Key Takeaway
Ocean Diagnostic awarded judgment on medical proof the insurer did not answer. Jason's 2012 note revisits the 2006 majority and concurrence.
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 ‘reverse’ in Jason’s title describes who supplied the unanswered medical evidence. Ocean Diagnostic was a provider’s successful summary-judgment motion in 2006, revisited in this 2012 note—not a ruling that medical-necessity cases invariably favor either side.
Last reviewed: September 2026.
Historical note: Ocean Diagnostic is a 2006 ruling discussed in 2012; the provider moved for judgment and supplied medical evidence the insurer did not answer. Read the 2006 decision.
The report the insurer did not answer
Ocean Diagnostic Imaging v Allstate, 2006 NY Slip Op 50140(U), decided February 3, 2006, addressed more than one claim. For the MRI claim discussed here, the provider submitted a sworn February medical report explaining necessity. The insurer’s peer review had relied on a later March report, and its opposition did not address the February evidence. The majority awarded the provider summary judgment.
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Justice Golia concurred in the result and emphasized that the obligation to answer properly established proof applies to both sides. His concurrence should not be presented as the majority’s entire reasoning. A different claim in the decision concerned verification timing; this note’s comparison focuses on the medical evidence.
What the comparison supports
Under CPLR 3212(b), the submitted proof—not a party’s identity—controls the motion. Ocean Diagnostic did not authorize courts to pick the ‘stronger’ expert whenever a genuine factual dispute exists. Here the relevant medical submission went unanswered.
Jason’s original 2012 note
Jason’s original 2012 introduction follows. Its judicial-appointment observations are dated commentary, not a description of today’s bench.
So many people complain that the Pan Chiro line of cases represent a one-way street on the issue of medical necessity . I remembered a case from 6 years ago that represented the same paradigm, “except the shoe being on the other foot”.
I would suggest a review of the below case including now retired Justice Golia’s concurrence below.
For those that do not know, Justice Golia has been replaced by Justice Martin M. Solomon. And for what it is worth, Justice Solomon to the best of my knowledge will be the first judge to serve on any Appellate Court who presided in a Civil Court after the beginning of the no-fault litigation tidal wave that began in 2001-2002.
Connect to the Encyclopedia
Start with the medical necessity and peer-review encyclopedia, then compare these records:
- Bronze Acupuncture: disagreement without supporting facts
- Five Boro: missing report pages and sufficient opposition
- B.Y., M.D.: an incomplete opposing affirmation
- Brooklyn Chiropractic: separate IME and peer-review claims
For review of a particular no-fault dispute, contact the firm with the relevant reports and motion 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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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.
