August 8, 2014

Promed Durable Equip., Inc. v GEICO Ins. (2014 NY Slip Op 51262(U))

Headnote

The relevant facts considered by the court in this case were that Promed Durable Equipment, Inc. as Assignee of ALLI SHAVANNA was seeking to recover assigned first-party no-fault benefits from GEICO Insurance. GEICO had timely mailed denial of claim forms which denied the claims on the ground of lack of medical necessity and also submitted two affirmed peer review reports. The main issue decided was whether GEICO had provided sufficient evidence to establish the lack of medical necessity for the supplies at issue. The holding of the court was that GEICO had made a prima facie showing and the plaintiff did not rebut this showing, therefore the court granted GEICO's cross motion for summary judgment dismissing the complaint.

Reported in New York Official Reports at Promed Durable Equip., Inc. v GEICO Ins. (2014 NY Slip Op 51262(U))

Promed Durable Equip., Inc. v GEICO Ins. (2014 NY Slip Op 51262(U)) [*1]

Promed Durable Equip., Inc. v GEICO Ins.

2014 NY Slip Op 51262(U) [44 Misc 3d 139(A)]

Decided on August 8, 2014

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This opinion is uncorrected and will not be published in the printed Official Reports.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 August 8, 2014

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

PRESENT: : PESCE, P.J., WESTON and ALIOTTA, JJ.
2012-1192 K C

Promed Durable Equipment, Inc. as Assignee of ALLI SHAVANNA, Respondent,
against
GEICO Insurance, Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Carol Ruth Feinman, J.), entered February 21, 2012. The order denied defendant’s cross motion for summary judgment dismissing the complaint.

ORDERED that the order 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, defendant appeals from an order of the Civil Court which denied defendant’s cross motion for summary judgment dismissing the complaint.

The affidavit submitted by defendant in support of its cross motion for summary judgment established that defendant had timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]) the denial of claim forms at issue, which denied the claims on the ground of lack of medical necessity. Defendant also annexed to its motion papers two affirmed peer review reports, each of which set forth a factual basis and medical rationale for the doctor’s determination that there was a lack of medical necessity for the supplies at issue. Plaintiff did not rebut defendant’s prima facie showing. Accordingly, the order 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., Weston and Aliotta, JJ., concur.

Decision Date: August 08, 2014