Key Takeaway
Plutno split a fee-schedule claim from medical-necessity claims. Read the evidence, the partial dismissal and Jason's original departmental comparison.
This article is part of our ongoing fee schedule coverage, with 283 published articles analyzing fee schedule 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.
Travelers won on the unpaid portion of one fee-schedule claim but failed to obtain summary judgment on the remaining medical-necessity claims. The title’s “Comp defense” refers to workers’ compensation fee schedules used in no-fault billing, not a workers’ compensation coverage ruling.
Two defenses, different claims
Martin Plutno v Travelers, 2014 NY Slip Op 50412(U), decided March 11, 2014, modified an order that had dismissed the complaint. The insurer established timely denials of the claims on the respective defenses.
For the August 3–25, 2007 services, its employee’s affidavit established the amount already paid and the fee-schedule basis for denying the balance. The provider did not raise a factual dispute over that unpaid portion. Dismissal remained in place for that part of the complaint.
The remaining claims turned on medical necessity. Travelers supplied a sworn statement from the chiropractor who performed the IME, with a factual basis and medical rationale for finding further treatment unnecessary. The treating chiropractor’s sworn letter then raised a triable issue. Those claims were not dismissed on summary judgment.
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What the split result does not establish
The opinion does not hold that arithmetic alone proves every fee-schedule defense or that a provider wins whenever it supplies a treating-doctor letter. It describes the evidence accepted in this record.
Jason’s comment below raised a possible difference between departments. The court did not announce a departmental split or compare competing standards. The Mendoza physical-therapy decision and DRD Medical’s later provider-side result, both from the First Department’s Appellate Term, show why the forum alone does not predict the result.
Keep the fee-schedule calculation separate from the medical opinion. Success on the first does not answer the second, and surviving the medical motion is not a payment judgment.
Jason’s original comment
Jason’s March 2014 comment proposed a departmental comparison. That was his reading, not a split announced in the Plutno opinion.
My own thought process is now there is another split in the departments. The First Department has a more stringent post-IME “here at issue test”. This Court solely requires a letter of medical necessity to defeat a summary judgment motion.
Historical note: Plutno’s March 2014 decision separates a fee-schedule claim from medical-necessity claims; its figures and service dates concern that record, not today’s reimbursement amounts or workers’ compensation coverage.
Last reviewed: September 2026.
Connect to the Encyclopedia
Start with the medical necessity and peer review hub.
- A treating-physician letter that raised a factual issue: Complete Radiology
- Normal range of motion and an inadequate rebuttal: Mendoza
- Conflicting physical-therapy opinions: DRD Medical
- Missing justification for additional studies: Neomy
For review of a particular no-fault dispute, contact the firm with the denial and supporting medical papers.
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
Fee Schedule Issues in No-Fault Insurance
The New York no-fault fee schedule establishes the maximum reimbursement rates for medical treatment provided to injured motorists. Disputes over fee schedule calculations, coding, usual and customary charges, and the applicability of workers compensation fee schedules to no-fault claims are common. These articles analyze fee schedule regulations, court decisions on reimbursement disputes, and the practical challenges providers face in obtaining appropriate payment under the no-fault system.
283 published articles in Fee Schedule
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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.
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