Why Trust This Analysis
This article is part of our ongoing 2106 and 2309 coverage, with 359 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)
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.
(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.
Related Articles
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.
359 published articles in 2106 and 2309
Keep Reading
More 2106 and 2309 Analysis
How to Talk to a Judge in New York: What to Say, What to Avoid, and How to Present Yourself
Address the judge as 'Your Honor,' stand when you speak, wait to be recognized, and keep answers short and honest. A Long Island trial lawyer explains.
Feb 24, 2026
CPLR § 2106 Amendment Eliminates Affidavit Notarization Requirement: What This Means for New York Litigation
New York's CPLR 2106 permits affirmations in place of many sworn documents. See the 2024 and 2025 changes, exceptions, and historical case notes.
Feb 18, 2026
A prima facie case of medical necessity?
Understanding medical necessity proof standards in NY personal injury and no-fault cases. Expert legal analysis from Long Island attorneys. Call 516-750-0595.
Nov 22, 2009
Lost to Dr. Bhatt
AP Orthopedic won its 2015 medical-necessity appeal. Separate the credibility holding from Jason's original comment and the later trial-burden explanation.
Nov 28, 2015
Court Takes Judicial Notice of Supreme Court Declaratory Judgment — Res Judicata in No-Fault Cases
How a default declaratory judgment in New York Supreme Court can have res judicata effect to end a no-fault Civil Court claim — key Long Island no-fault defense strategy.
Sep 9, 2013
Understanding CPLR 5019(a) Limitations: Why Courts Cannot Modify Judgment Amounts Based on Substantive Reasons
Mount Sinai rejected substantive policy-limit relief under CPLR 5019(a). St. Barnabas had reserved that procedural question, not approved the mechanism.
Feb 12, 2011Was 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 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.
