Key Takeaway
Court finds physician's affidavit insufficient under Pan Chiro standards, raising questions about evolving requirements for medical necessity evidence in no-fault cases.
No-fault insurance disputes often hinge on the quality and specificity of medical evidence presented to support claims for treatment. When insurance companies challenge the medical necessity of services through peer review reports, healthcare providers must respond with detailed documentation that goes beyond general assertions. The standards for what constitutes sufficient medical evidence continue to evolve through court decisions, creating important precedents for practitioners in New York no-fault insurance law.
The case analysis below examines a significant ruling where a physician’s affidavit was found inadequate to rebut an insurance company’s peer review findings. This decision highlights the increasingly stringent requirements courts may impose on medical professionals when defending their treatment decisions, particularly regarding diagnostic studies and imaging procedures that are frequently challenged in medical necessity disputes.
Jason Tenenbaum’s Analysis:
Neomy Med., P.C. v American Tr. Ins. Co., 2012 NY Slip Op 50769(U)(App. Term 2d Dept. 2012)
“Since the affidavit by plaintiff’s supervising physician failed to justify with specificity the additional studies, it did not rebut the conclusions set forth in the peer review report. Thus, plaintiff failed to raise an issue of fact (see Pan Chiropractic, P.C. v Mercury Ins. Co., 24 Misc 3d 136, 2009 NY Slip Op 51495 ).”
Compare this to: Quality Psychological Servs., P.C. v Mercury Ins. Group, 27 Misc.3d 129(A)(App. Term 2d Dept. 2010)(“In opposition to defendant’s motion, plaintiff submitted, among other things, a letter of medical necessity sworn to by the psychologist who had examined plaintiff’s assignor, which was sufficient to raise a triable issue of fact as to the medical necessity of the services rendered”
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Does a treating doctor’s affidavit need to have less in it than a plaintiff peer doctor?
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Has the quanta of evidence necessary to raise an issue of fact increased in two years since Quality v. Mercury?
I do not have an answer.
Key Takeaway
The comparison between these two cases reveals potential inconsistencies in how courts evaluate medical affidavits in no-fault litigation. While one case accepted a general letter of medical necessity as sufficient, another demanded specific justification for diagnostic studies, suggesting courts may be applying increasingly rigorous standards for medical evidence in summary judgment proceedings.
Legal Update (February 2026): Since this 2012 analysis, New York’s no-fault insurance regulations and medical necessity standards have been subject to various amendments and court interpretations. The specific evidentiary requirements for rebutting peer review reports and the “Pan Chiro analysis” framework may have evolved through subsequent regulatory changes or appellate decisions. Practitioners should verify current procedural requirements and recent case law developments when preparing medical necessity defenses.
