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Medical necessity reversalsAugust 20, 2014

Promed Durable Equip., Inc. v GEICO Ins., 2014 NY Slip Op 51262(U)(App. Term 2d Dept. 2014)

Civil Court of the City of New York, Kings County (Carol Ruth Feinman, J.)

“Defendant also an nexed to its motion papers two affirmed peer review reports, each of which set forth a factual basis and medical rationale for the doctor’s determination that there was a lack of medical necessity for the supplies at issue. Plaintiff did not rebut defendant’s prima facie showing. Accordingly, the order is reversed and defendant’s cross motion for summary judgment dismissing the complaint is granted”

Quality Health Prods., Inc. v Geico Ins. Co., 2014 NY Slip Op 51268(U)(App. Term 2d Dept. 2014)

Civil Court of the City of New York, Kings County (Carol Ruth Feinman, J.)

“In opposition to the cross motion, plaintiff submitted an affidavit from a doctor which failed to meaningfully refer to, let alone sufficiently rebut, the conclusions set forth in the peer review reports (see Pan Chiropractic, P.C. v Mercury Ins. Co., 24 Misc 3d 136[A], 2009 NY Slip Op 51495[U] [App Term, 2d, 11th & 13th Jud Dists 2009]).”

** I am sure the number would be higher if everybody appealed this judge’s orders.

One Response

  1. nycoolbreez says:

    If a presumption truly does get raised why doesnt the peer review negate the presumption and therefore raise a question of fact?
    isnt that what happens when you rebut every other presumption?

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