Key Takeaway
Three recent no-fault insurance cases demonstrate how plaintiffs consistently fail to provide adequate medical expert testimony to rebut insurance carriers' utilization reports.
This article is part of our ongoing 2106 and 2309 coverage, with 358 published articles analyzing 2106 and 2309 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.
Understanding Medical Utilization Reports in No-Fault Insurance Cases
In New York’s no-fault insurance system, insurance carriers frequently rely on medical utilization reports to deny claims for allegedly unnecessary treatments. These peer review reports evaluate whether medical services were medically necessary and appropriate. When carriers use these reports to deny coverage, healthcare providers must present compelling expert testimony to successfully challenge these denials.
The burden of proof in these cases often comes down to the quality and specificity of the medical expert’s affidavit. As seen in recent medical necessity reversals, courts require detailed, case-specific rebuttals that directly address the peer reviewer’s findings. Simply providing generic testimony or conclusory statements typically proves insufficient to overcome an insurance carrier’s medical utilization report.
Jason Tenenbaum’s Analysis:
Richmond Pain Mgt., P.C. v Clarendon Natl. Ins. Co., 2010 NY Slip Op 52015(U)(App. Term 2d Dept. 2010)
(my case) Radiology Today, P.C. v Mercury Ins. Co., 2010 NY Slip Op 52020(U)(App. Term 2d Dept. 2010). Dr. Shapiro’s affidavit was found not to sufficiently rebut the peer report. The Shapiro affidavit was somewhat detailed.
(my case) Delta Diagnostic Radiology, P.C. v Interboro Ins. Co., 2010 NY Slip Op 52022(U)(App. Term 2d Dept. 2010). This case also involves the failure to obtain a proper affidavit from a chiropractor; but the defect was overlooked due to the failure of the plaintiff to object to the same.
Key Takeaway
These cases highlight a persistent challenge in no-fault litigation: even detailed expert affidavits may fail to adequately rebut insurance carriers’ peer review reports. Healthcare providers must ensure their expert testimony specifically addresses each point raised in the utilization report and provides compelling medical reasoning to counter the denial. Procedural objections can also be waived if not timely raised during summary judgment motions.
Legal Update (February 2026): Since this 2010 post, New York’s no-fault insurance regulations have undergone significant revisions, including amendments to medical necessity standards, peer review procedures, and evidentiary requirements for challenging utilization reports. Additionally, court decisions over the past 15+ years may have refined the standards for sufficient medical expert testimony and rebuttal requirements. Practitioners should verify current regulatory provisions and recent case law when addressing medical utilization report challenges.
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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
CPLR 2106 and 2309: Affirmation & Oath Requirements
CPLR 2106 governs who may submit an affirmation in lieu of an affidavit in New York courts, while CPLR 2309 addresses the requirements for oaths, affidavits, and the certification of out-of-state documents. These seemingly technical provisions have significant practical impact — an improperly executed affirmation or affidavit can render an entire summary judgment motion defective. These articles analyze the formal requirements, common defects, and court decisions that practitioners must navigate when preparing sworn statements.
358 published articles in 2106 and 2309
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Oct 4, 2016Common Questions
Frequently Asked Questions
What is the difference between a CPLR 2106 affirmation and a CPLR 2309 affidavit?
A CPLR 2106 affirmation can be signed by an attorney, physician, dentist, or podiatrist without notarization — the affirmant simply affirms under penalty of perjury. A CPLR 2309 affidavit requires a notary public or authorized officer to administer an oath. Using the wrong form can result in a court rejecting the submission.
When must I use a notarized affidavit versus an affirmation in New York?
Licensed attorneys, physicians, dentists, and podiatrists may use unsworn affirmations under CPLR 2106. All other individuals must use notarized affidavits under CPLR 2309. In no-fault litigation, this distinction frequently arises when submitting medical evidence or opposing summary judgment motions.
Can a court reject evidence submitted in the wrong format?
Yes. Courts routinely reject affidavits and affirmations that do not comply with CPLR 2106 or 2309. An improperly sworn document may be treated as a nullity, which can be fatal to a motion for summary judgment or opposition. Proper formatting is a critical procedural requirement in New York practice.
What is a medical necessity denial in no-fault insurance?
A medical necessity denial occurs when the insurer's peer reviewer determines that treatment was not medically necessary based on a review of the patient's medical records. The peer reviewer writes a report explaining why the treatment does not meet the standard of medical necessity. To challenge this denial, the provider or claimant must present medical evidence — typically an affirmation from the treating physician — explaining why the treatment was necessary and rebutting the peer review findings.
How do you challenge a peer review denial?
To overcome a peer review denial, you typically need an affirmation or affidavit from the treating physician that specifically addresses and rebuts the peer reviewer's findings. The treating physician must explain the medical rationale for the treatment, reference the patient's clinical findings, and demonstrate why the peer reviewer's conclusions were incorrect. Generic or conclusory statements are insufficient — the response must be detailed and fact-specific.
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About the Author
Jason Tenenbaum, Esq.
Jason Tenenbaum is the founding attorney of the Law Office of Jason Tenenbaum, P.C., headquartered at 326 Walt Whitman Road, Suite C, Huntington Station, New York 11746. With over 24 years of experience since founding the firm in 2002, Jason has written more than 1,000 appeals, handled over 100,000 no-fault insurance cases, and recovered over $100 million for clients across Long Island, Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, the Bronx, and Staten Island. He is one of the few attorneys in the state who both writes his own appellate briefs and tries his own cases.
Jason is admitted to practice in New York, New Jersey, Florida, Texas, Georgia, and Michigan state courts, as well as multiple federal courts. His 2,353+ published legal articles analyzing New York case law, procedural developments, and litigation strategy make him one of the most prolific legal commentators in the state. He earned his Juris Doctor from Syracuse University College of Law.
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 2106 and 2309 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.