Key Takeaway
Court finds peer doctor testimony with medical rationale sufficient to prove lack of medical necessity, reversing trial court in no-fault case.
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Speciality Surgical Servs. v Travelers Ins. Co., 2010 NY Slip Op 50715(U)(App. Term 2d Dept. 2010)
“At trial, defendant’s doctor testified that the services provided were not medically necessary, and defendant also admitted into evidence a copy of the doctor’s affirmed peer review report, which was to the same effect. Both the doctor’s testimony and his report set forth a factual basis and medical rationale for his conclusion that the services rendered were not medical necessary. This evidence was not rebutted by plaintiff. In view of the foregoing, we disagree with the District Court’s finding that defendant failed to establish that the services provided were not medically necessary. Accordingly, the judgment is reversed and judgment is directed to be entered in favor of defendant dismissing the complaint.”
There was also a discussion regarding the validity of an assignment of benefits, but this issue was foreclosed due to the failure to address it during the claims stage.
I am more intrigued by the summary reversal of the District Court’s decision, after trial, that the services lacked medical necessity. Of course, we have no idea whether the reversal was on the law (CPLR 4404), in the exercise of the appellate court’s broad discretion, or based upon the appellate court’s opinion that the trial court’s decision was against the weight of the evidence. Also, it is interesting how the court made mention of a peer report which, in effect, bolstered the peer doctor’s testimony.
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I would hope, for the plaintiff’s bar, that the District Court sat solely as a proverbial “13th juror”, which would render the reversal as based upon the decision being against the weight of the evidence. If this decision was based on the law, then it would appear that as long as the testimony is not conclusory and supported by admissible evidence, a trial court is bound to find for the defendant absent rebuttal testimony.
I would like to see the appellate courts evaluate more of these unrebutted medical necessity trial cases, before I come to any conclusions.
Related Articles
- Medical necessity summary judgment motions in New York
- Peer doctor report requirements and evidentiary foundations
- Expert testimony standards for medical necessity determinations
- Continental Medical case analysis on medical necessity challenges
- New York No-Fault Insurance Law
Legal Update (February 2026): Since this 2010 decision, New York’s no-fault regulations have undergone significant revisions, including amendments to medical necessity standards, peer review procedures, and evidentiary requirements for expert testimony. Practitioners should verify current provisions regarding expert qualification standards and the specific procedural requirements for peer review reports under the updated regulatory framework.
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.
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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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