Key Takeaway
Parkway Hospital won without a rebuttal witness in 2019. Read the credibility holding and the distinction between initial and ultimate trial burdens.
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 hospital won Parkway Hospital v Integon without calling a rebuttal witness. After a stipulated medical-necessity trial, the Civil Court rejected the insurer’s expert as not credible. The Appellate Term affirmed on July 19, 2019.
Historical note: Parkway Hospital (2019) applied the insurer’s initial trial burden; the Dayan (2015) decision it cites places the ultimate burden on the provider after the insurer makes its required showing.
Last reviewed: September 2026.
The surgeon was qualified; his testimony was not credible
The parties stipulated that Integon’s orthopedic surgeon was an expert. He agreed with another doctor’s peer review, but the trial court did not find his testimony credible. The appellate court deferred to that assessment and found the record supported the provider’s judgment. The opinion does not identify a board-certification defect, a missing same-specialty qualification or a particular failure of preparation.
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Parkway describes the insurer’s initial burden to rebut the claim form’s presumption of medical necessity. It cites Dayan v Allstate (2015), which explains the next step: if the insurer succeeds at trial, the provider ultimately must prove necessity by a preponderance of the evidence. Dayan ordered a new trial because the lower court put the ultimate burden on the insurer.
The hospital’s win therefore does not eliminate the provider’s ultimate burden in a case where the insurer makes the required showing. Compare AP Orthopedic’s earlier credibility appeal. Claims handling, summary judgment and a stipulated trial present different procedural questions.
Connect to the Encyclopedia
Start with the medical-necessity case directory.
- AP Orthopedic: credibility review after a stipulated trial
- Easy Care: an insufficient insurer motion despite weak opposition
- 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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May 5, 2012Frequently Asked Questions
Common Questions About This Topic
5 answers from the firm's New York personal-injury and employment-law practice. Click any question to expand.
Q: What is the presumption of medical necessity, and how does it work?
Parkway identifies an initial presumption attached to the claim form. Under Dayan, the insurer must rebut it at trial; if that showing succeeds, the provider has the ultimate burden to prove necessity by a preponderance of the evidence.
Q: Can an insurance company deny coverage just by saying treatment wasn’t necessary?
Parkway is a trial decision, not a complete claims-denial rule. Integon had to support its defense at trial, and its witness was not credible. Denial timing and claims-handling requirements need separate review.
Q: What happens if both sides have expert witnesses who disagree?
The factfinder evaluates the evidence and credibility under the applicable burden of proof. Parkway itself did not involve dueling live experts: the hospital called no rebuttal witness.
Q: How important is expert witness credibility in these cases?
It decided the result here. The parties accepted the surgeon as an expert, but the trial court found him not credible. The appellate court deferred to that assessment; the opinion does not specify a credential or preparation defect.
Q: Can a healthcare provider win a medical necessity trial without expert testimony?
Yes, Parkway expressly records that result. It depended on the insurer's failure to make its initial showing. Dayan explains why the provider's ultimate burden still matters when the insurer does succeed.
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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.
