Why Trust This Analysis
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.
Medical necessity challenges represent one of the most common battlegrounds in New York no-fault insurance litigation. When insurance companies dispute whether medical services were truly necessary, they often file motions for summary judgment claiming the treatments weren’t medically justified. For healthcare providers seeking reimbursement, the response strategy can make or break their case.
The pattern emerging from appellate courts has become remarkably consistent across multiple judicial departments. Healthcare providers who fail to submit proper affidavits of merit when responding to medical necessity challenges find themselves facing almost certain defeat. This trend reflects the courts’ emphasis on substantive medical evidence rather than procedural arguments alone.
Understanding this judicial landscape is crucial for medical providers navigating the complex world of New York no-fault insurance law. The appellate courts have established clear expectations for how these disputes should be handled.
Jason Tenenbaum’s Analysis:
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.
Elmont Open MRI & Diagnostic Radiology, P.C. v Clarendon Natl. Ins. Co., 2010 NY Slip Op 52061(U)(App. Term 2d Dept. 2010)
Dynamic Med. Imaging, P.C. v New York Cent. Mut. Fire Ins. Co., 2010 NY Slip Op 52062(U)(App. Term 2d Dept. 2010)
I know the above heading looks like some secret code that is necessary to enter a gambling hall. But it is important to understand that a plaintiff will almost always succumb to a defendant’s medical necessity motion, at both divisions of the Appellate Term, Second Department, when that plaintiff fails to answer a medical necessity motion with a proper affidavit of merit.
As such, I would look at each unrebutted motion for summary judgment based upon the lack of medical necessity of a particular service that you might have lost in District Nassau and file a Notice of Appeal. As long as your mailing is in place, I suspect the respective orders of the District Court will be reversed.
Key Takeaway
The appellate courts consistently reverse district court decisions favoring insurance companies when medical providers failed to submit proper affidavits of merit. This creates opportunities for medical necessity reversals on appeal, provided the procedural requirements for filing notices of appeal are met. Healthcare providers should carefully evaluate whether their lost cases qualify for appellate review.
Legal Update (February 2026): Since this 2010 analysis of appellate court trends regarding medical necessity challenges, New York no-fault regulations have undergone significant revisions, including updates to fee schedules under Insurance Regulation 68, amendments to claim filing procedures, and modifications to evidentiary standards for medical necessity disputes. Practitioners should verify current regulatory provisions and recent appellate decisions, as the judicial landscape for handling medical necessity challenges and affidavit requirements may have evolved considerably.
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
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
Keep Reading
More Medical Necessity Analysis
MUA is dangerous
Mollo's 2020 MUA ruling turned on competing expert testimony. Read the actual trial result without treating an expert's safety concerns as a universal rule.
Mar 17, 2021
Another Medical Necessity?
DRD Medical defeated the insurer's motion in 2020. Compare the court's finding of a factual dispute with Jason's original criticism of the affidavit.
Apr 27, 2020
Witness Credibility in Personal Injury Cases: Standards for Medical and Expert Testimony in New York
Understanding witness credibility standards in NY personal injury law. Expert analysis of medical testimony, expert witnesses & courtroom credibility.
Apr 10, 2019
Mailing and the first time “objective” has landed in a medical rational case
Court ruling establishes "objective medical explanation" requirement for no-fault insurance medical necessity defenses and highlights proper mailing procedure standards.
Dec 23, 2014
The substitute peer doctor
Bajaj permitted a substitute peer doctor to testify, then ruled for the provider after cross-examination and rebuttal. Read both parts of the decision.
Jun 23, 2012
A $4,300 affidavit- and another Pan Chiro citing (or sighting)
Innovative Chiropractic's 2010 appeal turned on timely denials, a peer review and an IME. The treating doctor's bare reaffirmation did not answer that proof.
May 23, 2010Was 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 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.
