When personal knowledge is not so personal

Understanding Evidence Standards in No-Fault Insurance Cases

In New York no-fault insurance law, insurance companies frequently deny claims based on a patient’s failure to appear for Independent Medical Examinations (IMEs). However, proving that someone didn’t show up for an appointment requires more than just someone’s word—it requires proper documentation and evidence foundations.

The distinction between personal testimony and business records becomes critical when insurance companies attempt to deny benefits. While personal knowledge testimony has its place in legal proceedings, establishing that an event didn’t occur often requires more substantial proof, particularly in the context of no-fault insurance disputes where documentation standards are strictly scrutinized.

Jason Tenenbaum’s Analysis:

Psychology After Acc., P.C. v New York Cent. Mut. Fire Ins. Co., 2021 NY Slip Op 51072(U)(App. Term 2d Dept. 2021)

“The proof submitted by defendant was sufficient to demonstrate that plaintiff’s assignors had failed to appear for the IMEs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 ; cf. Satya Drug Corp. v Global Liberty Ins. Co. of NY, 65 Misc 3d [*2]127, 2019 NY Slip Op 51505 ), which showing plaintiff failed to rebut”

When someone avers that they were present somewhere and an event did not occur, that is different than laying a business record foundation for the proof that the even did not occur.

Key Takeaway

The case highlights the importance of proper evidence foundations in no-fault insurance litigation. Insurance companies must provide adequate documentation—not just personal testimony—to prove non-appearance at IMEs. Healthcare providers challenging such denials must understand the difference between personal knowledge testimony and business records to effectively rebut insurance company claims and protect their right to payment.