Key Takeaway
Court rules that unsigned peer review reports cannot establish prima facie entitlement to summary judgment in no-fault insurance medical necessity disputes.
In New York no-fault insurance law, insurance companies frequently challenge medical claims through peer review reports that question the necessity of treatment. When insurers seek summary judgment to dismiss these claims entirely, they must establish a strong foundational case — known as prima facie entitlement — through proper documentation and evidence.
The authentication and proper execution of peer review reports plays a crucial role in these proceedings. Courts require that such reports meet specific procedural standards to carry legal weight. This includes proper signatures from qualified reviewers, as these documents serve as expert medical opinions that can determine whether expensive treatments like MRI scans were medically necessary.
The case of Altair Med., P.C. v Clarendon Natl. Ins. Co. demonstrates how seemingly minor procedural defects can undermine an insurance company’s entire motion for summary judgment. When motions for summary judgment are pending, courts scrutinize the sufficiency of supporting documentation, and unsigned reports may lack the necessary foundation to proceed.
Jason Tenenbaum’s Analysis:
Altair Med., P.C. v Clarendon Natl. Ins. Co., 2010 NY Slip Op 51721(U)(App. Term 2d Dept. 2010)
Defendant’s contention that the Civil Court should have granted it summary judgment dismissing the claim by plaintiff Altair Medical, P.C. and the claim by plaintiff S & R Medical, P.C. in the amount of $793.24 lacks merit because the “peer review report” pertaining to these claims was unsigned. Accordingly, defendant failed to establish its prima facie entitlement to summary judgment dismissing these claim
Did Plaintiff object to the unsigned peer report? Compare, Continental Medical v. Mercury.
Key Takeaway
Insurance companies cannot rely on unsigned peer review reports to establish their right to summary judgment in no-fault medical necessity cases. The absence of a signature creates a foundational defect that prevents the insurer from meeting the initial burden required for summary judgment, regardless of the report’s substantive content. This procedural requirement protects medical providers from improperly authenticated challenges to their treatment decisions.
Legal Update (February 2026): Since this 2010 decision, New York’s no-fault insurance regulations have undergone several amendments affecting peer review requirements and summary judgment standards. The Insurance Department has updated authentication procedures for peer review reports, and appellate courts have refined the standards for establishing prima facie entitlement in medical necessity disputes. Practitioners should verify current regulatory provisions regarding peer review documentation requirements and recent case law developments in this evolving area.
