June 28, 2012

Yklik, Inc. v Electric Ins. Co. (2012 NY Slip Op 51287(U))

Headnote

The main issue in this case was whether the supplies provided by the plaintiff, Yklik, Inc. as Assignee of TREVARE WHITE, were medically necessary and therefore covered under a no-fault benefits policy. The court considered the fact that the defendant, Electric Insurance Co., had submitted affirmed peer review reports with factual basis and medical rationale for their determination that there was a lack of medical necessity for the supplies provided. In opposition, the plaintiff submitted an affirmation from a doctor, which did not meaningfully refer to, let alone rebut, the conclusions set forth in the peer review reports. The court held that as the plaintiff did not challenge the finding that the defendant was otherwise entitled to judgment, the defendant's cross motion for summary judgment dismissing the complaint was granted. Therefore, the order denying the defendant's cross motion for summary judgment was reversed and the defendant's cross motion for summary judgment dismissing the complaint was granted.

Reported in New York Official Reports at Yklik, Inc. v Electric Ins. Co. (2012 NY Slip Op 51287(U))

Yklik, Inc. v Electric Ins. Co. (2012 NY Slip Op 51287(U)) [*1]

Yklik, Inc. v Electric Ins. Co.

2012 NY Slip Op 51287(U) [36 Misc 3d 131(A)]

Decided on June 28, 2012

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This opinion is uncorrected and will not be published in the printed Official Reports.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 June 28, 2012

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

PRESENT: : WESTON, J.P., PESCE and ALIOTTA, JJ
2009-1566 K C.

Yklik, Inc. as Assignee of TREVARE WHITE, Respondent, —
against
Electric Insurance Co., Appellant.

Appeal from an order the Civil Court of the City of New York, Kings County (Lisa S. Ottley, J.), entered April 14, 2009. The order, insofar as appealed from as limited by the brief, denied defendant’s cross motion for summary judgment dismissing the complaint.

ORDERED that the order, insofar as appealed from, is reversed, without costs, and defendant’s cross motion for summary judgment dismissing the complaint is granted.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment and defendant cross-moved for summary judgment dismissing the complaint. The Civil Court found that plaintiff and defendant had established their prima facie cases and that the sole issue for trial was the medical necessity of the supplies provided to plaintiff’s assignor. Defendant appeals, as limited by its brief, from so much of the order as denied its cross motion for summary judgment dismissing the complaint.

In support of its cross motion, defendant submitted, among other things, affirmed peer review reports, each of which set forth a factual basis and medical rationale for the respective doctor’s determination that there was a lack of medical necessity for the supplies provided. In opposition to the cross motion, plaintiff submitted an affirmation from a doctor, which failed to [*2]meaningfully refer to, let alone rebut, the conclusions set forth in the peer review reports (see Pan Chiropractic, P.C. v Mercury Ins. Co., 24 Misc 3d 136[A], 2009 NY Slip Op 51495[U] [App Term, 2d, 11th & 13th Jud Dists 2009]). As plaintiff has not challenged the Civil Court’s finding, in effect, that defendant is otherwise entitled to judgment, defendant’s cross 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]).

Accordingly, the order, insofar as appealed from, is reversed and defendant’s cross motion for summary judgment dismissing the complaint is granted.

Weston, J.P., Pesce and Aliotta, JJ., concur.
Decision Date: June 28, 2012