Rivkin Radler Secures Complete Dismissal of Case Challenging Right to Use Peer Reviews to Evaluate MRI Claims

April 16, 2014 | Appeals

Barry Levy, Max Gershenoff, and Michael Schnepper, of Rivkin Radler’s Litigation & Appeals practice group, secured a major victory for New York no-fault automobile insurers in New York Diagnostic Medical Care, P.C. v. GEICO Casualty Insurance Co., Index No. 650766/2013, convincing the Supreme Court, New York County to grant a motion to dismiss a healthcare provider’s complaint against GEICO, challenging the use of medical peer reviews to deny no-fault claims for MRI studies.  In the New York Diagnostic Medical Care case, the plaintiff healthcare provider sought, among other things, a declaratory judgment to the effect that an automobile insurance company, could not lawfully rely upon medical peer reviews as a basis to deny claims for MRI studies, even if the peer reviews indicated that the underlying healthcare services were medically useless or illusory. In rejecting these contentions, and dismissing the plaintiff healthcare provider’s complaint in its entirety, the Supreme Court held that “an insurer can rely on a peer review report to support a denial of no-fault medical benefits based on lack of medical necessity.”  

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New York Diagnostic Medical Care, P.C. v. GEICO Casualty Insurance Co.

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