Lack of medical necessity defense upheld
Court upholds medical necessity defense despite plaintiff's challenges to peer review doctor qualifications in Five Boro Med case.
Read More →Sufficiency of medical evidence
74 articles by Jason Tenenbaum, Esq.
Another Geffner sighting
Court decision requiring medical experts to demonstrate proper qualifications when testifying outside their specialty area in NY personal injury cases.
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Mailing and the first time “objective” has landed in a medical rational case
Court ruling establishes "objective medical explanation" requirement for no-fault insurance medical necessity defenses and highlights proper mailing procedure standards.
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Peer review of acupuncture not substantitated
Court rules peer review report insufficient to deny acupuncture no-fault claims when review only addressed prior time period, not future treatments.
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Medical necessity reversals
Two 2014 New York appellate decisions demonstrate how insurance companies can successfully challenge medical necessity claims when healthcare providers fail to properly rebut peer review reports.
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Stipulated to defeat.
Court ruling on medical necessity burden shifting in no-fault insurance case where contemporaneous treatment notes defeat IME testimony in Nassau County trial.
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Peer review testimony is admissible and sufficient
Court ruling clarifies that peer review testimony with independent medical record analysis can establish lack of medical necessity in no-fault insurance disputes.
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The rambling man does not meet burden of lack of medical necessity at trial
Court rejects insurance company's confused medical expert testimony in no-fault case, showing that unopposed evidence must still meet basic quality standards.
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Another peer hearsay case
New York court upholds admission of doctor's peer review testimony on medical necessity despite hearsay objections in no-fault insurance case.
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A chiropractor may manipulate areas other than the vertebral column?
NY court ruling on chiropractor scope of practice beyond spinal manipulation in no-fault insurance cases. Impact on Willets Point precedent and treatment coverage.
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A motion for summary judgment is denied pending disclosure
New York court denies summary judgment in no-fault case where plaintiff timely requested but didn't receive peer review reports and medical documentation from defendant insurer.
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Understanding IME Cut-offs for Durable Medical Equipment: When Timing Matters
Learn how IME timing affects DME coverage in NY no-fault insurance. Expert guidance on prescription vs. acquisition rules. Call 516-750-0595.
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Another look at MUA
New York court ruling on MUA expert testimony qualifications in no-fault insurance cases, examining when medical experts can testify outside specialty areas.
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The peer review was insufficient
Court ruled peer review report lacked factual basis for denying medical supplies, showing First Department's higher scrutiny standards for peer reviews in no-fault cases.
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Some substance to an IME cut off defense
Court ruling establishes that IME reports must provide factual basis and medical rationale when claiming injuries are resolved in no-fault insurance cases.
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What’s a boy to do?
Court sanctions attorneys for frivolous no-fault insurance brief while ruling on medical necessity peer review challenges in New York PIP case.
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A snapshot in time saves 9 – Reversed (finally)
Court reversal highlights how IME timing affects medical necessity determinations in no-fault insurance disputes, with burden of proof shifting to plaintiffs.
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MUA services inconsistent with MUA guidelines – prima facie showing lack of medical necessity established
Court finds MUA procedures lacked medical necessity when services didn't follow established guidelines, showing how peer review can defeat no-fault claims.
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Triable issue of fact through another IME in a different specialty
Brooklyn Chiropractic v A. Cent. Ins. Co.: Court finds triable issue of fact when plaintiff's IME contradicts insurer's IME, but peer review denial stands unopposed.
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Unrebutted doctor’s testimony insufficient to prove the services lacked a medical necessity
NY court ruling shows insurance expert testimony needs factual basis and medical rationale to prove lack of medical necessity in no-fault cases.
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Appellate Term Second Department expounds on sufficient medical rationale in DME case
Appellate Term Second Department ruling clarifies medical rationale requirements in DME cases, emphasizing need for meaningful opposition to peer review reports.
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A copy of a peer report is all that is needed
New York court clarifies that peer review reports need only be copies when requested by providers, and cannot be used as evidence to prove lack of medical necessity at trial.
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“Deviation” does not need to be established with medical literature.
Court rules medical experts don't need literature citations to establish treatment deviation in no-fault cases, relying on professional experience instead.
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Malella and priority of coverage discovery disallowed
Court rejects insurer's discovery attempts to find primary coverage and investigate fraudulent incorporation in NY no-fault case, ruling demands improper.
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Reverse Pan Chiropractic
Ocean Diagnostic v. Allstate case analysis showing how medical necessity burden shifted when plaintiff provided stronger evidence than insurer's peer review report.
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Peer review
Court ruling emphasizes that peer review reports must provide clear medical rationale and factual basis to successfully challenge medical necessity claims in no-fault cases.
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Peer hearsay and electronic signatures
Appellate court rules on peer review requirements and electronic signature validity in no-fault insurance disputes, clarifying evidence standards for medical necessity challenges.
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No-Fault Insurance Medical Necessity: When Stipulated Evidence Defeats Claims
Expert guidance on no-fault insurance medical necessity disputes in NY. Learn how stipulated evidence can defeat claims. Strategic trial advice. Call 516-750-0595.
