Key Takeaway
Court sustains verdict for plaintiff in no-fault MRI medical necessity case after finding defendant's expert witness testimony not credible despite qualifications.
Metropolitan Diagnostic Med. Care, P.C. v Erie Ins. Co. of N.Y., 2016 NY Slip Op 51815(U) (1st Dept. 2016)
Facts
(1) At a nonjury trial of this action by a provider to recover assigned first-party no-fault benefits, the sole issue was the medical necessity of the MRIs of plaintiff’s assignor’s cervical and thoracic spines. The only witness was defendant’s doctor, a board-certified orthopedic surgeon with 30 years of experience, who also “write papers, and give lectures.
(2) The Civil Court, finding that defendant’s medical witness was not qualified as an expert and, in any event, that the witness’s testimony was not credible, awarded judgment in favor of plaintiff in the principal sum of $1,839.34.
Analysis
(1) The fact that defendant’s witness was an orthopedic surgeon and the MRIs at issue were prescribed by a doctor whose specialty is physical medicine and rehabilitation goes to the weight to be given to the testimony and not, contrary to the Civil Court’s determination, to the witness’s competency to testify as an expert
(2) “However, we find no basis to disturb the Civil Court’s finding that the witness’s testimony was not credible.”
My thoughts
The most recent theme running through these medical necessity trials is that the doctor is (or is not) credible. Upon the fact-finder making that threshold finding, the appeal will sink or swim.
Related Articles
- 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
- Civil Court Decisions in No-Fault Insurance: When Legal Reasoning Goes Wrong
- A prima facie case of medical necessity?
- New York No-Fault Insurance Law
