Key Takeaway
Gaetane's principal offered no medical rebuttal to an IME. Read what the affidavit omitted and why the 2015 decision did not disqualify all principals.
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 missing information mattered. In Gaetane Physical Therapy v Great Northern Insurance Co., decided May 1, 2015, the provider’s principal did not indicate that she had examined the patient or offer medical evidence rebutting the IME. The Appellate Term granted the insurer summary judgment.
That omission is different from a finding that she had never examined the patient.
What was missing from the opposition
The insurer supplied an affirmed orthopedic IME report with a factual basis and medical rationale. The principal’s affidavit did not create a medical dispute in response. The provider also left unchallenged the lower court’s determination that the insurer was otherwise entitled to judgment.
The defect was the evidence, not the affiant’s corporate title alone. Gaetane does not say that a practice principal is automatically disqualified, that only the treating professional may provide opposition, or that personal examination is the sole possible foundation. Jason’s description of a “know it all” affidavit addresses what this submission lacked.
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Denial timing is a separate issue. Beach Medical (2026) illustrates why a medical opinion cannot cure failure to preserve a medical-necessity defense through timely denial.
Jason’s original comment
Jason’s May 2015 comment reacts to this affidavit’s lack of medical evidence. It does not establish that a corporate principal can never offer competent opposition.
This is the “know it all” affidavit that does not offer medical evidence for post IME services. It is nice to see the Court taking a stand on this issue.
Historical note: Gaetane’s May 2015 decision rejected this principal’s inadequate affidavit, not all principal-authored evidence; Beach Medical (2026) separately illustrates preservation of the medical-necessity defense through timely denial. Last reviewed: September 2026.
Connect to the Encyclopedia
- Medical necessity: opinions, claim timing and related cases
- An affidavit that did not answer the peer review: Rosenzweig
- Unopposed and inadequately opposed motions: two Nassau appeals
- Timely denials and an unsupported attorney affirmation: Diagnostic Medicine
- A provider’s MUA win after competing testimony: Westcan
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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Sep 16, 2016Frequently Asked Questions
Common Questions About This Topic
3 answers from the firm's New York personal-injury and employment-law practice. Click any question to expand.
What evidence does a provider need to oppose an IME-based summary judgment motion?
Gaetane required evidence that raised a factual dispute after the insurer made its initial showing. The principal neither indicated an examination nor supplied other medical evidence answering the IME. The decision does not limit competent opposition to the treating provider alone.
Why was the principal's affidavit rejected in Gaetane Physical Therapy v Great Northern?
The affidavit omitted both an indication that the principal had examined the patient and medical evidence rebutting the IME. The opinion does not find that she had never examined the patient or disqualify her solely because she was a principal.
Can a provider bill for treatment after an IME cut-off?
Gaetane concerns payment for disputed treatment and the evidence on a summary-judgment motion. It does not decide that all later treatment is barred or guarantee payment. The claims, denial and medical evidence need individual review.
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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.
