Easy Care Acupuncture, P.C. v A. Cent. Ins. Co., 2015 NY Slip Op 50973(U)(App. Term 1st Dept 2015)
That the assignor may have subjectively reported during the course of the peer review examination that he “feels worse” after two months of treatment did not, by itself and without any objective medical explanation by the peer reviewer, eliminate all triable issues regarding the medical necessity of continued acupuncture treatment, especially in view of the peer reviewer’s own positive findings (see Easy Care Acupuncture, P.C. v 21 Century Advantage Ins. Co., 46 Misc 3d 126[A], 2014 NY Slip Op 51766[U][App Term, 1st Dept]). In addition, the peer reviewer’s statement that “with respect to the [assignor’s] right shoulder complaints, further comment outside my area of expertise is deferred to the appropriate specialist,” was hardly sufficient to permit a summary determination as to the medical necessity of continued treatment related to this injury.”
Again, an objective standpoint is used to discuss the gambit of the propriety of an IME review. Also, the “outside my expertise” argument furthermore spells disaster.
