January 27, 2014

Comprehensive MRI of N.Y., P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50128(U))

Headnote

The main issue in this case was whether the defendant, New York Central Mutual Fire Insurance Company, had timely denied the two claims at issue on the ground of lack of medical necessity. The defendant argued that they had timely mailed their denial of claim forms, which denied the claims. However, conflicting medical expert opinions were presented by the parties, demonstrating the existence of a triable issue of fact as to whether there was a lack of medical necessity for the services provided. The court ultimately held that the order denying the defendant's motion for summary judgment dismissing the complaint was affirmed, as the conflicting expert opinions were sufficient to demonstrate the existence of a triable issue of fact.

Reported in New York Official Reports at Comprehensive MRI of N.Y., P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50128(U))

Comprehensive MRI of N.Y., P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50128(U)) [*1]

Comprehensive MRI of N.Y., P.C. v New York Cent. Mut. Fire Ins. Co.

2014 NY Slip Op 50128(U) [42 Misc 3d 137(A)]

Decided on January 27, 2014

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This opinion is uncorrected and will not be published in the printed Official Reports.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 January 27, 2014

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 9th and 10th JUDICIAL DISTRICTS

PRESENT: : LaSALLE, J.P., NICOLAI and IANNACCI, JJ
2012-2768 S C.

Comprehensive MRI of New York, P.C. as Assignee of GENEVIEVE A. BARTLEY, Respondent,
against
New York Central Mutual Fire Insurance Company, Appellant.

Appeal from an order of the District Court of Suffolk County, Third District (C. Stephen Hackeling, J.), dated November 13, 2012. The order, insofar as appealed from as limited by the brief, denied defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order, insofar as appealed from, is affirmed, without costs.

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

Contrary to the determination of the District Court, the affidavit submitted by defendant in support of its motion for summary judgment established that defendant had timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]) its denial of claim forms, which denied the two claims at issue on the ground of lack of medical necessity. The conflicting medical expert opinions proffered by the parties were sufficient to demonstrate the existence of a triable issue of fact as to whether there was a lack of medical necessity for the services provided (see Zuckerman v City of New York, 49 NY2d 557 [1980] Dynamic Med. Imaging, P.C. v New York Cent. Mut. Fire Ins. Co., 29 Misc 3d 139[A], 2010 NY Slip Op 52062[U] [App Term, 9th & 10th Jud Dists 2010]). Defendant’s remaining contention lacks merit.

Accordingly, the order, insofar as appealed from, is affirmed.

LaSalle, J.P., Nicolai and Iannacci, JJ., concur.
Decision Date: January 27, 2014