Why Trust This Analysis
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.
In New York’s no-fault insurance system, peer review reports play a crucial role in determining medical necessity for treatments and services. These reports are generated when insurance companies question whether specific medical treatments were necessary for accident-related injuries. However, there’s often confusion about what format these reports must take when provided to healthcare providers, and more importantly, how they can be used in litigation.
A recent Appellate Term decision provides important clarity on both the procedural requirements for peer review reports and their evidentiary limitations. The ruling addresses two key issues: what constitutes adequate disclosure when providers request copies of peer review reports, and whether these reports can be admitted as evidence during trial proceedings involving medical necessity disputes.
Jason Tenenbaum’s Analysis:
A-Quality Med. Supply v GEICO Gen. Ins. Co., 2013 NY Slip Op 23088 (App. Term 2d Dept. 2013)
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 Insurance Department Regulations require merely that a “copy” of a peer review report be produced to a provider upon written demand…. Moreover, the Insurance Department Regulations do not prescribe a format for a peer review report. It is only when a peer review report is being submitted in support of or in opposition to a motion that it must be properly sworn or affirmed (see CPLR 3212 )”
…
“We note that, at trial, the issue of medical necessity is to be resolved based upon the testimony given by medical experts. A peer review report, unlike a witness, is not subject to cross-examination and is not admissible by defendant to prove lack of medical necessity. Indeed, admission of a peer review report into evidence as part of a defendant’s proof of lack of medical necessity may constitute impermissible bolstering of its expert’s testimony”
So, the peer review itself, if admitted into evidence, constitutes improper bolstering. Also, “admissible form” is limited to a motion for summary judgment in opposition to a motion thereto.
Key Takeaway
This decision establishes that insurance companies only need to provide simple copies of peer review reports to healthcare providers upon request - no special format is required. Crucially, these reports cannot be used as evidence at trial to prove lack of medical necessity, as they constitute impermissible bolstering of expert testimony and cannot be cross-examined like live witnesses would be during summary judgment proceedings.
Legal Update (February 2026): Since this 2013 decision, New York’s no-fault regulations have undergone several amendments, particularly regarding peer review procedures and documentation requirements. Practitioners should verify current provisions in 11 NYCRR Part 65 and any subsequent regulatory updates that may have modified the format requirements, disclosure procedures, or evidentiary standards for peer review reports in medical necessity disputes.
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.
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
A Plaintiff's own hospital records defeated his own threshold summary judgment motion
Court examines how plaintiff's own hospital records contradicted expert testimony in no-fault threshold case, creating triable issues of fact.
Jun 5, 2010
Understanding New York No-Fault Insurance Medical Necessity: Why Surgery Peer Review Alone Is Not Enough
Learn why surgery peer review alone isnt enough for NY no-fault medical necessity denials. Expert legal analysis from experienced Long Island attorneys.
May 22, 2019
Lack of medical necessity defense upheld
Five Boro Medical: two claims dismissed on peer-review proof, a third surviving on denial timing, and the limits of an expert-qualification objection.
Jan 3, 2015
Malella and priority of coverage discovery disallowed
Court rejects insurer's discovery attempts to find primary coverage and investigate fraudulent incorporation in NY no-fault case, ruling demands improper.
Jun 27, 2012Was 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.
