March 10, 2010

Co-Op City Chiropractic, P.C. v Mercury Ins. Group (2010 NY Slip Op 50452(U))

Headnote

The court considered the motion for summary judgment filed by the defendant, who sought to dismiss the complaint on the ground of lack of medical necessity. The defendant's chiropractor provided an affidavit and peer review report that concluded there was a lack of medical necessity for the services rendered, in line with previous cases. However, the plaintiff's treating chiropractor submitted an affidavit in opposition to the motion that demonstrated the existence of a triable issue of fact as to the medical necessity of the services rendered. The main issue decided was whether there was sufficient evidence to demonstrate the medical necessity of the services rendered, and the court held that the plaintiff's affidavit created a triable issue of fact, leading to the affirmation of the order denying the defendant's motion for summary judgment.

Reported in New York Official Reports at Co-Op City Chiropractic, P.C. v Mercury Ins. Group (2010 NY Slip Op 50452(U))

Co-Op City Chiropractic, P.C. v Mercury Ins. Group (2010 NY Slip Op 50452(U)) [*1]

Co-Op City Chiropractic, P.C. v Mercury Ins. Group

2010 NY Slip Op 50452(U) [26 Misc 3d 145(A)]

Decided on March 10, 2010

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This opinion is uncorrected and will not be published in the printed Official Reports.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 March 10, 2010

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : RIOS, J.P., PESCE and STEINHARDT, JJ
2009-402 Q C.

Co-Op City Chiropractic, P.C. a/a/o Gloria Fagan, Respondent,
against
Mercury Insurance Group, Appellant.

Appeal from an order of the Civil Court of the City of New York, Queens County (Leslie J. Purificacion, J.), entered November 18, 2008. The order, insofar as appealed from, denied the branch of defendant’s motion seeking 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 moved for, among other things, summary judgment dismissing the complaint on the ground of lack of medical necessity. As limited by the brief, defendant appeals from so much of the order of the Civil Court as denied the branch of defendant’s motion seeking summary judgment dismissing the complaint.

The affidavit and peer review report of defendant’s chiropractor set forth a factual basis and medical rationale for the chiropractor’s conclusion that there was a lack of medical necessity for the services rendered (Exclusive Med. Supply, Inc. v Mercury Ins. Group, 25 Misc 3d 136[A], 2009 NY Slip Op 52273[U] [App Term, 2d, 11th & 13th Jud Dists 2009]; 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]). However, the affidavit of plaintiff’s treating chiropractor, submitted in opposition to defendant’s motion for summary judgment, was sufficient to demonstrate the existence of a triable issue of fact as to the medical necessity of the services rendered (cf. Innovative Chiropractic, P.C. v Mercury Ins. Co., 25 Misc 3d 137[A], 2009 NY Slip Op 52321[U] [App Term, 2d, 11th & 13th Jud Dists 2009]; Pan Chiropractic, P.C. v Mercury Ins. Co., 24 Misc 3d 136[A], 2009 NY Slip Op 51495[U], *2 [App Term, 2d, 11th & [*2]13th Jud Dists 2009]). Accordingly, the order, insofar as appealed from, is affirmed.

Rios, J.P., Pesce and Steinhardt, JJ., concur.
Decision Date: March 10, 2010