Key Takeaway
Easy Care's 2015 appeal rejected an unexplained medical-necessity opinion. The insurer lost its motion despite inadequate opposition; payment was not awarded.
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.
A patient’s report of feeling worse did not establish that further acupuncture was unnecessary in Easy Care Acupuncture v A. Central. On June 30, 2015, the Appellate Term reversed the insurer’s summary judgment, denied its motion and reinstated the complaint.
Historical note: Easy Care (2015) reinstated a claim after an insufficient insurer motion; it did not decide that all continued acupuncture is necessary or that expert limitations always defeat dismissal.
Last reviewed: September 2026.
Why feeling worse did not resolve necessity
The reviewer did not provide an objective medical explanation connecting that complaint to a lack of necessity, despite positive findings in the review. The reviewer also deferred the right-shoulder issue to another specialist, leaving that part of the requested dismissal unsupported. The insurer’s separate billing and fee-schedule proof was insufficient too.
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The court expressly said the provider’s opposition would not have raised a triable issue. The motion still failed because the insurer had not met its initial burden. This restored the claim; it did not award payment or decide that continued acupuncture was medically necessary.
The cited 2014 Easy Care decision likewise rejected an unexplained inference from a patient feeling worse, and separately found mailing proof inadequate. These decisions concern the submitted medical rationale. They do not impose a universal testing protocol or establish that an expert’s acknowledgment of limits defeats every motion.
Jason’s original comment
Jason’s July 2015 comment follows. His reference to an IME and his prediction about an expert’s limits are historical commentary; the court described a peer review and decided the sufficiency of this motion.
Again, an objective standpoint is used to discuss the gambit of the propriety of an IME review. Also, the “outside my expertise” argument furthermore spells disaster.
Connect to the Encyclopedia
Start with the medical-necessity case directory.
- Parkway Hospital: a provider win without a rebuttal witness
- AP Orthopedic: credibility review after a stipulated trial
- Innovative Chiropractic: a treating doctor’s bare reaffirmation
- New Life Medical: two peer reviews left unanswered
For review of a particular claim or motion, contact the firm.
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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Jun 22, 2015Was this article helpful?
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.
