August 26, 2013

Intuitive Chiropractic, P.C. v REdland Ins. Co. (2013 NY Slip Op 51461(U))

Headnote

The main issue in this case was whether the defendant, Redland Insurance Company, had timely and properly denied the plaintiff's claims for first-party no-fault benefits based on a lack of medical necessity. The court considered a sworn peer review report submitted by the defendant, which provided a factual basis and medical rationale for the determination that there was a lack of medical necessity for the services at issue. The plaintiff, Intuitive Chiropractic, P.C. as Assignee of Ruth Santamaria, failed to rebut the defendant's prima facie showing. As a result, the court held that the defendant's cross motion for summary judgment dismissing the complaint should be granted. Therefore, the holding of the case was that the defendant was entitled to summary judgment dismissing the complaint, and the order of the Civil Court denying the defendant's cross motion was reversed.

Reported in New York Official Reports at Intuitive Chiropractic, P.C. v REdland Ins. Co. (2013 NY Slip Op 51461(U))

Intuitive Chiropractic, P.C. v REdland Ins. Co. (2013 NY Slip Op 51461(U)) [*1]

Intuitive Chiropractic, P.C. v Redland Ins. Co.

2013 NY Slip Op 51461(U) [40 Misc 3d 140(A)]

Decided on August 26, 2013

Appellate Term, Second Department

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

As corrected in part through April 21, 2014; it will not be published in the printed Official Reports.

Decided on August 26, 2013

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

PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ
2011-2757 Q C.

Intuitive Chiropractic, P.C. as Assignee of RUTH SANTAMARIA, Respondent, —
against
Redland Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Queens County (Richard G. Latin, J.), entered July 27, 2011. The order, insofar as appealed from, denied defendant’s cross motion for summary judgment dismissing the complaint.

ORDERED that the order, insofar as appealed from, is reversed, with $30 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 on the ground that it had timely and properly denied the claims at issue based on a lack of medical necessity. Insofar as is relevant to this appeal, the Civil Court denied defendant’s cross motion and held that the sole remaining issue for trial was medical necessity.

In support of its cross motion, defendant submitted a sworn peer review report setting forth a factual basis and medical rationale for the reviewer’s determination that there was a lack of medical necessity for the services at issue. Plaintiff failed to rebut defendant’s prima facie showing. In view of the foregoing, and as plaintiff has not challenged the Civil Court’s finding, in effect, that defendant is otherwise entitled to judgment, the order, insofar as appealed from, is reversed and 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]).

Pesce, P.J., Aliotta and Solomon, JJ., concur.
Decision Date: August 26, 2013