MUA trial victory

The new fee schedule notwithstanding, the question here is whether MUA treatments were necessary.  You saw part of the typical play by play in the MUA world.

Def witness

• “Defendant’s witness, a chiropractor who had prepared the peer review report upon which defendant had relied…that the assignor had received standard chiropractic treatment for 10 weeks before the MUA treatments commenced.”
• “The witness also stated that there was no indication that the assignor had not been responding to the chiropractic treatments and that, in the witness’s opinion, the MUA treatments had been done prematurely and were not medically necessary. Defendant’s witness further testified that he “took issue with” the lack of second opinions for the MUAs.”

Plaintiff witness

• Plaintiff’s rebuttal witness, the examining chiropractor, testified that, because the conservative care which the assignor had received for 10 weeks had resulted in only minimal improvement, he had recommended MUA treatments.
• Plaintiff’s witness testified that, based upon his own examinations of the assignor following each of the MUA treatments and his review of medical records, the assignor’s condition had improved because of the MUA treatments

District Court

• he manipulation itself appears to be warranted,” and awarded judgment to plaintiff. “

Appellate Term

Affirmed

What I always find helpful with the MUA cases are the MRI findings, EMG findings and Dr. Cerf is quite emphatic on data reliability and use of the outcome assessment test in formulating a treatment plan.  The question here and perhaps the linchpin is what are “minimal improvements”  and were some of the other treatment notes looked at?

The other thing that is unfortunate is that examinations prior and post MUA to determine whether an examination was done often do not occur.  This would require an EUO to discern of course.  This case, at best, looked a prototypical battle of the experts and plaintiff won. Absent some record gaffe, the order would invariably affirmed.

Related Articles

• Why conclusory affidavits fail in medical necessity summary judgment motions
• Understanding medical necessity denials and the four corners rule
• How IME doctors must explain their medical necessity opinions
• Building a prima facie case of medical necessity
• New York No-Fault Insurance Law

Legal Update (February 2026): Since this 2018 post, New York’s no-fault fee schedules have undergone multiple revisions, and the regulatory framework governing medical necessity determinations for manipulation under anesthesia (MUA) treatments may have been modified. Practitioners should verify current fee schedule provisions, medical necessity criteria, and any updated peer review standards that may affect MUA reimbursement claims.