Another Geffner sighting
Court decision requiring medical experts to demonstrate proper qualifications when testifying outside their specialty area in NY personal injury cases.
Read More →Sufficienty of medical opposition
53 articles by Jason Tenenbaum, Esq.
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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Post PT treatment not medically appropriate – chiro treatement considered
Court rules on physical therapy medical necessity denial based on chiropractor and physician IME reports, raising questions about cross-disciplinary treatment evaluations.
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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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Ground rule 11 and the IME cut off
Analysis of Triumph Assoc. Physical Therapy v New York Central Mutual case addressing Ground Rule 11 fee schedule disputes and IME-based medical necessity denials in no-fault law.
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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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Comp defense succeeds but medical necessity defense falters
Court rules fee schedule defense succeeds with employee affidavit but medical necessity defense fails when plaintiff submits sworn letter from treating chiropractor
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That the testing was necessary to rule out herniations is sufficient to warrant a trial on medical necessity
New York court rules that detailed medical affidavit explaining need for MRI to rule out disc herniations creates triable issue of medical necessity in no-fault case.
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Triable issue of fact – medical necessity
Hunt City Chiropractic case shows conflicting medical expert opinions can create triable issues of fact on medical necessity in no-fault insurance disputes.
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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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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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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 simple medical necessity decision
New York court rules that unsworn chiropractor letters lack probative value in no-fault insurance medical necessity disputes, requiring proper foundation.
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It involved a different matter.
Progressive Northeastern court case on medical necessity letters and prior trial testimony failing to rebut no-fault insurance peer review reports
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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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Conclusory affidavit?
Court ruled healthcare provider's affidavit was insufficient to rebut insurance company's peer review reports denying medical necessity claims.
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Affidavit deemed insufficient under a Pan Chiro analysis
Court finds physician's affidavit insufficient under Pan Chiro standards, raising questions about evolving requirements for medical necessity evidence in no-fault cases.
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Letter of medical necessity sufficient to raise an issue of fact
Court ruling demonstrates that a treating physician's letter of medical necessity can create sufficient factual disputes to defeat summary judgment in no-fault insurance cases.
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No-Fault Insurance Medical Necessity: Understanding the Praetorian Standard
Expert analysis of medical necessity requirements in NY no-fault insurance. Learn from Praetorian case precedent for Long Island & NYC medical providers.
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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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Improper Use of an Affirmation Cost Plaintiff Its Case: Understanding CPLR 2106 Requirements in New York
New York CPLR 2106 affirmation requirements in personal injury cases. Learn how improper affirmations can cost plaintiffs their cases and technical compliance rules.
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A Question of Fact Through an Affidavit of a Doctor: Medical Necessity in New York No-Fault Cases
Learn how doctor affidavits create questions of fact for medical necessity in NY no-fault insurance cases. Essential guidance for Long Island personal injury claims.
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I wish I had the record and the briefs on this one
Expert analysis of medical necessity defenses in NY no-fault cases. Learn how peer review reports affect insurance claims. Long Island & NYC legal representation.
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Geico now joins the Mercury and NYCM club in having their medical necesity motions denied based upon boilerplate letters of medical necessity
GEICO joins Mercury & NYCM with denied medical necessity motions. Important precedent for Long Island & NYC medical providers defending no-fault claims. Call 516-750-0595.
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It was a good run at the cards
Appellate Term ruling on medical necessity motions in no-fault insurance cases, examining hearsay rules and evidence standards for Nassau County plaintiff firms.
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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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More plaintiffs fail to rebut an insurance carrier’s medical utilization report
Three recent no-fault insurance cases demonstrate how plaintiffs consistently fail to provide adequate medical expert testimony to rebut insurance carriers' utilization reports.
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More Pan Chiropractic sightings – or perhaps I should say citings
New York appellate courts continue to cite the influential Pan Chiropractic v. Mercury decision in no-fault insurance disputes, reinforcing key precedents for medical necessity challenges.
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Pan Chiro sightings
Pan Chiro case continues to be cited in NY no-fault insurance medical necessity disputes, showing how poor affidavits of merit fail against proper peer review reports.
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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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A $4,300 affidavit- and another Pan Chiro citing (or sighting)
Court reverses $4,300 judgment due to insufficient medical affidavit that failed to address insurer's peer review determination in no-fault case.
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A letter of medical necessity raises a triable issue of fact?
Court ruling examining whether a letter of medical necessity creates triable fact issues in no-fault insurance disputes, questioning summary judgment standards.
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A poorly drafted affidavit of merit fails to defeat my summary judgment motion
Jason Tenenbaum successfully defeats plaintiff's medical necessity opposition with verbose but inadequate affidavit in Prime Psychological Services 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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Expert Qualification Standards in New York No-Fault Cases: Understanding Professional Sufficiency Requirements
Learn how New York courts determine expert qualifications in no-fault insurance cases. Essential guide for Long Island and NYC attorneys handling medical expert testimony challenges.
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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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An interesting 5102(d) case involving a knee surgery
Expert analysis of Gilmonio v Toussaint 5102(d) case involving knee surgery. Learn how incomplete medical history can defeat serious injury threshold claims in NY.
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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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Proof That Physician Was Internist Sufficient for Expert Medical Testimony in NY Personal Injury Cases
Learn how internist qualifications meet NY expert witness standards for personal injury cases. Nassau & Suffolk County medical malpractice lawyer insights. Call 516-750-0595
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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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NY No-Fault: When Treating Doctors Must Challenge IME Medical Necessity Findings
Learn when treating doctors must meaningfully disagree with IME findings in NY no-fault cases. Expert analysis of medical necessity disputes for Long Island & NYC injury victims.
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Understanding Peer Review Standards in New York No-Fault Insurance Cases
Learn how the Pan Chiropractic v Mercury Insurance case changed peer review standards in New York no-fault insurance litigation. Expert legal guidance for healthcare providers.
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Medical Necessity Evidence Standards in No-Fault Law | Long Island Lawyer | Jason Tenenbaum
Learn the evidence standards for challenging medical necessity in NY no-fault insurance cases. Expert analysis from Long Island personal injury attorney.
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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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