Key Takeaway
Court finds MUA treatment too aggressive without proper foundation. Expert testimony on medical necessity prevails in no-fault insurance dispute.
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.
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”
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.
