Key Takeaway
Prime Psychological's opposition did not answer the insurer's peer review. Compare the 2010 ruling, Jason's recollection and two successful rebuttals.
This article is part of our ongoing medical necessity coverage, with 171 published articles analyzing medical necessity 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.
The insurer won Prime Psychological Services v Mercury because the provider’s psychologist did not answer the peer review. On March 31, 2010, the Appellate Term affirmed the order granting Mercury summary judgment dismissing the complaint.
Historical note: Prime Psychological (2010) concerns a nonresponsive medical affirmation; the result does not create an affidavit-length test or establish that all provider opposition fails.
Last reviewed: September 2026.
Read the opinion alongside the recollection
Mercury established timely denial and submitted a psychologist’s sworn peer review with a factual basis and medical rationale. The provider’s affirmation did not meaningfully address that rationale. The opinion does not measure the affidavit’s length or say it narrowly missed a minimum standard.
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Jason’s original comment recalls the affidavit and his involvement in the appeal. His two comparison cases had different results: Infinity Health Products and Co-Op City Chiropractic each found the provider’s medical opposition sufficient to raise a factual dispute. The opposing evidence, rather than its length, explains the comparison.
For the same failure in a later record, see New Life Medical’s two peer reviews.
Jason’s original comment
Jason’s April 2010 recollection is preserved below. His assessment of the affidavit’s length and his involvement in the appeal come from this original comment, not findings in the published opinion.
Another Plaintiff failed to raise a triable issue of fact against a medical necessity summary judgment motion. This affidavit, if memory served me correct, was quite verbose. It was close to the minimal threshold needed to raise an issue of fact (See, Infinity v. Mercury and Coop City Chiro v. Mercury), but did not cut the mustard as they say. Oh by the way – I was the Respondent here, not the Appellant as is usually the case.
Connect to the Encyclopedia
Start with the medical-necessity case directory.
- Darlington: an affidavit without medical foundation
- Innovative Chiropractic: a treating doctor’s bare reaffirmation
- New Life Medical: two peer reviews left unanswered
- Park Slope: the early ruling and later missing-records authority
For review of a particular claim or motion, contact the firm.
Legal Context
Why This Matters for Your Case
New York law is among the most complex and nuanced in the country, with distinct procedural rules, substantive doctrines, and court systems that differ significantly from other jurisdictions. The Civil Practice Law and Rules (CPLR) governs every stage of civil litigation, from service of process through trial and appeal. The Appellate Division, Appellate Term, and Court of Appeals create a rich and ever-evolving body of case law that practitioners must follow.
Attorney Jason Tenenbaum has practiced across these areas for over 24 years, writing more than 1,000 appellate briefs and publishing over 2,353 legal articles that attorneys and clients rely on for guidance. The analysis in this article reflects real courtroom experience — from motion practice in Civil Court and Supreme Court to oral arguments before the Appellate Division — and a deep understanding of how New York courts actually apply the law in practice.
About This Topic
Medical Necessity Disputes in No-Fault Insurance
Medical necessity is the most common basis for no-fault claim denials in New York. Insurers hire peer reviewers to opine that treatment was not medically necessary, shifting the burden to providers and claimants to demonstrate otherwise. The legal standards for establishing and rebutting medical necessity — including the sufficiency of peer review reports, the qualifications of reviewing physicians, and the evidentiary burdens at arbitration and trial — are the subject of extensive case law. These articles provide detailed analysis of medical necessity litigation strategies and court decisions.
171 published articles in Medical Necessity
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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.
If you need legal help with a medical necessity 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.
