Innovative MR Imaging v Praetorian — Why Unsworn Chiropractor Letters Still Sink Medical Necessity Cases in 2026

Last reviewed: September 2026.

Understanding Medical Necessity Evidence Standards in No-Fault Insurance Cases

Medical necessity disputes form the backbone of many New York no-fault insurance litigation cases. When healthcare providers seek reimbursement for treatments like MRI scans, insurance companies often challenge whether those services were medically necessary. The quality and admissibility of evidence supporting medical necessity claims can make or break a case.

In these disputes, healthcare providers must present compelling medical evidence to overcome an insurer’s denial. However, not all medical documentation carries equal weight in court. The form and foundation of medical reports significantly impact their probative value—their ability to actually prove what they claim to establish.

This case from the Appellate Term demonstrates a fundamental principle: medical reports must meet basic evidentiary standards to be considered by the court. Summary judgment motions in medical necessity cases often hinge on whether the submitted medical evidence can withstand judicial scrutiny. When providers fail to submit properly sworn statements or provide conclusory findings without adequate detail, they risk having their claims dismissed entirely.

The intersection of CPLR 2106 affidavit requirements and substantive medical evidence standards creates particular challenges for providers. CPLR 2106 governs qualifying affirmations used in place of affidavits; it is not merely an out-of-state affidavit provision. When providers submit unsworn letters from treating physicians or chiropractors, they run afoul of these foundational evidentiary requirements regardless of the substantive content of the medical opinions expressed.

Case Background

Innovative MR Imaging, P.C. provided MRI services to an injured party and sought reimbursement from Praetorian Insurance Company under no-fault coverage. The insurer denied the claims based on lack of medical necessity, asserting that the MRI scans were not reasonably necessary to diagnose or treat the patient’s condition. Innovative MR Imaging commenced litigation seeking assigned no-fault benefits. Praetorian moved for summary judgment dismissing the complaint.

In opposition to the insurer’s summary judgment motion, the provider submitted a letter report from the assignor’s treating chiropractor. The report purported to establish that the MRI scans were medically necessary based on the patient’s clinical presentation and the chiropractor’s treatment planning. However, the letter was not sworn to under oath as required by CPLR 2106. Additionally, even setting aside the procedural defect, the chiropractor’s findings were largely conclusory, lacking the detailed analysis and reasoning necessary to withstand summary judgment scrutiny.

Jason Tenenbaum’s Analysis

Innovative MR Imaging, P.C. v Praetorian Ins. Co., 2013 NY Slip Op 50264(U)(App. Term 1st Dept. 2013)

“The unsworn letter report submitted by plaintiff from the assignor’s treating chiropractor was without probative value (see CPLR 2106; Pierson v Edwards, 77 AD3d 642 ), and, even if considered, the conclusory findings set forth therein were insufficient to withstand summary judgment (see CPT Med. Servs., P.C. v New York Cent. Mut. Fire Ins. Co., 18 Misc 3d 87 ).”

Legal Significance

This decision establishes two distinct evidentiary hurdles that medical providers must clear when establishing medical necessity on summary judgment. The first issue was the evidentiary form of the report under the law applied in 2013. Current CPLR 2106 also permits qualifying affirmations in place of affidavits. The second hurdle is substantive: even properly sworn reports must contain detailed, specific findings supported by clinical data and reasoning, rather than conclusory statements.

The opinion rejected the particular unsworn letter. It should not be read as eliminating recognized evidentiary routes for records or properly affirmed statements. The oath requirement ensures that individuals making factual assertions do so under penalty of perjury, providing accountability and deterring false or exaggerated claims. Pierson v Edwards, cited by the Appellate Term, reinforced this principle in the medical necessity context.

The substantive requirement addresses the quality of medical opinions offered. CPT Medical Services, P.C. v New York Central Mutual Fire Insurance Co. established that medical professionals must provide detailed explanations connecting clinical findings to medical necessity determinations. Stating that an MRI was “necessary” without explaining why based on objective findings, differential diagnosis considerations, and treatment planning proves insufficient.

Together, these requirements serve important gatekeeping functions. They prevent frivolous medical necessity claims from proceeding while ensuring that legitimate claims are supported by credible, detailed medical evidence. The standards protect insurers from paying for unnecessary medical services while protecting injured parties’ access to necessary treatment when properly documented.

Practical Implications

For medical providers and their attorneys, this decision demands meticulous attention to both procedural and substantive aspects of medical evidence. Before filing summary judgment motions in medical necessity cases, providers must check that their medical opinions are supplied in a legally sufficient form, including a qualifying affirmation under current CPLR 2106. Simple letter reports, even from highly credentialed practitioners, will not suffice.

The affidavits must go beyond conclusory statements. Treating providers should document the specific clinical findings that necessitated the disputed services, explain their diagnostic reasoning, describe the relationship between symptoms and ordered tests, and articulate how the services related to treatment planning. Generic statements that services were “necessary” or “appropriate” prove insufficient without supporting detail.

