December 8, 2011

All Is. Med. Care, P.C. v State Farm Mut. Auto. Ins. Co. (2011 NY Slip Op 52227(U))

https://www.beynensonlaw.com/case-law/all-is-med-care-p-c-v-state-farm-mut-auto-ins-co-2011-ny-slip-op52227u/

Court: Appellate Term, Second Department
Decided: December 8, 2011
Citation: 2011 NY Slip Op 52227(U) · 33 Misc 3d 142(A)
Posture: Trial
Outcome: Insurer prevailed
Later treatment: Followed in 1 later decision (see Cited by)
Issues: Medical necessity Trial and evidence
Legal questions: Lack of medical necessity (see the maps)

Cite as

All Is. Med. Care, P.C. v State Farm Mut. Auto. Ins. Co., 33 Misc 3d 142(A), 2011 NY Slip Op 52227(U) (App Term, 2d Dept, 9th & 10th Jud Dists 2011)

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 insurer's doctor's testimony and peer review report established at trial that the services lacked medical necessity. In the provider's action for assigned no-fault benefits, the parties stipulated that medical necessity was the sole trial issue. At the nonjury trial, the insurer's doctor testified that the services were unnecessary, and the corresponding peer review report was admitted into evidence. The provider called no rebuttal witnesses. The Appellate Term, Second Department, found the insurer's proof sufficient and affirmed the judgment dismissing the complaint.

Reported in New York Official Reports at All Is. Med. Care, P.C. v State Farm Mut. Auto. Ins. Co. (2011 NY Slip Op 52227(U))

[*1]

All Is. Med. Care, P.C. v State Farm Mut. Auto. Ins. Co.

2011 NY Slip Op 52227(U) [33 Misc 3d 142(A)]

Decided on December 8, 2011

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This opinion is uncorrected and will not be published in the printed Official Reports.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 8, 2011

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 9th and 10th JUDICIAL DISTRICTS

PRESENT: : MOLIA, J.P., TANENBAUM and LaCAVA, JJ
2010-1133 N C.

All Island Medical Care, P.C. as Assignee of PAULINA GONZALEZ, Appellant,
against
State Farm Mutual Automobile Insurance Company, Respondent.

Appeal from a decision of the District Court of Nassau County, First District (Michael A. Ciaffa, J.), dated January 29, 2009, deemed from a judgment of the same court entered April 19, 2010 (see CPLR 5520 [c]). The judgment, after a nonjury trial, dismissed the complaint.

ORDERED that the judgment is affirmed, without costs.

In this action by a provider to recover assigned first-party no-fault benefits, the parties stipulated that the only issue for trial would be whether the services rendered to plaintiff’s assignor on December 23, 1999 were medically necessary. After a nonjury trial, the District Court issued a decision awarding judgment in defendant’s favor. Plaintiff appeals from this decision. A judgment was subsequently entered, from which we deem the appeal to have been taken (see CPLR 5520 [c]).

At trial, defendant’s doctor testified that, in his opinion, the medical services provided by plaintiff were not medically necessary. His peer review report concluding that there was a lack of medical necessity was also entered into evidence. This evidence was sufficient to establish that the services rendered were not medically necessary. Plaintiff called no witnesses in rebuttal. [*2]In view of the foregoing, the judgment dismissing the complaint is affirmed (see Speciality Surgical Servs. v Travelers Ins. Co., 27 Misc 3d 134[A], 2010 NY Slip Op 50715[U] [App Term, 9th & 10th Jud Dists 2010]).

Molia, J.P., Tanenbaum and LaCava, JJ., concur.
Decision Date: December 08, 2011

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: Insurer's proof established lack of medical necessity and the provider failed to rebut it

Held the insurer's doctor's trial testimony and admitted peer review report established lack of medical necessity, and the provider called no rebuttal witnesses, so dismissal of the complaint was affirmed.

Unrebutted, insurer prevailsProvider's rebuttal sufficientInsurer raised triable issueInsurer's proof insufficientTrial error, new trialThis decisionCites it or cited by itCited or followed

Of the 617 decisions on this question in the Second Department courts and the Court of Appeals, 315 (this one included) are in the same category. One decision in other departments that cites or is cited by this one is on the full map.

Cited in this decision

A label shows how this decision treated the case it cites.

Speciality Surgical Servs. v Travelers Ins. Co. (2010 NY Slip Op 50715(U)) FollowedThe insurer's unrebutted medical testimony and affirmed peer review report established that the services were not medically necessary.

Cited by

A label shows how the later decision treated this one.

Cappello v Global Liberty Ins. Co. of N.Y. (2017 NY Slip Op 51415(U)) FollowedThe insurer's unrebutted peer review testimony established that electromyography and nerve conduction testing lacked medical necessity.

Similar decisions

New York Diagnostic Med. Care, P.C. v GEICO Gen. Ins. Co. (2013 NY Slip Op 50419(U))The provider's doctor's affidavit raised a factual issue on medical necessity, defeating the insurer's cross motion for summary judgment.
All Mental Care Medicine, P.C. v State Farm Mut. Ins. Co. (2009 NY Slip Op 50042(U))The provider's trial dismissal for failure to establish a prima facie case was affirmed.
Greater NY Med. Care, P.C. v Allstate Ins. Co. (2017 NY Slip Op 51849(U))The provider's trial judgment was reversed because it contradicted findings that the insurer proved lack of medical necessity without rebuttal.
Metropolitan Diagnostic Med. Care, P.C. v New York Cent. Mut. Fire Ins. Co. (2015 NY Slip Op 50383(U))The provider's physician affirmation raised a triable issue as to whether the services were medically necessary.
All Borough Group Med. Supply, Inc. v Unitrin Advantage Ins. Co. (2014 NY Slip Op 50462(U))Peer review reports are inadmissible to prove lack of medical necessity at trial, but their admission did not require reversal here.