Unrebutted doctor’s testimony insufficient to prove the services lacked a medical necessity

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Radiology Today, P.C. v Travelers Ins. Co.,  2013 NY Slip Op 50849(U)(App. Term 2d Dept. 2013)

“Since defendant’s expert’s testimony did not include a factual basis or medical rationale for her opinion, it was insufficient to establish that there was a lack of medical necessity for the services rendered (see A-Quality Med. Supply v GEICO Gen. Ins. Co., Misc 3d , 2013 NY Slip Op 23088 [App Term, 2d, 11th & 13th Jud Dists 2013]; PSW Chiropractic Care, P.C. [*2]v Maryland Cas. Co., 32 Misc 3d 144[A], 2011 NY Slip Op 51719[U] [App Term, 2d, 11th & 13th Jud Dists 2011]). Additionally, a peer review report, unlike a witness, is not subject to cross-examination and is not admissible by defendant to prove lack of medical necessity (see A-Quality Med. Supply, Misc 3d , 2013 NY Slip Op 23088). Thus, the Civil Court’s determination that defendant had not established that the services at issue were not medically necessary, could have been reached under a fair interpretation of the evidence”

So why bring the treating doctor to court?

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2 Responses

  1. I am puzzled. The peer review doctor herself could not get her own report into evidence?

  2. Peer doctor’s own IME report is a pure hearsay.
    How the peer doctor could not establish a factual basis for her medical rationale is a better question!

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