Key Takeaway
State Farm v Burke Physical Therapy case analysis on post-EUO document demands and verification requirements under New York no-fault insurance law.
This article is part of our ongoing no-fault coverage, with 271 published articles analyzing no-fault issues across New York State. Attorney Jason Tenenbaum brings 24+ years of hands-on experience to this analysis, drawing from his work on more than 1,000 appeals, over 100,000 no-fault cases, and recovery of over $100 million for clients throughout Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx. For personalized legal advice about how these principles apply to your specific situation, contact our Long Island office at (516) 750-0595 for a free consultation.
State Farm Mut. Auto. Ins. Co. v Burke Physical Therapy, P.C, 2022 NY Slip Op 30580(U)(Sup. Ct. Nassau Co. 2022) If you’re dealing with a no-fault insurance defense matter, an experienced attorney can help protect your rights.
This one interested me. The carrier suspects something is amiss or wants to come up with a reason not to pay a claim, i.e., ATIC. A demand is made for the EUO of the provider that takes place. There is nothing about the testimony in and of itself that leads to the conclusion that a provision of the law has been broken.
That said, document demands are forwarded. There are no wholly answered and the 120-day denial is issued.
DJ action is brought based upon failure to respond to verification and Malella basis. Summary Judgment motion is interposed on the verification count of the complaint.
Free Consultation · No Fee Unless We Win
Does this apply to your situation?
Every case is different. Get a free, confidential case review from an experienced attorney who can tell you exactly where you stand.
In this Court’s view, only one conclusion can be drawn-that on the precise question at issue here, the law is unsettled. To the extent that the Court finds one position more persuasive than the other, the Court is of the opinion that for purposes of the determination herein, it is of no import. What matters is the reasonableness ofBURKE’sjustification{or refusing to provide the documents sought.
In the absence of a clear answer as to whether or not STATE FARM was entitled to obtain the numerous documents sought at the verification stage of the claims, the Court cannot find, as a matter oflaw, thatBURKE’sjustification was unreasonable. Accordingly, the Court cannot find, as a matter oflaw, that BURKE failed to satisfy its obligation µnder 11 NYCRR 65-3.5(0) to offer, within 120 days, “written proof providing reasonable justification for the failure to comply.” The Court thus finds that, on the record presented, STATE FARM has failed to meet its burden to establish a right to disclaim coverage. See TAM Medical Supply Corp. v Tri State Consumers Ins. Co., 57 Misc 3d 133(A) (App Term, 2d Dept., 2d, 1Ith & 13th Jud. Dists. 2017).
It appears that ST A TE FARM may have proceeded to; seek declaratory relief on the basis of an outstanding verification defense, rather than on its potential Malella defense, in Order to expedite judgment, and because summary judgment might be unavailable on the Malella defense, particularly
without the documentation sought.
The Court is not incfined to short-circuit the process of determining entitlement to declaratory relief, particularly in view of the potentially broad and far reaching impact of such a determination. To the extent that STATE FARM believes that it has a viable Malella defense, nothing in this decision precludes STATE FARM from seeking discovery in the context of this declaratory judgment action, or proceeding to litigate the central issue underlying this case; that is, whether ST ATE FARM is entitled to disclaim coverage on the basis that BURKE was not in compliance with the applicable licensing and incorporation statutes.
Related Articles
- New York No-Fault Insurance Law
- Understanding CPLR 3212(g) paradigm for summary judgment motions
- Critical timing rules for summary judgment motions under CPLR 3212(a)
- No-fault verification requirements and partial compliance issues
- Understanding reasonable excuse standards despite jurisdictional challenges
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
Keep Reading
More No-Fault Analysis
Car Accident Recorded Statement in New York: Should You Give One?
The at-fault driver's adjuster wants a recorded statement within days of a New York car accident — and that call is designed to weaken your case.
Apr 5, 2026
Who Pays Car Accident Medical Bills in New York? A Step-by-Step Guide
New York no-fault PIP, primary health insurance, Medicaid/Medicare, and litigation liens — the full payment ladder for car-accident medical bills.
Apr 5, 2026
MPPR reductions
Florida's 4th DCA ruled Progressive can apply Medicare's MPPR reductions to chiropractor bills despite Medicare not covering chiropractic services at all.
Oct 7, 2021
Texting your friend who kills someone: Are you liable?
Court rules texting someone who kills in car accident doesn't create liability. Remote senders lack control over drivers unlike passengers in vehicle.
May 4, 2018
Another no-fault physician commits insurance fraud
Doctor convicted of insurance fraud for falsifying no-fault C-4 forms, showing patient as disabled when they were working.
Mar 21, 2012
Another priority of payment?
Understanding NY no-fault priority of payment rules and how they affect your medical bills. Expert legal analysis. Call 516-750-0595 for consultation.
Jun 25, 2023Was this article helpful?
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.
If you need legal help with a no-fault matter, contact our office at (516) 750-0595 for a free consultation. We serve clients throughout Long Island (Huntington, Babylon, Islip, Brookhaven, Smithtown, Riverhead, Southampton, East Hampton), Nassau County (Hempstead, Garden City, Mineola, Great Neck, Manhasset, Freeport, Long Beach, Rockville Centre, Valley Stream, Westbury, Hicksville, Massapequa), Suffolk County (Hauppauge, Deer Park, Bay Shore, Central Islip, Patchogue, Brentwood), Queens, Brooklyn, Manhattan, the Bronx, Staten Island, and Westchester County. Prior results do not guarantee a similar outcome.
