Why Trust This Analysis
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.
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)
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.
“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”
-
Does a treating doctor’s affidavit need to have less in it than a plaintiff peer doctor?
-
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.
Related Articles
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
Keep Reading
More Medical Necessity Analysis
MUA is dangerous
Court finds MUA treatment too aggressive without proper foundation. Expert testimony on medical necessity prevails in no-fault insurance dispute.
Mar 17, 2021
Another Medical Necessity?
New York court finds conflicting medical opinions create triable issue on physical therapy necessity, despite provider's weak affidavit of merit in no-fault insurance case.
Apr 27, 2020
A Prima facie showing of lack of serious injury does not require a review of plaintiff’s records
New York court ruling confirms insurance medical experts don't need to review all plaintiff records to establish prima facie case for lack of serious injury.
Jun 20, 2013
Appellate Term Aligns Medical Necessity Evidence Standards Across New York No-Fault Districts
Appellate Term aligns medical necessity evidence standards across New York no-fault judicial districts, ending favorable treatment for Nassau County plaintiffs.
Dec 27, 2010
Understanding Peer Review Standards in New York No-Fault Insurance Cases
Learn how the Pan Chiropractic v Mercury Insurance case changed peer review standards in New York no-fault insurance litigation.
Jul 16, 2009
The Reply that introduced a proper reply was itself proper
Court rules that unsigned peer review reports can be properly remedied when identical signed versions are submitted in reply papers without prejudicing the opposing party.
Oct 6, 2015Was 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.
