Key Takeaway
Hernandez affirmed a no-fault summary judgment in 2022. Separate its billing and medical-proof holdings from Jason's broader reaction about surgery claims.
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Hernandez affirmed a patient’s no-fault summary judgment over a denied surgical claim. The Second Department found the required billing proof and no admissible opposition sufficient to create a factual dispute about medical justification.
Historical note: Hernandez (2022) affirmed a summary judgment supported by the surgeon’s claims; it did not decide entitlement to the hospital’s charges or establish a new trial rule for every surgery dispute.
Last reviewed: September 2026.
Hernandez v Merchants Mutual, decided June 29, 2022, addressed claims supported by the surgeon’s affidavit, billing materials and the insurer’s denials. The court found proof that the statutory forms were mailed and received and that the insurer had not paid or validly denied the surgeon’s claims within the applicable period.
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The insurer’s opposition failed to raise a triable medical-justification issue. The court also rejected its standing objection. But the surgeon’s outstanding claims already exceeded the judgment, so the court expressly declined to decide entitlement to the hospital charges.
That limit matters when reading Jason’s reaction below. The opinion resolved a summary-judgment appeal; it did not decide that assuming a hospital bill guarantees reimbursement or announce a new trial rule for all surgery claims.
Jason’s original comment
Jason’s July 2022 reaction follows unchanged. His trial-practice extrapolation and reference to assuming the hospital bill are commentary. Hernandez decided a summary-judgment appeal and expressly did not reach entitlement to the hospital charges.
I went through the papers and I have zero understanding why this went as far as it did.
I can take a lot from this case. (1) Standard prima facie appears to be back on motion and at trial; (2) The Geffner rule now applies to PIP – funny I argued this at the App Term and I was turned down; (3) Having assumed personal liability for the hospital bill, Plaintiff has standing to bring this action.
I would say this case on medical necessity cases has the potential to make being an insurance carrier in surgery cases that much more difficult.
Connect to the Encyclopedia
Start with the medical-necessity and peer-review topic hub.
- Throgs Neck: inadequate opposition to an IME-based motion
- Forest Drugs: an affirmation that did not answer the IME
- Radiology Today: peer reports and live trial testimony
- All-In-One: stipulated post-IME records at trial
For review of a particular New York no-fault dispute, contact our office.
Legal Context
Why This Matters for Your Case
New York's no-fault insurance system, established under Insurance Law Article 51, is one of the most complex insurance frameworks in the country. Every motorist must carry Personal Injury Protection coverage that pays medical expenses and lost wages regardless of fault, up to $50,000 per person.
But insurers routinely deny valid claims using peer reviews, EUO scheduling tactics, fee schedule reductions, and coverage defenses. The Law Office of Jason Tenenbaum has handled over 100,000 no-fault cases since 2002 — from initial claim submissions through arbitration before the American Arbitration Association, trials in Civil Court and Supreme Court, and appeals to the Appellate Term and Appellate Division. Jason Tenenbaum is one of the few attorneys in the state who both writes his own appellate briefs and tries his own cases.
His 2,353+ published legal articles on no-fault practice are cited by attorneys throughout New York. Whether you are dealing with a medical necessity denial, an EUO no-show defense, a fee schedule dispute, or a coverage question, this article provides the kind of detailed case-law analysis that helps practitioners and claimants understand exactly where the law stands.
About This Topic
New York No-Fault Insurance Law
New York's no-fault insurance system requires every driver to carry Personal Injury Protection (PIP) coverage that pays medical expenses and lost wages regardless of who caused the accident. But insurers routinely deny, delay, and underpay valid claims — using peer reviews, IME no-shows, and fee schedule defenses to avoid paying providers and injured claimants. Attorney Jason Tenenbaum has litigated thousands of no-fault arbitrations and court cases since 2002.
271 published articles in No-Fault
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Disclaimer: This article is published by the Law Office of Jason Tenenbaum, P.C. for informational and educational purposes only. It does not constitute legal advice, and no attorney-client relationship is formed by reading this content. The legal principles discussed may not apply to your specific situation, and the law may have changed since this article was last updated.
New York law varies by jurisdiction — court decisions in one Appellate Division department may not be followed in another, and local court rules in Nassau County Supreme Court differ from those in Suffolk County Supreme Court, Kings County Civil Court, or Queens County Supreme Court. The Appellate Division, Second Department (which covers Long Island, Brooklyn, Queens, and Staten Island) and the Appellate Term (which hears appeals from lower courts) each have distinct procedural requirements and precedents that affect litigation strategy.
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