Key Takeaway
Hunt City Chiropractic case shows conflicting medical expert opinions can create triable issues of fact on medical necessity in no-fault insurance disputes.
In New York no-fault insurance litigation, one of the most contentious battlegrounds involves disputes over medical necessity. Insurance companies frequently challenge the medical necessity of treatments through Independent Medical Examinations (IMEs) and peer reviews, while healthcare providers must defend their treatment decisions with compelling medical evidence.
The concept of a “triable issue of fact” becomes crucial when courts must determine whether conflicting medical opinions warrant a trial rather than summary judgment. When medical experts present opposing views on treatment necessity, courts often find that these disputes involve questions of fact that cannot be resolved without a full trial. This principle protects healthcare providers from having their claims dismissed prematurely when there’s legitimate medical disagreement.
Medical necessity determinations are particularly complex in chiropractic care cases, where treatment protocols may extend over longer periods. The timing of treatment relative to IME examinations often becomes a focal point, especially when providers continue treatment after an IME recommends discontinuation. Understanding how courts handle medical necessity reversals and the standards for supporting medical evidence is essential for practitioners navigating these disputes.
Jason Tenenbaum’s Analysis:
Hunt City Chiropractic, LLP v Chubb Indem. Ins. Co., 2013 NY Slip Op 51679(U)(App. Term 1st Dept. 2013)
“We agree that the conflicting medical expert opinions adduced by the parties sufficed to raise a triable issue as to the medical necessity of the chiropractic services underlying plaintiff’s first-party no-fault claim.”
This appear to be a post-IME cut off case. I am curious if the affidavit discussed the treatment at issue, and whether there was supporting medical evidence to substantiate the medical appropriateness of the post-IME services. Compare, Utica Acupuncture v. Interboro
Key Takeaway
The Hunt City Chiropractic decision demonstrates that when both parties present conflicting medical expert opinions, courts will typically find a triable issue of fact exists regarding medical necessity. This prevents insurance companies from obtaining summary judgment solely based on their own medical experts’ opinions when the healthcare provider presents competing medical evidence. The case highlights the importance of having strong medical documentation and expert testimony to counter insurance company challenges, particularly in post-IME treatment scenarios where sufficient medical opposition becomes critical.
Legal Update (February 2026): Since this 2013 post, New York’s no-fault insurance regulations have undergone several amendments affecting medical necessity determinations, including updates to IME procedures and peer review standards. Additionally, fee schedule revisions and changes to documentation requirements may impact how triable issues of fact are evaluated in medical necessity disputes. Practitioners should verify current regulatory provisions and recent case law developments when handling medical necessity challenges.
