February 21, 2013

Innovative MR Imaging, P.C. v Praetorian Ins. Co. (2013 NY Slip Op 50264(U))

Headnote

The court considered the defendant-insurer's denial of the plaintiff's first-party no-fault claim based on a sworn peer review report by a chiropractor, which stated that the MRI tests lacked medical necessity. The main issue decided was whether the defendant was entitled to summary judgment dismissing the complaint, which the court ultimately granted. The holding of the case was that the defendant-insurer had made a prima facie showing of entitlement to judgment as a matter of law by timely denying the claim based on the peer review report, and that the plaintiff had failed to raise a triable issue in opposition. The court also found that the unsworn letter report submitted by the plaintiff's chiropractor was without probative value, and even if considered, the findings were insufficient to withstand summary judgment.

Reported in New York Official Reports at Innovative MR Imaging, P.C. v Praetorian Ins. Co. (2013 NY Slip Op 50264(U))

Innovative MR Imaging, P.C. v Praetorian Ins. Co. (2013 NY Slip Op 50264(U)) [*1]

Innovative MR Imaging, P.C. v Praetorian Ins. Co.

2013 NY Slip Op 50264(U) [38 Misc 3d 143(A)]

Decided on February 21, 2013

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This opinion is uncorrected and will not be published in the printed Official Reports.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 February 21, 2013

SUPREME COURT, APPELLATE TERM, FIRST DEPARTMENT

PRESENT: Lowe, III, P.J., Schoenfeld, Hunter, Jr., JJ
570308/12.

Innovative MR Imaging, P.C., a/a/o Elizabeth Alliksen Plaintiff-Respondent, – –
against
Praetorian Insurance Company, Defendant-Appellant.

Defendant appeals from an order of the Civil Court of the City of New York, Bronx County (Ben R. Barbato, J.), entered December 10, 2010, which denied its motion for summary judgment dismissing the complaint.

Per Curiam.

Order (Ben R. Barbato, J.), entered December 10, 2010, reversed, with $10 costs, motion granted and complaint dismissed. The Clerk is directed to enter judgment accordingly.

The defendant-insurer made a prima facie showing of entitlement to judgment as a matter of law by demonstrating that it timely denied plaintiff’s first-party no-fault claim based on a chiropractor’s sworn peer review report, which set forth a factual basis and medical rationale for the chiropractor’s stated conclusion that the underlying MRI tests lacked medical necessity. In opposition, plaintiff failed to raise a triable issue. The unsworn letter report submitted by plaintiff from the assignor’s treating chiropractor was without probative value (see CPLR 2106; Pierson v Edwards, 77 AD3d 642 [2010]), and, even if considered, the conclusory findings set forth therein were insufficient to withstand summary judgment (see CPT Med. Servs., P.C. v New York Cent. Mut. Fire Ins. Co., 18 Misc 3d 87 [2007]).

THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.
Decision Date: February 21, 2013