December 22, 2017

Greater NY Med. Care, P.C. v Allstate Ins. Co. (2017 NY Slip Op 51849(U))

https://www.beynensonlaw.com/case-law/greater-ny-med-care-p-c-v-allstate-ins-co-2017-ny-slip-op-51849u/

Court: Appellate Term, Second Department
Decided: December 22, 2017
Citation: 2017 NY Slip Op 51849(U) · 58 Misc 3d 139(A)
Posture: Trial
Issues: Medical necessity Trial and evidence
Legal questions: Lack of medical necessity (see the maps)

Cite as

Greater NY Med. Care, P.C. v Allstate Ins. Co., 58 Misc 3d 139(A), 2017 NY Slip Op 51849(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2017)

Posture, outcome, issues and treatment by other decisions are Beynenson Law’s classification. Treatment labels are assigned by a language model reading the citing decision; negative and appeal-history labels are checked by a second reader.

Summary

Editorial summary by Beynenson Law, not part of the court’s decision.

The provider's trial judgment was reversed because it contradicted findings that the insurer proved lack of medical necessity without rebuttal. After a nonjury trial on assigned no-fault claims, the Civil Court found that credible expert testimony established the insurer's prima facie medical-necessity defense and that the provider had not rebutted it. Nevertheless, the Civil Court awarded judgment to the provider. The Appellate Term, Second Department, held that the contradiction between the findings and the award warranted a new trial, reversed the judgment and remitted the matter. It also treated the notice of appeal from the decision as a premature notice of appeal from the judgment under CPLR 5520 (c).

Reported in New York Official Reports at Greater NY Med. Care, P.C. v Allstate Ins. Co. (2017 NY Slip Op 51849(U))

[*1]

Greater NY Med. Care, P.C. v Allstate Ins. Co.

2017 NY Slip Op 51849(U) [58 Misc 3d 139(A)]

Decided on December 22, 2017

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This opinion is uncorrected and will not be published in the printed Official Reports.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 December 22, 2017
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, MARTIN M. SOLOMON, JJ
2014-2794 RI C

Greater NY Medical Care, P.C., as Assignee of Owoeye, Princess, Respondent,
against
Allstate Insurance Company, Appellant.

Law Offices of Peter C. Merani, P.C. (Eric M. Wahrburg, Esq.), for appellant. Lana Sukhman, Esq., for respondent (no brief filed).

Appeal from a judgment of the Civil Court of the City of New York, Richmond County (Mary Kim Dollard, J.), entered December 2, 2014. The judgment, after a nonjury trial, awarded plaintiff the principal sum of $3,119.44.

ORDERED that, on the court’s own motion, the notice of appeal from a decision of that court dated June 28, 2013 is deemed a premature notice of appeal from the judgment entered December 2, 2014 (see CPLR 5520 [c]); and it is further,

ORDERED that the judgment is reversed, with $30 costs, and the matter is remitted to the Civil Court for a new trial.

Following a nonjury trial in this action by a provider to recover assigned first-party no-fault benefits, the Civil Court determined that defendant had demonstrated, prima facie, through the presentation of credible expert witness testimony, that the medical services at issue had not been medically necessary and that plaintiff had not rebutted defendant’s case. Notwithstanding the foregoing, the Civil Court awarded judgment to plaintiff in the principal sum of $3,119.44. In light of the contradiction between the Civil Court’s findings and its award, a new trial is warranted.

Accordingly, the judgment is reversed and the matter is remitted to the Civil Court for a new trial.

PESCE, P.J., ALIOTTA and SOLOMON, JJ., concur.

ENTER:
Paul Kenny
Chief Clerk
Decision Date: December 22, 2017

Legal questions

A question of no-fault law this decision rules on, from our Legal Questions pages. Bars count the decisions on the question by year and court, coloured by category; circles are this decision and the decisions on the question it cites or that cite it. Point at a bar or circle for details. The categories and summaries are Beynenson Law’s classification, made by a language model and checked by a second reading.

Lack of medical necessity

Open the full map

Did the insurer’s proof establish lack of medical necessity, and did the provider’s evidence rebut it?

This decision: Trial ruling on burden or admissibility of the insurer's proof; matter sent back without a finding

Ordered a new trial because the trial court found the insurer's credible expert proved lack of medical necessity unrebutted yet awarded judgment to the provider, a contradiction requiring retrial.

Unrebutted, insurer prevailsProvider's rebuttal sufficientInsurer raised triable issueInsurer's proof insufficientTrial error, new trialThis decision

Of the 617 decisions on this question in the Second Department courts and the Court of Appeals, 32 (this one included) are in the same category.

Similar decisions

Ap Orthopedic & Rehabilitation, P.C. v Allstate Ins. Co. (2015 NY Slip Op 51656(U))The insurer failed at trial to prove lack of medical necessity, and the record supported the provider's recovery on the third cause of action.
Main St. Medcare, P.C. v GEICO Gen. Ins. Co. (2019 NY Slip Op 50686(U))The provider's directed verdict on medical necessity was reversed after the insurer's substitute expert was excluded as hearsay.
James J. Kim, L.A.C., P.C. v Allstate Ins. Co. (2023 NY Slip Op 50587(U))A provider bears the ultimate burden of proving medical necessity by a preponderance of the evidence at a no-fault trial.
All Is. Med. Care, P.C. v State Farm Mut. Auto. Ins. Co. (2011 NY Slip Op 52227(U))The insurer's doctor's testimony and peer review report established at trial that the services lacked medical necessity.
Gentlecare Ambulatory Anesthesia Servs. v Allstate Ins. Co. (2018 NY Slip Op 51607(U))The insurer failed to establish timely denial mailing, and the provider failed to establish prima facie entitlement to payment.