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.
Understanding IME Report Requirements in No-Fault Insurance Cases
In New York’s no-fault insurance system, Independent Medical Examinations (IMEs) play a crucial role when insurance companies seek to deny coverage based on lack of medical necessity. These examinations, conducted by doctors hired by the insurance carrier, are often used to dispute ongoing treatment claims. However, a significant court ruling has established important standards for what constitutes a legally sufficient IME report.
The case of Premier Health Choice Chiropractic, P.C. v Praetorian Ins. Co. represents a potentially groundbreaking development in New York No-Fault Insurance Law. This decision may mark the first time a court has explicitly stated the evidentiary requirements for IME reports when insurance companies claim that injuries have resolved and treatment is no longer medically necessary.
This ruling has significant implications for both healthcare providers seeking payment for services and insurance companies defending against no-fault claims. The decision could influence how courts evaluate medical necessity reversals and set new standards for the sufficiency of medical evidence in these disputes.
Jason Tenenbaum’s Analysis:
Premier Health Choice Chiropractic, P.C. v Praetorian Ins. Co., 2013 NY Slip Op 51802(U)(App. Term 1st 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.
“sworn independent medical examination (IME) report of its examining chiropractor, which set forth a factual basis and medical rationale for the chiropractor’s stated conclusion that the assignor’s injuries were resolved and that the chiropractic treatment giving rise to plaintiff’s no-fault claim lacked medical necessity.”
Perhaps this is the first time that the Court has opined that a lack of medical necessity defense on an IME case requires proof that a factual basis and medical rational for showing that injuries were resolved.
Key Takeaway
This ruling establishes that insurance companies cannot simply rely on conclusory statements from IME doctors. Instead, they must provide detailed factual foundations and medical reasoning when claiming that a patient’s injuries have resolved. This standard could significantly impact how courts evaluate the sufficiency of medical evidence in no-fault insurance disputes, potentially making it more difficult for carriers to successfully deny ongoing treatment claims without substantial supporting documentation.
Legal Update (February 2026): Since this post’s publication in 2013, New York’s no-fault insurance regulations and IME requirements have undergone several revisions, including updates to 11 NYCRR 65 and potential amendments to fee schedules and procedural standards. The evidentiary standards for IME reports discussed in Premier Health Choice may have been further refined through subsequent appellate decisions and regulatory changes. Practitioners should verify current IME reporting requirements and medical necessity standards under the most recent Insurance Department regulations and case law.
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
Court finds MUA treatment too aggressive without proper foundation. Expert testimony on medical necessity prevails in no-fault insurance dispute.
Mar 17, 2021
Another Medical Necessity?
New York court finds conflicting medical opinions create triable issue on physical therapy necessity, despite provider's weak affidavit of merit in no-fault insurance case.
Apr 27, 2020
Medical Necessity Rebuttal Affidavits: When a Run-of-the-Mill Case Becomes a Roll of the Dice
Two similarly deficient rebuttal affidavits, two opposite results. Throgs Neck v State Farm shows how unpredictably NY courts grade medical necessity proof.
Dec 7, 2015
What’s a boy to do?
Court sanctions attorneys for frivolous no-fault insurance brief while ruling on medical necessity peer review challenges in New York PIP case.
Aug 27, 2013
Civil Court Decisions in No-Fault Insurance: When Legal Reasoning Goes Wrong | Long Island Attorney
Critical analysis of Consolidated Imaging v Travelers Indemnity Co. - examining flawed Civil Court reasoning in Long Island and NYC no-fault insurance cases.
Mar 5, 2011
Concerns about the use of a first-party no-fault IME to support a third-party defendant's summary judgment motion
Understanding how no-fault IME findings affect third-party personal injury lawsuits in NY. Expert legal analysis from Long Island attorneys. Call 516-750-0595.
Nov 24, 2009Was 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.
