October 30, 2013

Premier Health Choice Chiropractic, P.C. v Praetorian Ins. Co. (2013 NY Slip Op 51802(U))

Headnote

The main issue in this case was whether the defendant-insurer was entitled to summary judgment dismissing the complaint made by Premier Health Choice Chiropractic, P.C. The court considered the fact that the defendant made a prima facie showing of entitlement to judgment as a matter of law by demonstrating that it timely denied the plaintiff's first-party no-fault claims based on a sworn independent medical examination (IME) report of its examining chiropractor. The court held that the unsworn doctor's report submitted with the plaintiff's attorney's affirmation was without probative value and did not meaningfully refer to, let alone rebut, the contrary findings made by the defendant's peer reviewer. Therefore, the court reversed the order of the Civil Court of the City of New York and granted the defendant's motion for summary judgment, directing the clerk to enter judgment accordingly.

Reported in New York Official Reports at Premier Health Choice Chiropractic, P.C. v Praetorian Ins. Co. (2013 NY Slip Op 51802(U))

Premier Health Choice Chiropractic, P.C. v Praetorian Ins. Co. (2013 NY Slip Op 51802(U)) [*1]

Premier Health Choice Chiropractic, P.C. v Praetorian Ins. Co.

2013 NY Slip Op 51802(U) [41 Misc 3d 133(A)]

Decided on October 30, 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This opinion is uncorrected and will not be published in the printed Official Reports.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 October 30, 2013

SUPREME COURT, APPELLATE TERM, FIRST DEPARTMENT

PRESENT: Lowe, III, P.J., Schoenfeld, Hunter, Jr., JJ
570566/13.

Premier Health Choice Chiropractic, P.C., a/a/o Jose Argueta, Plaintiff-Respondent, – –
against
Praetorian Insurance Company, Insurance Company, Defendant-Appellant.

Defendant appeals from an order of the Civil Court of the City of New York, Bronx County (Fernando Tapia, J.), dated September 6, 2011, which denied its motion for summary judgment dismissing the complaint.

Per Curiam.

Order (Fernando Tapia, J.), dated September 6, 2011, reversed, without 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 claims based on a sworn independent medical examination (IME) report of its examining chiropractor, which set forth a factual basis and medical rationale for the chiropractor’s stated conclusion that the assignor’s injuries were resolved and that the chiropractic treatment giving rise to plaintiff’s no-fault claim lacked medical necessity. In opposition, the unsworn doctor’s report submitted with plaintiff’s attorney’s affirmation was without probative value (see Grasso v Angerami, 79 NY2d 813 [1991]; Henkin v Fast Times Taxi, Inc., 307 AD2d 814 [2003]). Moreover, even if considered, the report did not meaningfully refer to, let alone rebut, the contrary findings made by defendant’s peer reviewer (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: October 30, 2013