Key Takeaway
AP Diagnostic's 2013 MRI ruling: pain, restricted cervical motion and a diagnostic explanation defeated summary dismissal, not established a right to payment.
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.
An explanation for ordering an MRI kept the claim alive in AP Diagnostic Medical v Chubb Indemnity, 2013 NY Slip Op 51647(U). The provider’s affidavit described pain, restricted cervical motion and the need to investigate possible disc herniations. The court upheld denial of the insurer’s summary-judgment motion; it did not award the provider payment.
Historical note: AP Diagnostic (October 7, 2013) found the particular MRI opposition sufficient to resist dismissal; its reference to a personal-injury decision does not equate no-fault medical necessity with the serious-injury threshold.
Last reviewed: September 2026.
Why this affidavit was enough
On October 7, 2013, the First Department’s Appellate Term accepted the insurer’s initial showing against medical necessity, but found the provider’s response sufficient to create a factual dispute. The explanation linked the test to the patient’s reported symptoms and examination findings.
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The result is narrower than saying that the words “rule out herniations” always require a trial. Read the clinical explanation and the competing report together.
The personal-injury citation has limits
The court cited Lee v McQueens (2009), a serious-injury case involving quantified limitations measured with a goniometer. That was a comparison about medical proof, not a holding that a provider must satisfy the personal-injury serious-injury threshold to recover a no-fault bill.
It also contrasted CPT Medical Services (2007), where the opposition did not address an earlier negative diagnostic study. That contrast is useful when reading a rebuttal: does it explain why this test was needed despite the reason offered for denying it?
Jason’s original comment
Jason’s October 2013 reaction follows unchanged. His suggested trend and comparison to another case are commentary, not findings that AP Diagnostic adopted a new statewide test.
This is the second time this Court has cited to a personal injury case to find that medical necessity or lack thereof of diagnostic testing. Diagnostic Medicine, P.C. v Clarendon Natl. Ins. Co., 34 Misc.3d 143(A)(App. Term 1st Dept. 2012). All I can think is that this Court on some level is requiring an objective basis to be found in rebuttal affidavits to defeat medical necessity motions.
Connect to the Encyclopedia
Start with the medical necessity and peer-review topic hub for the archive’s case directory. Compare these related records:
- Hunt City: competing chiropractic opinions left a trial issue
- Huntington Regional Chiropractic: medical affidavits answered two IMEs
- Arnica: an IME rebuttal that missed objective findings
- Devonshire: a conclusory peer review could not defeat the providers’ motion
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.
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.
