Key Takeaway
Compare Total Equipment's unopposed motion with Elmont Open MRI's inadequate opposition. These 2012 Nassau appeals both required a supported insurer motion.
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.
Both carriers won, but the opposition was different in the two cases. Total Equipment v Praetorian concerned an unopposed motion. Elmont Open MRI v Tri State Consumer concerned opposition that lacked sufficient medical evidence. Both decisions were issued January 17, 2012, by the Appellate Term for the 9th and 10th Judicial Districts, reversing Nassau County District Court orders.
The moving party still had to establish its case
In Total Equipment, a claims employee’s affidavit established timely denial. The chiropractor’s affidavit and IME report supplied a sufficient factual basis and medical rationale. Only after that showing did the absence of opposing papers matter.
In Elmont Open MRI, the provider conceded timely mailing of the denials. The insurer’s affirmed peer review made the required medical showing, and the provider’s opposition failed to raise a factual issue. The court dismissed the complaint on that ground; the alternative fee-schedule ground was not the basis of its analysis.
These are decisions about two records, not evidence of a continuing pattern of local judicial bias. Jason’s original reaction is preserved below as commentary.
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For the other side of the timing question, Beach Medical (2026) precluded the medical-necessity defense after inadequate proof of timely denial. The first question remains whether the moving papers establish entitlement to judgment.
Jason’s original comment
Jason’s January 2012 reaction follows. His reference to an unopposed motion fits Total Equipment; Elmont Open MRI had opposition, which the court found insufficient. Neither opinion establishes a continuing pattern of judicial bias.
The 9th and 10th again tell Nassau District Court that they are not exempt from the rule that an unopposed lack of medical necessity motion spells doom.
I like this line:
In Elmont Open MRI, the court explained that the provider’s opposing medical evidence had not raised a triable issue. The insurer had already made its initial showing.
Historical note: Total Equipment and Elmont Open MRI applied the carrier’s initial evidentiary burden in January 2012; Beach Medical (2026) separately addresses failure to preserve a medical-necessity defense. Last reviewed: September 2026.
Connect to the Encyclopedia
- Medical necessity: opinions, claim timing and related cases
- Timely denials and an unsupported attorney affirmation: Diagnostic Medicine
- A principal’s affidavit without a medical rebuttal: Gaetane
- An affidavit that did not answer the peer review: Rosenzweig
- Substitute testimony and a separate concurrence: Park Slope
For review of a particular denial or litigation record, contact the firm or see the no-fault defense practice.
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
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Apr 27, 2011Frequently Asked Questions
Common Questions About This Topic
5 answers from the firm's New York personal-injury and employment-law practice. Click any question to expand.
What happens if I don't oppose a medical necessity motion in a New York no-fault case?
The carrier still has to make its initial showing. In Total Equipment, timely denial and sufficient IME evidence established that showing; the lack of opposition then left it unrebutted. An unopposed motion is not automatically sufficient.
Can an attorney's affirmation alone defeat a medical necessity motion?
An unsupported attorney affirmation did not raise a medical factual dispute in the linked Diagnostic Medicine case. Legal objections and defects in the carrier's initial showing remain separate questions.
What type of medical evidence is most effective in opposing medical necessity motions?
Responsive evidence addressing the specific report matters. Total Equipment concerned an IME; Elmont Open MRI concerned a peer review. Neither supplies a ranking of medical documents or a universal template for opposition.
How do these appellate decisions affect pending no-fault cases?
Check the governing court, procedural posture and later authority with counsel. These are historical Appellate Term decisions; this note does not certify their treatment in every pending case.
Should I be concerned if my medical necessity case is in Nassau County District Court?
These two 2012 reversals do not establish how a current judge will decide your case or prove continuing local bias. The useful comparison is the moving proof and the adequacy of any opposition.
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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.
