Key Takeaway
Khanfour distinguished cervical degeneration from unexplained later lumbar restrictions. Read the 2017 ruling and Jason's comparison with Huntington.
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.
In Khanfour v Nayem, 148 AD3d 426 (2017), the First Department affirmed dismissal of the plaintiff’s serious-injury claims. The cervical and lumbar claims failed for different reasons.
Legal Update (September 2026): Chapter 58 of 2026, Part EE §§ 1 and 4 removed the 90/180-day serious-injury category for actions and proceedings commenced on or after May 26, 2026; the historical decision discussed here predates that amendment.
Last reviewed: September 2026.
Two records, two problems
For the cervical spine, the plaintiff’s own X-ray report showed degenerative disc disease and osteophytes. His specialist gave no medical explanation for attributing that condition to the accident rather than the degeneration.
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The lumbar history was different. The evidence that a ten-year-old injury had healed was uncontradicted. But treatment records showed normal or nearly normal range of motion within two months of the new accident. The specialist found significant restrictions three years later without reconciling those earlier findings. That gap in the medical explanation defeated the claim.
Jason compared the lumbar reasoning with Huntington Medical Plaza v Travelers. Huntington concerned collateral estoppel in a provider’s later no-fault bills, including different treatment dates and new medical affidavits. It also identified missing proof of prior judgments. The two decisions address different questions; Huntington does not make a patient’s good and bad days a substitute for explaining conflicting measurements.
Jason’s original 2017 commentary
Jason’s March 2017 comments are preserved below. His Huntington comparison was an analogy across different causes of action, not a holding that the courts had adopted conflicting rules.
The prior medical conditions of Plaintiff’s looking to beat the threshold get it their way, many times. This case is a great example of causal relationship gone awry
As to the lumbar spine, this actually conflicts (somewhat) with the no-fault case of Huntington Med. Plaza, P.C. v. Travelers Indem. Co., 43 Misc. 3d 129(A) (App. Term 2d Dept. 2014): “As the Civil Court stated, one of those doctors specifically noted that a person’s condition can “wax and wane” after a motor vehicle accident and that, therefore, a finding that the treatments at issue in the prior cases were not medically necessary does not conclusively prove that the treatments at issue in this case were not medically necessary.”
The analogy being that if the Claimant is deemed fine, there needs to be more of an explanation then “good days and bad days” to escape the finding of lack of causation (assuming resolved injuries). I never liked Huntinton/Travelers for the reason that once its prima facie proven that the injury is resolved, the “good day/bad day” analogy is weak.
Connect to the Encyclopedia
Start with the pre-existing injuries and causation topic hub.
- Shah: the defense expert’s unexplained post-accident ROM loss
- Malloy: medical reasons connecting a knee injury to the collision
- Jones: delayed complaints and unaddressed prior conditions
- Donoso: missing causal proof at trial, distinguished from stipulated no-fault records
- Cariddi: the basis of an expert opinion and missing records
For review of a particular dispute, 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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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.
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