Key Takeaway
Appellate Term affirms Civil Court ruling against medical provider in no-fault case where defendant failed to prove services weren't medically necessary.
Ap Orthopedic & Rehabilitation, P.C. v Allstate Ins. Co., 2015 NY Slip Op 51656(U)(App. Term 2d Dept. 2015)
“In reviewing a determination made after a nonjury trial, the power of this court is as broad as that of the trial court, and this court may render the judgment it finds warranted by the facts, bearing in mind that the determination of a trier of fact as to issues of credibility is given substantial deference, as a trial court’s opportunity to observe and evaluate the testimony and demeanor of the witnesses affords it a better perspective from which to assess their credibility (see Northern Westchester Professional Park Assoc. v Town of Bedford, 60 NY2d 492, 499 ; Hamilton v Blackwood, 85 AD3d 1116 ; Zeltser v Sacerdote, 52 AD3d 824, 826 ).
In the present case, the record supports the determination of the Civil Court, based upon its assessment of the credibility of defendant’s witness and the proof adduced at trial, that defendant failed to demonstrate that the services rendered were not medically necessary. As we find no basis to disturb the Civil Court’s findings, the judgment, insofar as appealed from, is affirmed.”
A somewhat pro-defendant judge ruled in favor of the medical provider; the medical provider did not have a rebuttal; the Appellate Term affirmed. Not good.
Related Articles
- Understanding how credibility assessments impact medical necessity determinations in Civil Court
- Building strong medical evidence to counter conclusory affidavits in necessity cases
- Establishing a prima facie case for medical necessity in no-fault claims
- How IME doctors must explain their medical necessity findings
- New York No-Fault Insurance Law
