In Metropolitan Diagnostic Med. Care, P.C. v. Erie Ins. Co. of N.Y., 54 Misc.3d 129(A) (App. Term, 2d, 11th & 13th Jud. Dists 2016), the MRIs that were the subject of the suit were prescribed by a physician who specialized in physical medicine and rehabilitation (PMR). The defendant insurer denied the claim based on a peer review report issued by a physician specializing in orthopedic surgery. At trial, defendant’s peer review expert testified to the lack of medical necessity of the MRIs. The trial court ruled for the plaintiff, holding that as the peer review physician practiced in a different specialty than the prescribing physician, he was not competent to testify. The trial court further held that nevertheless, defendant’s expert witness testimony was not credible.
On appeal, the Appellate Term held:
