs and expert testimony requirements in serious injury threshold cases.