Key Takeaway
All Borough upheld a no-fault defense based on expert testimony in 2014. Separate the report-admission objection from the doctor's independent record review.
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.
The peer review reports were admitted at trial. The expert’s independent analysis, rather than those reports, supplied the medical proof. In All Borough Group Medical Supply v Unitrin Advantage Insurance Co., decided March 17, 2014, the Appellate Term affirmed dismissal of the provider’s complaint.
On appeal, the provider challenged admission of the reports rather than the substance of the doctor’s testimony. That limited appellate argument is central to the result.
The witness did the evidentiary work
The court explained that peer review reports are not admissible at trial to prove lack of medical necessity. Here, the doctor’s testimony based on an independent review of the patient’s medical records established the defense, and the provider had failed to rebut it. The report-admission argument therefore did not warrant reversal.
The opinion does not describe a two-stage “sub-peer review” program. That phrase appears in Jason’s commentary, not the court’s explanation. Nor does the ruling mean every expert wins by appearing in person or that cross-examination removes all foundation problems.
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The later Radiology Today v GEICO decision (2017) again separates the report’s truth from an expert’s testimony. The linked 2011 and 2012 substitute-expert notes concern the opportunity to present testimony; this 2014 appeal concerned the effect of the testimony actually given.
Jason’s original comment
Jason’s April 2014 comment extends the point to a substitute reviewer and expresses his own view of trial practice. The court did not discuss a two-tier review program or guarantee a win whenever an expert reviewed records.
So an independent review of the medical records that is consistent with the medical rationale in the peer review will win the day for the carrier. This holds true for a sub-peer review. Perhaps, I can convince a Kings County Civil Court judge that this is the law…
Historical note: All Borough’s March 2014 decision relied on expert testimony whose substance was not challenged on appeal; Radiology Today (2017) separately explains the report’s limited trial role. Last reviewed: September 2026.
Connect to the Encyclopedia
- Medical necessity: opinions, claim timing and related cases
- Excluding a substitute expert led to a new trial: Radiology Today (2011)
- Substitute testimony and a separate concurrence: Park Slope
- A provider’s MUA win after competing testimony: Westcan
- An affidavit that did not answer the peer review: Rosenzweig
For review of a particular denial or litigation record, contact the firm or see the no-fault defense practice.
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
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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.
