Key Takeaway
Court ruled healthcare provider's affidavit was insufficient to rebut insurance company's peer review reports denying medical necessity claims.
In New York no-fault insurance disputes, healthcare providers must present compelling evidence to overcome insurance companies’ denials of medical necessity. When insurers submit detailed peer review reports challenging the necessity of medical services, providers cannot simply file conclusory affidavits in response. The court’s decision in New Life Med., P.C. v GEICO Ins. Co. demonstrates how critical it is for medical practitioners to provide substantive rebuttals that address the specific medical rationale outlined in peer reviews.
This case highlights a common pitfall in New York no-fault insurance law litigation: providers assuming that any affidavit from a healthcare practitioner will suffice to create a genuine issue of material fact regarding medical necessity.
Jason Tenenbaum’s Analysis:
New Life Med., P.C. v GEICO Ins. Co., 2012 NY Slip Op 51061(U)(App. Term 2d Dept. 2012)
It was just insufficient.
“In support of its cross motion, defendant submitted, among other things, two affirmed peer review reports, each of which set forth the factual basis and medical rationale for the doctor’s determination that there was a lack of medical necessity for the services at issue. The affidavit by plaintiff’s health care practitioner submitted in response failed to meaningfully rebut the conclusions set forth in the peer review reports (see Innovative Chiropractic, P.C. v Mercury Ins. Co., 25 Misc 3d 137, 2009 NY Slip Op 52321 ; Pan Chiropractic, P.C. v Mercury Ins. Co., 24 Misc 3d 136, 2009 NY Slip Op 51495 ).”
Key Takeaway
Healthcare providers must submit detailed, substantive affidavits that specifically address and counter the medical findings in insurance company peer reviews. Generic or conclusory statements from practitioners will not create sufficient factual disputes to survive summary judgment motions in medical necessity cases.
Legal Update (February 2026): Since this 2012 post, New York’s no-fault insurance regulations governing medical necessity determinations and peer review procedures have undergone multiple amendments, including updates to 11 NYCRR § 65-3.16 and related provisions. Practitioners should verify current regulatory requirements for medical opposition affidavits and peer review response standards, as procedural and substantive requirements may have evolved significantly.
