Key Takeaway
Prospect Medical's 2011 New Jersey MUA appeal was dismissed under limited arbitration review. A contested precertification denial did not prove necessity.
This article is part of our ongoing medical necessity coverage, with 170 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.
Prospect Medical challenged a New Jersey PIP precertification denial after three manipulation-under-anesthesia procedures. That challenge did not establish that the procedures were medically necessary.
Historical note: Prospect Medical (June 22, 2011) is an unpublished New Jersey opinion dismissing an appeal under APDRA. Its discussion of MUA protocols is not current clinical guidance or controlling New York law.
Last reviewed: September 2026.
What the appeal actually decided
In its unpublished June 22, 2011 opinion, the New Jersey Appellate Division dismissed the appeal from the trial court’s refusal to vacate an arbitration award. The provider argued that review by a chiropractor rather than a physician made the precertification response defective.
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.
The dispute-resolution professional had separately found inadequate proof of medical necessity after examining the records against the MUA protocols presented. The appellate court held that the precertification argument did not remove the provider’s burden. It applied the limited appellate role under the Alternative Procedure for Dispute Resolution Act, not a fresh clinical determination. Read Prospect Medical, docket A-5061-09T3.
A New Jersey comparison, not a New York rule
This is a New Jersey arbitration-review example. The old protocol discussion should not become a current treatment checklist, and the unpublished opinion should not be presented as controlling New York authority. The New York cases below are comparisons, not extensions of its holding.
Connect to the Encyclopedia
- Medical necessity: case directory and related decisions
- Surgicare: the trial court rejected the surgery expert’s reasoning
- Dayan: a new trial under the correct burden of proof
- Elmont Open MRI: why the purpose of treatment records mattered
- Promed Orthocare: substitute testimony and a preserved objection
For review of a particular no-fault dispute, contact the firm with the denial, relevant records and procedural history.
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.
170 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
Affirmation of opposing expert sufficient to thwart summary judgment in a malpractice case
Court affirms opposing expert affidavit sufficient to defeat summary judgment in medical malpractice when expert has proper credentials and specialty certification.
Jan 13, 2010
A sighting of “interboard” in action
Court ruling shows "interboard" IME cutoff requirements in action - acupuncture provider loses no-fault case for lack of medical evidence opposing summary judgment motion.
Jun 30, 2016
A chiropractor may manipulate areas other than the vertebral column?
NY court ruling on chiropractor scope of practice beyond spinal manipulation in no-fault insurance cases.
Feb 8, 2014
Nassau County Medical Necessity Motions: Appellate Term Demands Proper Evidence Standards
Compare Total Equipment's unopposed motion with Elmont Open MRI's inadequate opposition. These 2012 Nassau appeals both required a supported insurer motion.
Jan 27, 2012Was 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.
