Medical Expertise v. Trumbull Ins. Co

In Medical Expertise v. Trumbull Ins. Co. (196 Misc. 2d 389 [Civ Ct, Queens County 2003]), the billed-for psychological services were almost identical to those that are the subject of this case, including referral based upon a "self referral consent and authorization form" and administration of the three Beck instruments (see id. at 390). The claim was denied, based upon a peer review that was "critical of using diagnostic tests instead of personal interviews." (Id. at 391.) Judge Siegal found the conflicting expert testimony to be "equally credible." (Id. at 394.) Ruling that the controlling questions were "could a psychologist hold an objective and reasonable belief that a tool used will further the patient's diagnosis and treatment and whether that tool is warranted given the circumstances" (id. at 395), Judge Siegal concluded that the testing instruments "appear to be administered too soon after the motor vehicle accident and by the very nature of some of the questions, not appropriate, given the circumstances" (id.). Other than noting that the instruments were administered "a mere two days" after the accident (see id. at 394), Judge Siegal did not elaborate. Although she concluded that the testing was not "medically necessary," she concluded to the contrary with respect to the review of records, interview and therapy session, again without elaboration. (See id. at 395.)