Key Takeaway
Amato's 2013 appeal reversed the provider's trial judgment on post-IME treatment. See the testimony, stipulations and absence of opposing evidence.
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.
The “snapshot” ruling did not survive appeal. In Amato v State Farm, 2013 NY Slip Op 51113(U), the Appellate Term reversed the provider’s judgment after trial and directed judgment for the insurer. The relevant comparison is between the trial court’s reasoning and that later disposition.
Legal Update (September 2026): The judgment following the 2010 Amato decision was reversed on July 3, 2013, with judgment directed for the insurer; the trial court’s contrary result is historical, not the disposition to rely on.
Last reviewed: September 2026.
The ruling that was reversed
The Nassau District Court’s October 13, 2010 decision treated the IME as a description of the patient’s condition on the examination date. It found the insurer’s proof insufficient because the examiner had not reviewed the later treatment records. That led to a provider judgment; it is not the final outcome of the case.
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Why the insurer won the appeal
The IME occurred on September 8, 2005; the disputed treatment ran from January 3, 2006 through January 30, 2007. The parties had stipulated to timely claims and denials, leaving medical necessity for trial.
The chiropractor testified that the patient had returned to her pre-accident state and that the later treatment was unnecessary. After that showing, the provider had to prove necessity by a preponderance of credible evidence. It offered none. The appellate court would not speculate that the condition had worsened.
Keep trial and motion practice separate
The July 3, 2013 order dismissed the attempted appeal from the decision itself, but reversed the judgment entered on it. It directed dismissal, not a new trial. This was a trial-evidence ruling on stipulated issues—not a holding that the date of an IME alone defeats every later bill. The related notes distinguish that situation from motions opposed by actual medical evidence.
Connect to the Encyclopedia
Start with the medical necessity and peer-review topic hub for the archive’s case directory. Compare these related records:
- Glenn Segal: inadequate opposition to two IME reports
- Hunt City: competing chiropractic opinions left a trial issue
- Arnica: an IME rebuttal that missed objective findings
- Huntington Regional Chiropractic: medical affidavits answered two IMEs
For review of a particular no-fault dispute, contact the firm with the relevant reports, submissions and orders.
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
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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.
