Pomona Med. Diagnostics, P.C. v GEICO Ins. Co., 2011 NY Slip Op 50276(U)(App. Term 1st Dept. 2011)
“[t]he report of defendant’s peer review doctor, which relied on the assignor’s medical records , raised a triable issue of fact as to whether the services provided by plaintiff were medically necessary . Contrary to defendant’s contention, however, its submissions did not conclusively establish as a matter of law its defense of lack of medical necessity, and its cross motion was properly denied”.
I would love to find out what happened on this one. How did this differ from Enko v. Claredon? Could someone send me the briefs and the record…
Thanks.
5 Responses
I’m looking for the briefs too. Interesting.
I suspect Respondent did their homework on this one, but I am only left to speculate.
I know from first-hand experience that the First Department reads the briefs carefully. That is why it took 3 months for them to rule on A-plus v. Mercury – incorrectly I still believe. I think Justice Klein-Heitler bought my arguments in that case, but was persuaded to rule against me by Justices McKeon and Schoenfeld. I actually was granted leave to go to the Appellate Division, but I left my then job and the rest is history, it appears to the detriment of my defense brethren.
I would assume that the report was not very good but as compared to what. It is sort of like asking who was the smartest member of the Three Stooges. Actually like asking who was the dumbest Stooge.
The reports are all ridiculous. The Letters of Medical Necessity are no better but should at least be given equal weight.
I had one Peer Review say that it is impossible to tell whether the PT, Chiro or Acupuncture was providing the beneficial effect because it was all given at once so don’t pay for the Acupuncture treatment.
I actually won that one at trial but usually such a report carries the day.
Not ours, I’m sad to say.
would love to see the record as well. Does anyone have it?