Why Trust This Analysis
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.
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)
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“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.
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.