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Understanding Medical Necessity and Peer Review Requirements in New York No-Fault Cases
Learn how New York no-fault insurance medical necessity determinations and peer review requirements impact healthcare providers in Long Island and NYC court cases.
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Medical necessity motion wins in a tough venue
Medical necessity motion victory in challenging New York no-fault venue shows proper legal strategy can overcome difficult courts. Learn key insights.
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9th and 10th are telling the Nassau County District Court (again) that enough is enough
9th and 10th Judicial Districts correct Nassau County District Court on medical necessity standards in NY no-fault insurance cases, emphasizing proper evidence requirements.
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First Presbyterian, then PSW – Maryland is at it again
New York court affirms Civil Court ruling that insurance company failed to prove chiropractic services weren't medically necessary in no-fault case.
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Appellate Term First Department does not seem to be too fond of durable medical equipment
Appellate Term First Department rules against durable medical equipment provider in no-fault case, finding insufficient evidence of medical necessity for summary judgment.
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A potent dissent
A dissenting judge criticizes vague peer review reports in no-fault insurance cases, highlighting the importance of detailed medical necessity determinations.
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Who cares about what the Appellate Division has to say about hearsay
Appellate Division ruling on hearsay and peer review reports in no-fault medical necessity cases - analysis of when medical records must be attached to peer reviews.
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New Jersey Appellate Division discusses MUA
New Jersey Appellate Division reviews MUA medical necessity standards, examining $18K+ claims and NAMUAP protocols in no-fault insurance dispute
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A 2007 causation case – affidavit insufficient
2007 New York case shows how conclusory medical expert affidavits fail to establish causation in personal injury claims, highlighting importance of substantive evidence.
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Appellate Term, First Departments latest statement on peer reviews
New York's Appellate Term reveals stark differences between First and Second Departments in handling peer review reports for no-fault insurance medical necessity denials.
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Civil Court Decisions in No-Fault Insurance: When Legal Reasoning Goes Wrong | Long Island Attorney
Critical analysis of Consolidated Imaging v Travelers Indemnity Co. - examining flawed Civil Court reasoning in Long Island and NYC no-fault insurance cases.
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Strategic MRI Timing in Personal Injury Cases: Why Later Can Be Better
Expert analysis of strategic MRI timing in NY personal injury cases. Learn why delayed imaging can be better. Long Island & NYC attorneys. Call 516-750-0595.
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Medical Necessity in No-Fault Insurance: Understanding the First Department’s Victory for Insurance Carriers
Learn about medical necessity in New York no-fault insurance from the First Department's Enko decision. Expert legal help for healthcare providers. Call 516-750-0595.
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And now the Ninth and Tenth follow lockstep with the Second, Eleventh and Thirteenth
Court decisions show consistent pattern: medical providers failing to submit proper affidavits of merit in medical necessity challenges will almost certainly lose at appellate level.
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I was wrong about the necessity of annexing the reports that the peer doctor relied upon
Analysis of Active Imaging v Progressive case where Appellate Term rejected challenge to medical necessity motion based on peer report without underlying medical records.
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Crazy
Nassau County District Court ruling on IME cut-offs and medical necessity burden of proof in no-fault insurance claims - analyzing flawed legal reasoning.
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Prima facie entitlement to summary judgment was not established through an unsigned peer report
Court rules that unsigned peer review reports cannot establish prima facie entitlement to summary judgment in no-fault insurance medical necessity disputes.
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Be careful what you ask for: Discovery by summary judgment motion
Learn how summary judgment motions in no-fault insurance cases can backfire on carriers when discovery rules work against them in medical necessity disputes.
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A signifcant knee surgery does not defeat the 5102(d) serious injury threshold
Court rules knee surgery including ACL reconstruction doesn't meet NY serious injury threshold when medical records show full strength and range of motion post-surgery.
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Analysis or reference to scientific data is necessary to defeat a motion based upon the lack of causal connection between lead paint and attendant poisoning
New York Court of Appeals ruling demonstrates that expert testimony in toxic exposure cases requires scientific data and analysis, not mere speculation, to establish causation.
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The failure to explain decreased range of motion after a somwhat normal examination with plaintiff's own doctor is fatal to plaintiff's 5102(d) action
When treating physicians show conflicting findings about range of motion limitations, courts require proper reconciliation to establish medical necessity under New York's no-fault law.
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Peer Review Reports in No-Fault Insurance: Elmont Open MRI v State Farm
Learn how the Elmont Open MRI v State Farm case impacts personal injury claims and what peer review reports mean for your recovery.
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Another Pan Medical sighting (or is it citing?)
New York court reinforces Pan Chiropractic standard for medical necessity denials, requiring affirmed peer review reports with factual basis and medical rationale.
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Peer doctor's testimony is sufficient to prima facie demonstrate a service's lack of medical necessity
Court finds peer doctor testimony with medical rationale sufficient to prove lack of medical necessity, reversing trial court in no-fault case.
