Key Takeaway
Appellate Division ruling on hearsay and peer review reports in no-fault medical necessity cases - analysis of when medical records must be attached to peer reviews.
Neomy Med., P.C. v GEICO Ins. Co., 2011 NY Slip Op 51532(U)(App. Term 2d Dept. 2011)
“In support of its cross motion for summary judgment, defendant also submitted, among other things, a peer review report, which set forth a factual basis and medical rationale for the conclusion that there was a lack of medical necessity for the services at issue. Contrary to the determination of the Civil Court, there was no need for defendant to annex the medical records examined by the peer review doctor (cf. Matter of State of New York v Wilkes, 77 AD3d 1451 ). Furthermore, [*2]since the purpose of the peer review report submitted by defendant was not to attempt to prove that plaintiff’s assignor was injured as documented in his medical records, or that she was treated as set forth in those records, but to establish that, assuming the facts set forth therein were true, the treatment allegedly provided by plaintiff was not medically necessary, defendant was not required to demonstrate that the records fell within an exception to the rule against hearsay (see id.; Urban Radiology, P.C. v Tri-State Consumer Ins. Co., 27 Misc 3d 140, 2010 NY Slip Op 50987 ).”
Look, I think the medical records on a peer need to be attached. The Appellate Term is wrong, and the Appellate Division or the Appellate Term, First Department will take a different view when the issue is properly raised. Yet, I am not sure that this Court has any sympathy towards Mr. Neomi and its “owner” -hence this decision and the other ones.
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- First Department’s approach to medical necessity summary judgment
- Civil Court reasoning problems in no-fault hearsay cases
- Requirements for IME doctor explanations in diminished range of motion cases
- New York No-Fault Insurance Law
Legal Update (February 2026): Since this 2011 decision, New York courts have continued to develop precedent regarding peer review report requirements and the necessity of attaching underlying medical records, particularly following subsequent Appellate Division rulings that may have clarified or modified the hearsay analysis discussed in this Appellate Term decision. Practitioners should verify current judicial interpretations of peer review documentation standards and any updated procedural requirements for supporting medical necessity determinations in no-fault litigation.
