Medical necessityJune 11, 2016

Ji Sung Kim Acupuncture, P.C. v American Tr. Ins. Co., 2016 NY Slip Op 50873(U)(App. Term 2d Dept. 2016)

“The IME report set forth a factual basis and medical rationale for the doctor’s conclusion that there was a lack of medical necessity for further treatment. In opposition to the motion, plaintiff submitted an affidavit from plaintiff’s owner who had treated plaintiff, which failed to meaningfully refer to, [*2]let alone sufficiently rebut, the conclusions set forth in the doctor’s report”

This was my case so therefore I am posting it.  More importantly, this case is interesting because the IME report stated that the person still had disabilities and that further PT was appropriate.  Dr. Cole stated that further acupuncture would not be necessary.  This was sufficient to prove lack of medical necessity.

The discusses why the IME is wrong; that acupuncture would help the patient and that upon a review of the chart, the acupuncture treatment was helpful.  In years passed, this would have been enough to raise an issue of fact.  I believe in the post Arnica v. Interboard world, things are different now.

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