Providers should also consider the credentials and specialty of the medical professional providing the affidavit. While this case involved a chiropractor supporting the medical necessity of MRI scans, questions may arise about whether chiropractors possess the expertise to opine on advanced imaging necessity. Obtaining supporting affidavits from radiologists or physicians specializing in diagnostic imaging may strengthen medical necessity claims for MRI and similar diagnostic procedures.

Defense counsel, conversely, should carefully scrutinize plaintiff’s medical evidence for both procedural and substantive deficiencies. Objecting to unsworn reports and highlighting conclusory findings can defeat otherwise legitimate-appearing medical necessity claims. These challenges should be raised early and prominently in opposition papers to ensure courts focus on the evidentiary deficiencies.

Key Takeaway

This decision highlights two critical evidence requirements in no-fault medical necessity cases. First, the medical opinion needs a proper evidentiary form; a qualifying affirmation under current CPLR 2106 can replace an affidavit. Second, even properly sworn reports must contain detailed, specific findings rather than conclusory statements. Healthcare providers pursuing medical necessity claims must ensure their supporting documentation meets both procedural and substantive standards to avoid dismissal. The combination of sworn, detailed medical evidence creates the foundation for successful medical necessity litigation in New York’s no-fault system.

---

May 2026 Practitioner Update

The 2013 ruling addressed both form and medical reasoning. Current CPLR 2106 changes the available form of a witness statement; it does not make a conclusory medical opinion sufficient.

The practical 2026 takeaway for any provider’s-side practitioner: current CPLR §2106 offers a way to avoid the historical form problem, but the substance problem, conclusory findings that do not engage the carrier’s peer-review reasoning, must still be addressed in the current motion. The cleanest opposition affidavit in 2026 looks no different from what Praetorian and CPT Medical Services would have required in 2013: a sworn (or now properly affirmed) statement that walks point-by-point through the disputed treatment, the clinical findings supporting it, and a direct response to the carrier’s peer-review or IME criticism. A change in signature formalities does not answer the disputed medical question.

For the broader procedural architecture this decision sits inside, see our analysis of proof of objective standards waived if EUO demand is not responded to, the protection of MRI facilities on medical necessity motions, and the Praetorian standard medical necessity peer review framework. Our New York no-fault insurance hub covers the full §5102(d) / §5106 / 11 NYCRR Part 65 framework that this 2013 holding fits inside.

Correct the procedural posture before using the case

In Innovative MR Imaging v Praetorian, decided February 21, 2013, the insurer moved for summary judgment dismissing the claim. The Civil Court denied that motion. The insurer appealed, and the Appellate Term reversed and dismissed the complaint.

The provider’s chiropractor supplied the letter in opposition. Describing the case as a provider’s failed affirmative motion confuses the burdens. Praetorian first established timely denial and supplied a sworn peer review with a factual and medical explanation. Only then did the sufficiency of the provider’s response become dispositive.

The reviewing chiropractor’s evidence was sufficient in that record. The case therefore does not establish that only a radiologist can supply medical-necessity evidence about MRI services. Whether a particular witness can give a particular opinion must be evaluated from the witness’s knowledge and the subject addressed.

What a current affirmation changes

The current text of CPLR 2106 allows a person’s qualifying affirmation under penalties of perjury to be used in a New York action in place of an affidavit, subject to the statute’s stated exceptions. That route is available to a chiropractor. The old occupational distinction cannot be carried forward as a blanket requirement to obtain notarization from every chiropractor.

A signed clinical letter is not automatically a CPLR 2106 affirmation. Check the form of the statement and whether the witness actually adopted its truth under the prescribed penalties. An affirmation also does not turn another person’s unsupported statement into competent proof or supply medical reasoning absent from the report.

The historical opinion contains two grounds concerning the provider’s response: the defect in form and, independently, the conclusory substance. A current affirmation can address the former. Counsel still needs a clinician to explain the medical disagreement.

A practical review of the response

Read the report in light of the actual question the insurer raised. Find out what it says about the clinical findings that were used as the basis for performing this test and explain how or why that finding would lead someone to believe that this test was necessary. And then if there’s a particular record that the medical opinion relies upon, make sure you identify that record and address its evidentiary foundation.

Avoid adding a differential diagnosis, examination result or treatment history simply because it would make the response sound stronger. The clinician must be able to support the statements made. The opinion’s brief discussion cannot supply facts missing from the client’s file.

For the broader distinction between form and substance, use the site’s CPLR 2106 amendment guide. For a case in which the insurer’s own medical showing failed, compare Amherst Medical Supply.

Legal Update (September 2026): The chiropractor-specific form limitation described in the 2013 opinion must now be read with CPLR 2106. A qualifying affirmation is available, while the need for a nonconclusory medical response remains a separate question under CPLR 3212(b).

Connect to the Encyclopedia

Start with the medical-necessity and peer-review hub. Use these related notes to compare the initial showing, the response and the result:

• Park Slope: competing proof requires trial

• GZ Medical: medical opposition and missing discovery

• Amherst: the insurer’s initial proof failed

• High Quality: an inadequate rebuttal

• Current CPLR 2106 affirmation requirements

For help assessing a pending claim or motion, contact the firm with the denial, medical reports, motion papers and any court order. This historical discussion is general information, not advice on a particular file.