Key Takeaway
Bajaj permitted a substitute peer doctor to testify, then ruled for the provider after cross-examination and rebuttal. Read both parts of the decision.
This article is part of our ongoing medical necessity coverage, with 170 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.
Bajaj allowed the substitute peer doctor to testify—and the provider still won. The two results belong together: admitting an expert’s opinion does not require the fact-finder to accept it.
Last reviewed: September 2026.
Historical note: Bajaj is a District Court trial decision; permission to testify did not establish that the insurer’s defense ultimately succeeded. Read the 2012 decision.
Admission and outcome were separate questions
Bajaj v GEICO, 2012 NY Slip Op 51106(U), decided June 18, 2012, is a Nassau District Court trial ruling. The parties stipulated to billing, denial timing and the substitute doctor’s expertise. The original peer review was not offered as evidence in chief.
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.
The court allowed the substitute’s testimony under the appellate decisions it discussed. It considered the original report for the limited purpose of controlling the testimony’s scope, not as substantive proof of the defense. This was a trial court applying appellate authority, not overruling it.
Cross-examination then weakened the substitute’s reasoning, and the treating physician explained why the nerve testing was useful. The court found that the insurer had not carried its ultimate burden and entered judgment for the provider.
Why keep both parts of the case?
A categorical objection to the substitute witness failed, but testing that witness’s reasoning mattered. Do not turn permission to testify into a prediction about the verdict, or confuse this trial record with the proof required on a paper motion.
Jason’s original 2012 note
Jason’s original 2012 account follows. His prediction about another appeal and criticism of a trial ruling are historical commentary; Bajaj applied appellate authority rather than overruling a higher court.
The first thing someone asks me in Brooklyn is whether “you have a substitute peer doctor”. I shrug my shoulder for the simple reason that either I will have a medical necessity framed issue hearing, or a record that will go to the 15th Floor and be decided in 2015 reversing the order of the Civil Court precluding my doctor, and granting me another day in court. When the case is remanded, that judge will be at Supreme Court, down the block.
I think you know what he case holds based upon the above. I will summarize:
Substitute peer may testify.
Case from Judge Buggs is considered wrong on constraint of Appellate Term precedent.
Original peer does not have to be in evidence for substitute to try case.
Acknowledgment that cross-examination of substitute peer doctor may bear more fruit than crossing original doctor, due to the “four corners” rule.
Read the case. Harold Soloman won in the end.
Connect to the Encyclopedia
Start with the medical necessity and peer-review encyclopedia, then compare these records:
- Radiology Today: insufficient testimony at trial
- Ocean Diagnostic: medical proof the insurer did not answer
- Mingmen: examination findings and the opposing affidavit
- 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.
170 published articles in Medical Necessity
Keep Reading
More Medical Necessity Analysis
MUA is dangerous
Mollo's 2020 MUA ruling turned on competing expert testimony. Read the actual trial result without treating an expert's safety concerns as a universal rule.
Mar 17, 2021
Another Medical Necessity?
DRD Medical defeated the insurer's motion in 2020. Compare the court's finding of a factual dispute with Jason's original criticism of the affidavit.
Apr 27, 2020
Trial de novo summary judgment motion appealed
Appellate Division reverses trial court on no-fault insurance denial mailing practices and medical necessity evidence, establishing prima facie case standards.
Feb 11, 2016
Some substance to an IME cut off defense
Premier Health Choice: the supported IME cutoff, the provider's two opposition defects, and why an examination is different from an IME no-show.
Nov 3, 2013
A 2007 causation case – affidavit insufficient
Selective's insurer submitted the deficient affidavit; the hospital won. A corrected account of the 2007 no-fault causation and payment ruling.
Apr 27, 2011
How Medical Experts Become Qualified to Testify in New York Courts
Learn NY medical expert testimony standards from Shectman v Wilson case. Expert qualification requirements for medical malpractice cases in NYC and Long Island.
Dec 12, 2009Was 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.
