December 13, 2013
Pomona Med. Diagnostics, P.C. v Praetorian Ins. Co. (2013 NY Slip Op 52131(U))
https://www.beynensonlaw.com/case-law/pomona-med-diagnostics-p-c-v-praetorian-ins-co-2013-ny-slip-op52131u/
- Decided
- December 13, 2013
- Citation
- 2013 NY Slip Op 52131(U) · 42 Misc 3d 126(A)
- Posture
- Summary judgment
- Outcome
- Provider prevailed
- Issues
- Medical necessity
- Legal questions
- Lack of medical necessity (see the maps)
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.
Reported in New York Official Reports at Pomona Med. Diagnostics, P.C. v Praetorian Ins. Co. (2013 NY Slip Op 52131(U))
| Pomona Med. Diagnostics, P.C. v Praetorian Ins. Co. |
| 2013 NY Slip Op 52131(U) [42 Misc 3d 126(A)] |
| Decided on December 13, 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| This opinion is uncorrected and will not be published in the printed Official Reports. |
SUPREME COURT, APPELLATE TERM, FIRST DEPARTMENT
PRESENT: Lowe, III, P.J., Hunter, Jr., Torres, JJ
570567/13.
against
Praetorian Insurance Company, Defendant-Appellant.
Defendant, as limited by its brief, appeals from so much of an order of the Civil Court of the City of New York, Bronx County (Donald A. Miles, J.), entered on or about July 19, 2012, as denied its motion for summary judgment dismissing the complaint.
Per Curiam.
Order (Donald A. Miles, J.), entered July 19, 2012, affirmed, with $10 costs.
We agree that the conflicting medical expert opinions adduced by the parties sufficed to raise a triable issue as to the medical necessity of the diagnostic tests underlying plaintiff’s first-party no-fault claim.
THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.
Decision Date: December 13, 2013
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.
Did the insurer’s proof establish lack of medical necessity, and did the provider’s evidence rebut it?
This decision: Provider's evidence rebutted the insurer's showing (triable issue, or necessity found at trial)
Affirmed denial of the insurer's summary judgment motion because the parties' conflicting medical expert opinions raised a triable issue as to the medical necessity of the diagnostic tests.
Of the 73 decisions on this question in the First Department courts and the Court of Appeals, 10 (this one included) are in the same category.
Similar decisions
- Pomona Med. Diagnostic P.C. v Praetorian Ins. Co. (2013 NY Slip Op 51798(U))The provider failed to establish mailing of its verification response, leaving its no-fault claim premature.
- Pomona Med. Diagnostics, P.C. v GEICO Ins. Co. (2010 NY Slip Op 52059(U))The insurer's peer reviews established lack of medical necessity, and the claimed rebuttal letter was absent from the record.
- Pomona Med. Diagnostics, P.C. v Travelers Ins. Co. (2011 NY Slip Op 50447(U))The provider's action was premature because it had not answered timely mailed verification requests before commencing suit.
- Pomona Med. Diagnostic P.C. v Adirondack Ins. Co. (2012 NY Slip Op 51165(U))An insurer cannot deny a no-fault claim on the ground that another carrier is primarily liable.
- Pomona Med. Diagnostics, P.C. v Motor Veh. Acc. Indem. Corp. (2012 NY Slip Op 51684(U))MVAIC failed to establish existing insurance coverage through conflicting statements in the assignor's notice of intention to file a claim.