Medical necessity – rebutting a peer review

Westcan Chiropractic, P.C. v Hertz Claim Mgt., 2015 NY Slip Op 51066(U)(App. Term 2d Dept. 2014)

“In support of its motion, defendant submitted a sworn peer review report which set forth a factual basis and medical rationale for the reviewer’s determination that there was a lack of medical necessity for the services at issue (see American Chiropractic Care, P.C. v Praetorian Ins. Co., 42 Misc 3d 145[A], 2014 NY Slip Op 50346[U] [App Term, 9th & 10th Jud Dists 2014]). However, in opposition to the motion, plaintiff submitted an affidavit by one of the assignor’s treating doctors, which, as plaintiff argues on appeal, “meaningfully referred to defendant’s peer review report and sufficiently rebutted the conclusions set forth therein””

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