Surgery peer review is not enough on its faceMay 22, 2019
Allstate Ins. Co. v Buffalo Neurosurgery Group, 2019 NY Slip Op 03749 (2d Dept. 2019)
” This action pursuant to Insurance Law § 5106(c) arises from a motor vehicle accident that occurred on February 6, 2013. Christopher Krull allegedly was injured in the accident, and he underwent spinal fusion surgery performed by P. Jeffrey Lewis of the defendant, Buffalo Neurosurgery Group”
“Here, we agree with the Supreme Court’s denial of that branch of the plaintiff’s motion which was for summary judgment on so much of the complaint as, in effect, sought a determination that it was not obligated to pay the defendant no-fault benefits relating to Krull’s surgery, since the surgery was not medically necessary. The peer review reports submitted in support of that branch of the motion failed to demonstrate, prima facie, that the surgery performed on Krull was not medically necessary “
Those surgery peer reviews, unsurprisingly, are insufficient to establish a prima facie entitlement to summary judgment.