July 9, 2009
Delta Diagnostic Radiology, P.C. v Integon Natl. Ins. Co. (2009 NY Slip Op 51502(U))
Headnote
The insurer's examining physician supplied an unrebutted factual basis and medical rationale that the billed MRI was unnecessary. The Appellate Term, Second Department, affirmed the order, insofar as appealed from, granting the insurer summary judgment dismissing the assigned-benefits complaint upon reargument. The insurer's claims-representative affidavit established timely mailing of the denial through its standard office practice and procedure, contrary to the provider's challenge. The examining physician's affirmed report adequately supported the medical-necessity defense, and the provider failed to rebut it. The appeal was limited to the grant of summary judgment.
Reported in New York Official Reports at Delta Diagnostic Radiology, P.C. v Integon Natl. Ins. Co. (2009 NY Slip Op 51502(U))
[*1]
Decided on July 9, 2009
PRESENT: : PESCE, P.J., GOLIA and RIOS, JJ
2008-1304 K C.
| Delta Diagnostic Radiology, P.C. v Integon Natl. Ins. Co. |
| 2009 NY Slip Op 51502(U) [24 Misc 3d 136(A)] |
| Decided on July 9, 2009 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports. |
SUPREME COURT OF THE STATE OF NEW YORK
APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., GOLIA and RIOS, JJ
2008-1304 K C.
Delta Diagnostic Radiology, P.C. a/a/o
JOSEPH GISCARD, Appellant,
against
Integon National Insurance Co., Respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (George J. Silver, J.), entered February 7, 2008. The order, insofar as appealed from as limited by the brief, upon granting the branch of defendant’s motion seeking leave to reargue, granted the branch of defendant’s motion seeking summary judgment dismissing the complaint.
Order, insofar as appealed from, affirmed without costs.
In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint on the ground of lack of medical necessity. Plaintiff cross-moved for summary judgment and argued in opposition to defendant’s motion that defendant had failed to come forward with proof that the performed MRI was not medically necessary. The Civil Court denied defendant’s motion and plaintiff’s cross motion. By order entered February 7, 2008, the Civil Court granted defendant’s motion seeking leave to reargue and, upon reargument, summary judgment. As limited by the brief, plaintiff appeals from so much of the February 7, 2008 order as granted the branch of defendant’s motion seeking summary judgment.
Contrary to plaintiff’s contention, the affidavit submitted by defendant’s claims representative sufficiently established that the denial of claim form at issue was timely mailed pursuant to defendant’s standard office practice and procedure (see Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [2001]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]). As the affirmed report by [*2]defendant’s examining physician provided a factual basis and medical rationale for his opinion that the billed-for MRI was not medically necessary (see Delta Diagnostic Radiology, P.C. v Progressive Cas. Ins. Co., 21 Misc 3d 142[A], 2008 NY Slip Op 52450[U] [App Term, 2d & 11th Jud Dists 2008]; Crossbridge Diagnostic Radiology, P.C. v Progressive Ins. Co., 20 Misc 3d 143[A], 2008 NY Slip Op 51761[U] [App Term, 2d & 11th Jud Dists 2008]), and plaintiff failed to rebut such proof, the Civil Court properly granted defendant summary judgment. Accordingly, the order, insofar as appealed from, is affirmed.
Pesce, P.J., Golia and Rios, JJ., concur.
Decision Date: July 09, 2009
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