June 12, 2015

SMB Med., PC v Federal Ins. Co. (2015 NY Slip Op 50895(U))

Headnote

The court considered a motion for summary judgment by the defendant-insurer to dismiss the plaintiff's no-fault claims for acupuncture treatment rendered to the plaintiff's assignor. The defendant submitted an independent medical examination (IME) report of its examining acupuncturist, which concluded that no further acupuncture treatment was medically necessary. The plaintiff's opposing submissions, consisting of an attorney's affirmation and the report of its examining doctor, did not address the medical necessity of the acupuncture services rendered. The court ruled that the defendant made a prima facie showing of entitlement to summary judgment dismissing the claims for acupuncture services. However, the court also ruled that the conflicting medical expert opinions submitted by the parties raised a triable issue as to the medical necessity of the remaining medical services underlying the plaintiff's claims. The holding of the case was that the defendant was granted partial summary judgment dismissing the portion of the claims seeking reimbursement for acupuncture services, and the matter was remanded for further proceedings to determine the amount of the claims for acupuncture services. The defendant's motion for summary judgment dismissing the remaining no-fault claims was denied, and the case was remanded for further proceedings.

Reported in New York Official Reports at SMB Med., PC v Federal Ins. Co. (2015 NY Slip Op 50895(U))

SMB Medical, PC, a/a/o Faim Forto Plaintiff-Respondent, –

against

Federal Insurance Company, Defendant-Appellant.

Defendant, as limited by the briefs, appeals from so much of an order of the Civil Court of the City of New York, Bronx County (David B. Cohen, J.), entered October 17, 2013, as denied, in part, its motion for summary judgment dismissing the complaint.

Per Curiam.

Order (David B. Cohen, J.), entered October 17, 2013, insofar as appealed from, modified to grant defendant partial summary judgment dismissing the portion of the claims seeking reimbursement for acupuncture services rendered to the assignor; as modified, order affirmed, with $10 costs to defendant, and the matter remanded for further proceedings in accordance herewith.

Defendant-insurer made a prima facie showing of entitlement to summary judgment dismissing plaintiff’s no-fault claims for acupuncture treatment rendered to plaintiff’s assignor, by submitting the independent medical examination [IME] report of its examining acupuncturist which set forth a sufficient factual basis and medical rationale for the conclusion that no further acupuncture treatment was medically necessary (see V.S. Care Acupuncture PC v MVAIC, 47 Misc 3d 126[A], 2015 NY Slip Op 50350[U] [App Term, 1st Dept]). Plaintiff’s opposing submissions, consisting of an attorney’s affirmation and the report of its examining doctor, which, as plaintiff concedes on appeal, did not mention, much less address the medical necessity of the acupuncture services rendered, was insufficient to raise a triable issue (see Munoz v Hollingsworth, 18 AD3d 278, 279 [2005]; CPT Med. Servs., P.C. v New York Cent. Mut. Fire Ins. Co., 18 Misc 3d 87 [App Term, 1st Dept 2007]). We remand the matter to Civil Court for a determination of the amount of the claims for acupuncture services, since defendant has failed to establish such amount in its motion papers.

We sustain so much of the order under review as denied defendant’s motion for summary judgment dismissing plaintiff’s remaining no-fault claims, since the conflicting medical expert opinions adduced by the parties sufficed to raise a triable issue as to the medical necessity of the medical services underlying these claims.


THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.
I concur I concur I concur
Decision Date: June 12, 2015