May 30, 2007

Spruce Med. & Diagnostic, P.C. v Lumbermen’s Mut. Cas. Co. (2007 NY Slip Op 51104(U))

Headnote

The Civil Court granted the provider's motion to preclude the insurer's medical expert and awarded the provider $3,969.74. The provider argued the expert should be barred because he was not the doctor who prepared the peer review report on which the denial was based. The Appellate Term held that the motion should have been denied because the expert would be subject to full cross-examination and his testimony on lack of medical necessity would be limited to the basis for denial in the original peer review report. The order was reversed and the matter remanded for a new trial.

Reported in New York Official Reports at Spruce Med. & Diagnostic, P.C. v Lumbermen’s Mut. Cas. Co. (2007 NY Slip Op 51104(U))

[*1]
Spruce Med. & Diagnostic, P.C. v Lumbermen’s Mut. Cas. Co.
2007 NY Slip Op 51104(U) [15 Misc 3d 143(A)]
Decided on May 30, 2007
Appellate Term, First Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
This opinion is uncorrected and will not be published in the printed Official Reports.


Decided on May 30, 2007
APPELLATE TERM OF THE SUPREME COURT, FIRST DEPARTMENT

PRESENT: McKEON, P.J., McCOOE, DAVIS, JJ
570787/06.

Spruce Medical and Diagnostic, P.C.,a/a/o Mireya Lobo, Plaintiff-Respondent, – –

against

Lumbermen’s Mutual Casualty Co. Defendant-Appellant.


Defendant appeals from an order of the Civil Court of the City of New York, Bronx County (Larry S. Schachner, J.), dated March 30, 2006, which granted plaintiff’s motion to preclude defendant’s expert testimony and awarded plaintiff judgment in the principal amount of $3,969.74.


Per Curiam.

Order (Larry S. Schachner, J.), dated March 30, 2006, reversed, with $10 costs, and the matter remanded for a new trial.

Plaintiff moved to preclude the testimony of defendant’s medical expert on the ground that the expert was not the doctor who prepared the peer review report upon which defendant’s denial of no-fault benefits was based. The motion should have been denied since defendant’s expert witness “would be subject to full cross-examination and his testimony as to lack of medical necessity would be limited to the basis for denial set forth in the original peer review report” (Home Care Orthos. Med. Supply v American Mfrs. Mut. Ins. Co., 14 Misc 3d 139[A], 2007 NY Slip Op 50302[U][2007]).

THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.
Decision Date: May 30, 2007