Key Takeaway
NY no-fault medical necessity cases show inconsistent court rulings on deficient rebuttal affidavits, highlighting the unpredictable nature of summary judgment motions.
Medical necessity disputes represent a cornerstone of New York No-Fault Insurance Law, where healthcare providers must prove their treatments were medically necessary to secure reimbursement from insurance companies. These cases often hinge on the quality of expert affidavits and rebuttal evidence presented by both sides.
When insurance companies challenge the medical necessity of treatments through summary judgment motions, healthcare providers must respond with compelling rebuttal affidavits from qualified medical experts. The strength of these rebuttals can determine whether a case proceeds to trial or gets dismissed outright.
However, as recent appellate decisions demonstrate, courts don’t always apply consistent standards when evaluating seemingly similar deficient affidavits. This inconsistency creates uncertainty for practitioners handling medical necessity cases and underscores the importance of thorough preparation and strong expert testimony.
The unpredictable nature of these rulings affects healthcare providers seeking reimbursement and highlights broader challenges in no-fault insurance litigation.
Jason Tenenbaum’s Analysis:
Throgs Neck Multicare, P.C. v State Farm Mut. Auto. Ins. Co., 2015 NY Slip Op 51756(U)(App. Term 2d Dept. 2015)
The rebuttal affidavit was pretty poor. Yet, I would note that except for the amount of paragraphs, the rebuttal was equally as deficient as that in another recent case. In South Nassau , the Court found a triable issue of fact. Here, the Court non-suited Plaintiff. Sometimes, it really is a roll of the dice with how the Court’s will rule on particular deficient affidavits of merit.
Key Takeaway
This case illustrates the frustrating inconsistency in how New York courts evaluate deficient rebuttal affidavits in medical necessity disputes. Despite similar quality issues, one court found triable issues while another granted summary judgment for the defendant. This unpredictability emphasizes the critical importance of submitting thorough, well-crafted expert affidavits rather than relying on potentially favorable judicial interpretation of weaker submissions.