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Why Poorly Drafted Medical Affidavits Fail Against Insurance Medical Necessity Motions
Expert defense against medical necessity summary judgment motions in NY. Protect your healthcare practice from insurance carrier challenges. Call (516) 750-0595.
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Effective Peer Review Rebuttals in New York No-Fault Insurance Cases
Learn how to craft effective peer review rebuttals in New York no-fault insurance cases. Expert legal analysis from experienced Long Island personal injury attorney.
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The Convergence of Medical Malpractice and No-Fault Litigation: Understanding Cross-Practice Legal Principles
Explore how medical malpractice and no-fault litigation intersect in New York courts. Essential insights for Long Island and NYC attorneys handling complex medical-legal cases.
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Why Conclusory Affidavits Fail: Building Strong Opposition to Medical Necessity Summary Judgment Motions
Learn why conclusory affidavits fail in medical necessity summary judgment motions. Long Island & NYC legal defense strategies. Call 516-750-0595.
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The CPLR 2106 Trap: Why Medical Practice Owners Must Avoid This Critical Procedural Error
Avoid the CPLR 2106 trap that destroys medical practice no-fault claims. Long Island & NYC legal defense against procedural errors. Call 516-750-0595.
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Knee Surgery for ACL and Meniscus Tears: Understanding the Serious Injury Threshold in New York Personal Injury Cases
Learn why knee surgery for ACL and meniscus tears may not automatically meet NY serious injury threshold. Expert legal analysis from Long Island personal injury lawyers.
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An IME doctor must offer an explanation why he believes a Claimant's diminished range of motion is self restricted
Learn how Kim v O'Rourke established standards requiring IME physicians to provide objective evidence when claiming range of motion limitations are self-restricted.
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Medical Necessity Determinations: A Landmark Ruling in No-Fault Insurance Litigation
Landmark Progressive case changed medical necessity burden of proof in NY no-fault insurance. Expert analysis for healthcare providers. Call (516) 750-0595.
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Neurologist Expert Testimony Limits in MRI Medical Necessity Cases – Long Island & NYC
Nassau County court rules neurologists cannot challenge chiropractor MRI orders without proper foundation. Important ruling for Long Island and NYC medical providers.
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Affirmation of opposing expert sufficient to thwart summary judgment in a malpractice case
Court affirms opposing expert affidavit sufficient to defeat summary judgment in medical malpractice when expert has proper credentials and specialty certification.
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The Appellate Division discusses how an expert becomes comptent to testify about the standard of care in a specific area of practice
Learn NY medical expert testimony standards from Shectman v Wilson case. Expert qualification requirements for medical malpractice cases in NYC and Long Island.
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Plaintiff's conclusory affidavit is insufficient to defeat an insurance carrier's lack of medical necessity motion
Why conclusory medical necessity affidavits fail against insurance companies. Expert analysis of Innovative Chiropractic v Travelers case. Call 516-750-0595.
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A prima facie case of medical necessity?
Understanding medical necessity proof standards in NY personal injury and no-fault cases. Expert legal analysis from Long Island attorneys. Call 516-750-0595.
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A physician's affirmation and a chiropractor's affidavit will prove the lack of medical necessity of medical equipment
Expert analysis of medical equipment peer review determinations in New York no-fault insurance cases. Understanding evidence requirements and medical necessity standards for Long Island practitioners.
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May an insurance carrier's expert offer an opinion beyond the confines of his peer or IME report?
Expert analysis of insurance carrier expert testimony scope in NY no-fault medical necessity disputes. Understanding Krishna case precedent, IME reports, and peer review limitations for NYC and Long Island.
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Conclusory affidavits will not defeat an insurance carrier's summary judgment motion
Learn how conclusory affidavits fail to defeat insurance carriers' summary judgment motions in NY no-fault cases. Bronze Acupuncture v Mercury shows what works.
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The first of hopefully many
Long Island personal injury law blog discusses landmark Bongiorno v State Farm decision, marking first Richmond County reversal on medical necessity summary judgment in no-fault insurance cases.
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A minus v. Mercury
New York appellate court inconsistencies in no-fault insurance cases affecting venue selection and case outcomes for Long Island residents.
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A Common Sense Approach to Defeating Medical Necessity Motions | Long Island Lawyer | Jason Tenenbaum
Learn effective strategies for defeating medical necessity motions in New York no-fault insurance cases. Expert legal insights on peer review challenges.
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NY Medical Necessity Challenges: Continental Medical Case Analysis
Analyzing NY no-fault medical necessity challenges from Continental Medical v. Mercury Casualty case, examining CPLR 2106 affirmation defects and IME report requirements.
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Understanding Foundation Requirements in Medical Malpractice Expert Testimony
New York medical malpractice expert testimony foundation requirements. Learn critical standards for expert witness preparation in Nassau and Suffolk County cases.
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The Future is Bright for Medical Necessity Summary Judgment Motions in New York
New York medical necessity summary judgment motions are evolving with stricter expert testimony standards, creating opportunities for skilled no-fault insurance attorneys.
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