Key Takeaway
Shirom's 2014 acupuncture ruling rejected use of a narrowly reasoned earlier peer review for later bills. It did not approve a formula for denying future care.
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.
Shirom concerned the reach of an earlier peer review. Its narrow criticism of initial acupuncture documentation did not establish that the later services covered by the lawsuit were unnecessary.
Historical note: Shirom Acupuncture (September 22, 2014) confined the earlier peer review to its actual reasoning and treatment period. It did not validate a blanket future-treatment denial.
Last reviewed: September 2026.
The period and reasoning of the report
On September 22, 2014, the First Department’s Appellate Term affirmed the order insofar as appealed. The reviewer had addressed an earlier treatment period, relying on perceived vagueness in the initial report and notes. That did not support the later claim’s dismissal. A separate claim’s dismissal was outside the appeal because the provider had not cross-appealed. Read Shirom.
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The court rejected this report’s reach; it did not approve a future-denial template. Nor did it instruct providers to bring separate lawsuits for different billing periods. That unsupported strategy has been removed from the old expansion. The relevant comparison is between the services sued on and what the report actually explains.
Jason’s original comment
Jason’s September 2014 reaction follows unchanged. His suggestion about a broader peer review is an inference, not a ruling that inserting a future-treatment sentence establishes a defense.
This one is interesting. How many acupuncture cases have you seen where the insurance carrier denied all billing based upon a prior peer review? I am surprised this was taken on appeal. But what is interesting is that a peer review for an initial set of services can state broadly that all further services would not be medically necessary and the peer would (it appears) satisfy the initial burden of persuasion.
This case can definitely be used (with a proper peer review) to substantiate the denial of all pre-IME conservative therapeutic service.
Connect to the Encyclopedia
- Medical necessity: case directory and related decisions
- All Boro: a rebuttal that addressed another case
- Healing Art: medical necessity was outside the moving papers’ issues
- Surgicare: the trial court rejected the surgery expert’s reasoning
- Promed Orthocare: substitute testimony and a preserved objection
For review of a particular no-fault dispute, contact the firm with the denial, relevant records and procedural history.
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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Nov 24, 2009Frequently Asked Questions
Common Questions About This Topic
4 answers from the firm's New York personal-injury and employment-law practice. Click any question to expand.
What did the court rule in Shirom Acupuncture v. Kemper?
The First Department's Appellate Term affirmed the order insofar as appealed. The narrow earlier peer review did not establish that the later billed acupuncture services lacked medical necessity.
How does this affect no-fault insurance claims in New York?
The dates and reasoning of the actual report matter. Shirom does not provide a universal rule requiring a new report for every bill.
What is a peer review report in no-fault insurance?
In this case, the reviewer evaluated earlier acupuncture services and criticized the provider's initial report and notes. The question was how far that reasoning reached.
Can a single peer review deny all future treatment claims?
Shirom did not decide that question affirmatively. It rejected this report's use for later claims; adding a broad conclusion alone is not a defense approved by the decision.
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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.
