Key Takeaway
New York courts recognize that MRI facilities need discovery to defend against medical necessity challenges, unlike other providers who may not require extensive documentation.
Understanding Discovery Rights for MRI Facilities in Medical Necessity Cases
In New York no-fault insurance disputes, the type of medical provider significantly impacts their ability to defend against medical necessity challenges. While some healthcare providers can mount effective defenses with limited documentation, imaging facilities like MRI centers face unique challenges that courts have begun to recognize.
The distinction becomes particularly important when insurance companies file medical necessity reversals and seek summary judgment to dismiss claims. Different medical specialties have varying capacities to rebut these challenges based on the nature of their services and available documentation.
Jason Tenenbaum’s Analysis:
Medical Arts Radiological Group, P.C. v NY Cent. Mut. Fire Ins. Co., 2015 NY Slip Op 51035(U)(App. Term 2d Dept. 2015)
“Thus, when defendant moved for summary judgment dismissing the complaint, an automatic stay of disclosure went into effect pursuant to CPLR 3214 (b) (see Arts4All, Ltd. v Hancock, 54 AD3d 286 ), and remained in effect (see Rockaway Med. & Diagnostic, P.C. v Utica Mut. Ins. Co., 19 Misc 3d 142, 2008 NY Slip Op 51033 ) until February 8, 2013, when the Civil Court directed defendant to provide verified responses to plaintiff’s demands for discovery. Plaintiff demonstrated that there was a legitimate need for discovery with respect to defendant’s defense of lack of medical necessity (see Reilly, 269 AD2d at 582; Metropolitan Diagnostic Med. Care, P.C. v A. Cent. Ins. Co., 42 Misc 3d 133, 2013 NY Slip Op 52246 ). “Therefore, the court properly considered during the pendency of motion for summary judgment” (Reilly, 269 AD2d at 582).”
I do not think this would apply to an EMG provider or most conservative care providers. Yet, MRI providers and DME providers cannot legitimately interpose meaningful rebuttal without any discovery.
Key Takeaway
Courts recognize that MRI and DME providers require access to discovery materials to mount effective defenses against medical necessity challenges, unlike EMG or conservative care providers who typically have sufficient documentation readily available. This principle helps prevent summary judgment motions from unfairly disadvantaging imaging facilities.
