MUA is dangerous

Manipulation Under Anesthesia (MUA) represents one of the more controversial treatments in chiropractic care, particularly when it comes to no-fault insurance coverage disputes. This aggressive procedure involves manipulating joints while a patient is under sedation, and insurance carriers frequently challenge its medical necessity. The recent Appellate Term decision in Mollo Chiropractic demonstrates how courts evaluate competing expert testimony when determining whether such treatments meet the required standards.

In New York No-Fault Insurance Law cases, the burden of proving medical necessity often hinges on the quality and credibility of expert testimony. This case illustrates how insurers can successfully challenge expensive treatments by presenting evidence that the procedure was premature or inadequately documented. The decision also highlights the importance of establishing proper medical foundation before pursuing aggressive interventions, as courts will scrutinize whether traditional treatments were attempted first.

Case Background

Mollo Chiropractic sought reimbursement for Manipulation Under Anesthesia procedures provided to a patient following a motor vehicle accident. The chiropractor submitted claims to American Commerce Insurance Company, which denied them based on medical necessity grounds. After the insurer retained an expert who concluded that the MUA treatment was premature and lacked adequate documentation, the case proceeded to trial where competing expert witnesses testified about the appropriateness of the treatment.

At trial, the central dispute focused on whether the patient’s condition warranted such aggressive intervention and whether the medical records adequately established the foundation for MUA. The defendant’s expert presented detailed testimony explaining why the treatment appeared premature, while the plaintiff’s expert defended the decision to proceed with MUA. The trial court was tasked with weighing these competing expert opinions and determining which testimony was more credible and persuasive.

Jason Tenenbaum’s Analysis:

Mollo Chiropractic, PLLC v American Commerce Ins. Co., 2020 NY Slip Op 51548(U)(App. Term 2d Dept. 2020)

“Defendant’s experts’s theory in both his peer review report and at trial was, essentially, that MUA is an “aggressive” and possibly dangerous treatment and should therefore be used very rarely, limited to cases where, among other things, there has first been improvement with a course of traditional chiropractic care, and that the records here were inconsistent and not clear enough to show that this was one of those cases. The court was entitled to credit that testimony. The court also implicitly found that plaintiff’s witness’s testimony was less credible and failed to sufficiently rebut defendant’s expert’s testimony”

Legal Significance

This decision establishes important precedent for how courts evaluate medical necessity challenges in no-fault insurance disputes involving aggressive or expensive treatments. The Appellate Term affirmed that trial courts have broad discretion in weighing competing expert testimony, particularly when one expert presents a systematic framework for when such treatments are appropriate. The court’s reasoning suggests that medical treatments exist on a spectrum of aggressiveness, and more aggressive interventions require correspondingly stronger justification and documentation.

The case also reinforces that consistency in medical records matters significantly when defending treatment decisions. Where records contain gaps or inconsistencies, courts are more likely to credit defense experts who point to these deficiencies as evidence that proper protocols weren’t followed. This aligns with broader New York jurisprudence requiring that healthcare providers maintain thorough, contemporaneous documentation to support their treatment decisions.

Furthermore, the decision clarifies that chiropractors and other providers cannot simply rely on their own testimony that a treatment was necessary. When faced with contrary expert opinion backed by recognized treatment protocols, providers must present equally compelling expert testimony that directly addresses and rebuts the insurer’s expert conclusions. Conclusory statements or general assertions of medical necessity will not suffice.

Practical Implications

For healthcare providers considering MUA or similar aggressive interventions, this case underscores several critical practice points. First, document thoroughly any conservative treatments attempted before resorting to more aggressive procedures. Second, ensure that medical records clearly demonstrate why traditional approaches were insufficient and why escalation to more aggressive treatment became necessary. Third, when facing peer review challenges, secure expert witnesses who can articulate specific, detailed reasons why the treatment met accepted standards of care rather than offering only general support.

For insurance companies and their defense counsel, this decision provides a roadmap for successfully challenging aggressive treatments. By presenting experts who articulate clear standards for when such treatments are appropriate and demonstrating that those standards weren’t met, insurers can overcome the general presumption favoring medical treatment decisions. The key is establishing what the proper protocols should be, then showing concrete deficiencies in how those protocols were followed.

Key Takeaway

This decision reinforces that MUA procedures face heightened scrutiny in no-fault disputes. Courts will examine whether conservative treatments were attempted first and whether medical records clearly support the need for such aggressive intervention. Provider documentation must be thorough and consistent to overcome peer review challenges in medical necessity reversals.

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