Key Takeaway
Darlington rejected an unsupported medical affidavit in 2012. Read the actual peer-review holding alongside Jason's original comments about Praetorian.
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.
The provider’s affidavit failed in Darlington Medical Diagnostics v Praetorian, decided February 16, 2012. The First Department’s Appellate Term reversed the denial of Praetorian’s motion and dismissed the no-fault complaint. Its reasoning concerned the medical evidence submitted, not an insurer-specific legal test.
Historical note: Darlington (2012) rejected the evidence submitted in that case; “Praetorian standard” is the archive’s description, not a separate legal test announced in the opinion.
Last reviewed: September 2026.
What the affidavit left unanswered
Praetorian submitted a chiropractor’s sworn peer review explaining why the diagnostic testing lacked medical necessity. The opposing physician gave generic conclusions without indicating that they came from an examination or a review of the patient’s records. The physician’s field of practice was unspecified, and the affidavit did not answer the peer reviewer’s contrary findings. A separate unsigned medical report was not considered.
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The phrase “Praetorian standard” in the historical title is not the name of a test announced by the court. Nor does the opinion establish the company’s overall quality or success rate. Jason’s praise below is his own 2012 assessment.
Compare Pan Chiropractic v Mercury (2009): after a supported insurer motion, merely disagreeing with the peer reviewer did not raise a factual dispute. A forceful disagreement still has to answer the medical reasoning.
Jason’s original comment
Jason’s February 2012 comments below praise the insurer and compare earlier cases. Those are his historical views; the court did not announce a named “Praetorian standard” or a universal same-specialty requirement.
Extension of Pan Medical
I always said Praetorian mean business. I truthfully have never seen a company that had its ducks in a row like these guys. This case goes to show one thing. If you have good paper and solid procedures in place, the plaintiffs should really have something to fear.
I recall the Second Department saying that it just did not matter what specialty the doctor was. It is nice to see Pan Medical (which cited to CPT Medical) get the expansion and context it deserves. This and ENKO have started to define, albeit piecemeal, the parameters of CPT and Pan.
Connect to the Encyclopedia
Start with the medical-necessity case directory.
- Innovative Chiropractic: a treating doctor’s bare reaffirmation
- Prime Psychological: inadequate opposition and two contrasting outcomes
- New Life Medical: two peer reviews left unanswered
- Park Slope: the early ruling and later missing-records authority
For review of a particular claim or motion, contact the firm.
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
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Feb 3, 2012Frequently 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.
Q: What makes Praetorian Insurance Company’s approach so effective?
That was Jason's favorable assessment in 2012. Darlington establishes that Praetorian supported this motion and the provider did not adequately oppose it; the opinion does not measure the insurer's general effectiveness.
Q: How does the Pan Medical doctrine affect medical providers in NYC and Long Island?
The relevant comparison is Pan Chiropractic's rejection of a conclusory response to a supported peer review. Darlington applied CPT Medical; the historical phrase "Pan Medical doctrine" should not be mistaken for a separately announced rule.
Q: What specific documentation do medical providers need to include in their affidavits?
Darlington identified missing medical foundation and a failure to address the peer review. The separate unsigned report was not considered. The opinion does not supply an exhaustive documentation checklist for every affidavit.
Q: How can medical providers improve their success rate in no-fault litigation?
Start with what the insurer's evidence actually says and whether it supports the motion. Darlington shows why generic conclusions failed in this record; it gives no success-rate estimate or guaranteed strategy.
Q: What are the financial implications of losing medical necessity cases?
Darlington dismissed the provider's claim. It does not establish a general schedule of legal-fee exposure, a reduction in future reimbursement rates or the finances of other cases.
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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.
