August 5, 2015

Lynbrook Med. of NY, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51226(U))

Headnote

The court considered the evidence submitted by the defendant in support of its motion seeking summary judgment in a case brought by a medical provider to recover assigned first-party no-fault benefits. The evidence established that the defendant had timely mailed the denial of claim forms, which were based on lack of medical necessity, and also submitted an affirmed peer review report supporting this determination. The plaintiff did not submit any medical evidence in opposition to rebut the defendant's showing. As a result, the court reversed the order of the Civil Court and granted the defendant's motion for summary judgment, dismissing the complaint. The main issue decided in this case was whether the defendant's evidence established a prima facie showing of lack of medical necessity for the services at issue. The holding of the court was that the defendant had indeed made a prima facie showing, and the plaintiff's failure to submit any medical evidence in opposition resulted in the granting of the defendant's motion for summary judgment.

Reported in New York Official Reports at Lynbrook Med. of NY, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51226(U))

Lynbrook Med. of NY, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51226(U)) [*1]

Lynbrook Med. of NY, P.C. v Praetorian Ins. Co.

2015 NY Slip Op 51226(U) [48 Misc 3d 139(A)]

Decided on August 5, 2015

Appellate Term, Second 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This opinion is uncorrected and will not be published in the printed Official Reports.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 August 5, 2015

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-771 K C

Lynbrook Medical of New York, P.C. as Assignee of WINSOME BRANDFORD, Respondent, August 5, 2015
against
Praetorian Insurance Company, Appellant. ORDERED that the order is reversed, with $30 costs, and defendant’s motion for summary judgment dismissing the complaint is granted.

In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from an order of the Civil Court which denied defendant’s motion for summary judgment dismissing the complaint.

The evidence submitted by defendant in support of its motion established that defendant had timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]) the denial of claim forms at issue, which denied the claims on the ground of lack of medical necessity. Defendant also submitted an affirmed peer review report, which set forth a factual basis and medical rationale for the doctor’s determination that there was a lack of medical necessity for the services at issue. Plaintiff did not submit any medical evidence in opposition to rebut defendant’s prima facie showing. Accordingly, the order is reversed and defendant’s motion for summary judgment dismissing the complaint is granted (see Delta Diagnostic Radiology, P.C. v Integon Natl. Ins. Co., 24 Misc 3d 136[A], 2009 NY Slip Op 51502[U] [App Term, 2d, 11th & 13th Jud Dists 2009]; Delta Diagnostic Radiology, P.C. v American Tr. Ins. Co., 18 Misc 3d 128[A], 2007 NY Slip Op 52455[U] [App Term, 2d & 11th Jud Dists 2007]; A. Khodadadi Radiology, P.C. v NY Cent. Mut.Fire Ins. Co., 16 Misc 3d 131[A], 2007 NY Slip Op 51342[U] [App Term, 2d & 11th Jud Dists 2007]).

Pesce, P.J., Aliotta and Solomon, JJ., concur.

Decision Date: August 05, 2015