Key Takeaway
Mendoza dismissed specified physical-therapy claims after an inadequate IME rebuttal. Read the findings, timely-denial proof and limits of the decision.
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 insurer won because the treating therapist’s affidavit did not answer the IME doctor’s contrary findings. The appeal concerned specified physical-therapy claims, not the automatic cancellation of every no-fault benefit.
What Mendoza actually dismissed
Rummel G. Mendoza v Chubb, 2015 NY Slip Op 50900(U), decided June 17, 2015, concerned the claims of L.N.L. Physical Therapy Rehabilitation for the service periods identified in the opinion. The Appellate Term, First Department, reversed the denial of Chubb’s motion and dismissed those claims.
Chubb established timely denials and supplied its orthopedist’s IME report and follow-up report. The reports gave a factual basis and medical rationale for finding that the injuries had resolved and that further physical therapy was unnecessary.
The treating therapist’s affidavit did not meaningfully address the contrary findings, including normal cervical and lumbar range-of-motion results. That failure defeated the opposition on this record. The court also declined to consider arguments first raised in the reply brief.
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What to compare in an IME rebuttal
Read the examiner’s actual findings against the treating professional’s response. If the report relies on normal range of motion, identify whether the opposition addresses those findings and explains the claimed need for the disputed treatment. The opinion does not prescribe a mandatory testing instrument or say that later measurements automatically create a factual issue.
An IME report does not win a motion merely by existing. Here, the insurer established timely denial and supported its medical conclusion before the court considered the therapist’s response. DRD Medical’s 2020 physical-therapy appeal reached the opposite result when conflicting opinions raised a factual dispute.
A medical-necessity denial also differs from exhaustion of available benefits. The first disputes the need for treatment; the second concerns payments reaching an applicable coverage limit.
Historical note: Mendoza’s June 2015 decision dismissed specified physical-therapy claims; Beach Medical (2026) separately confirms the need to preserve a medical-necessity defense through timely denial, unlike its distinct causation defense.
Last reviewed: September 2026.
Connect to the Encyclopedia
Start with the medical necessity and peer review hub.
- An IME rebuttal that did not address the examiner: Eastern Star
- Conflicting physical-therapy opinions: DRD Medical
- A treating-physician letter that raised a factual issue: Complete Radiology
- Missing justification for additional studies: Neomy
- No-fault exhaustion: a different reason for unpaid bills (2026)
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
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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Jan 27, 2012Frequently 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 is an IME cut off in a New York no-fault case?
The phrase commonly refers to a medical-necessity denial following an IME. Mendoza concerned specified physical-therapy claims; it did not hold that one report automatically terminates all benefits.
How does a medical provider rebut an IME cut off?
Read the IME's findings and provide responsive medical evidence about the disputed treatment. In Mendoza, the therapist did not meaningfully address the orthopedist's contrary findings, including normal range-of-motion testing.
Does the insurer automatically win if it has an IME report?
No. Mendoza relied on timely denials and reports containing a factual basis and medical rationale before considering the opposing affidavit. The mere existence of an IME report does not reproduce that showing.
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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.
