Lotus Acupuncture, P.C. a/a/o Marilyn Rivera v. Unitrin Advantage Ins. Co, 51 Misc.3d 139
Insurer made a motion for summary judgment based on the lack of medical necessity. Appellate Term reversed the lower court saying:
the peer review report pertaining to acupuncture services rendered November 19, 2007 through November 29, 2007, failed to make a prima facie showing that the services rendered during this time frame were not medically necessary. The peer reviewer’s assertion, in effect, that the documentation submitted for his review lacked “supportive information” was insufficient to sustain defendant’s burden of eliminating all triable issues as to medical necessity (see Amherst Med. Supply, LLC v. New York Cent. Mut. Fire Ins. Co., 39 Misc.3d 135[A], 2013 N.Y. Slip Op 50586[U][App Term, 1st Dept 2013] ). Moreover, inasmuch as the peer reviewer did not address plaintiff’s claim for services rendered January 2, 2008, and “stopped short of concluding that the assignor’s medical condition could never be shown to warrant further acupuncture treatment,” his report cannot properly form the basis for denial of this claim (see Shirom Acupuncture, P.C. v. Kemper Independence Ins. Co., 44 Misc.3d 144[A], 2014 N.Y. Slip Op 51407[U][App Term, 1st Dept.2014] ).