Key Takeaway
Complete Radiology's treating-physician letter defeated GEICO's motion in 2012. Compare the actual result with decisions rejecting insufficient opposition.
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.
Complete Radiology’s treating-physician letter was enough to reopen the medical-necessity dispute. It defeated the insurer’s motion; it did not establish a rule that every treating doctor’s letter must be accepted.
The result in Complete Radiology
Complete Radiology v GEICO, 2012 NY Slip Op 50419(U), decided March 6, 2012, reversed a judgment dismissing the provider’s complaint. GEICO had made its initial showing of lack of medical necessity, but the affirmed letter from the patient’s treating physician raised a triable issue.
The appellate court vacated the grant of GEICO’s cross motion and denied that motion. It did not grant the provider summary judgment or decide that the disputed services had to be paid.
A successful letter is not an automatic preference
The court cited Quality Psychological Services v Mercury, 2010 NY Slip Op 50601(U), where a sworn letter from the examining psychologist also raised a factual dispute. In that case, the court denied the provider’s cross motion as well. Competing evidence prevented either side from obtaining summary judgment.
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Neither short opinion creates a categorical evidentiary preference for treating professionals. Complete Radiology does not reproduce its letter in full, so it cannot be used as a checklist of language that will always suffice.
Read it with Neomy’s insufficient justification for additional studies. Both decisions came from the same Appellate Term in 2012. The opinions reached different results. Neither says the court had abandoned the other’s approach.
Jason’s original comment
Jason’s March 2012 comment followed the court’s reference to the treating physician:
See the buzz words.
Historical note: Complete Radiology’s March 2012 decision found this treating-physician letter sufficient; compare Neomy’s additional-studies ruling rather than treating professional status as dispositive.
Last reviewed: September 2026.
Connect to the Encyclopedia
Start with the medical necessity and peer review hub.
- Missing justification for additional studies: Neomy
- An IME rebuttal that did not address the examiner: Eastern Star
- Conflicting physical-therapy opinions: DRD Medical
- A fee-schedule win alongside a medical-necessity dispute: Plutno
For review of a particular no-fault dispute, contact the firm with the denial and supporting medical papers.
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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Jul 7, 2018Frequently Asked Questions
Common Questions About This Topic
4 answers from the firm's New York personal-injury and employment-law practice. Click any question to expand.
What did the court rule about letters of medical necessity in no-fault cases?
In Complete Radiology, the affirmed letter from the patient's treating physician raised a triable issue after GEICO made its initial showing. The insurer's cross motion was denied and the dismissal vacated.
How does this ruling affect no-fault insurance claims in New York?
It supplies an example of medical opposition that defeated summary judgment. The provider did not receive judgment for payment, and the decision does not make every treating-provider letter sufficient.
What is medical necessity in New York no-fault insurance law?
The dispute is whether the services at issue were medically necessary. Complete Radiology addressed the adequacy of the evidence on a summary-judgment motion, not the full range of no-fault coverage defenses.
Why does treating physician testimony carry special weight in no-fault cases?
Complete Radiology identified the letter's author as the treating physician, but did not announce a categorical evidentiary preference. The sufficiency of that letter should not be converted into an automatic rule for 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.
