July 28, 2008

Mollins v Allstate Ins. Co. (2008 NY Slip Op 51616(U))

https://www.beynensonlaw.com/case-law/mollins-v-allstate-ins-co-2008-ny-slip-op-51616u/

Court: Appellate Term, First Department
Decided: July 28, 2008
Citation: 2008 NY Slip Op 51616(U) · 20 Misc 3d 141(A)
Posture: Summary judgment
Outcome: Provider prevailed
Issues: Medical necessity Provider's prima facie case
Legal questions: Lack of medical necessity · Claimant's prima facie case on motions (see the maps)

Cite as

Mollins v Allstate Ins. Co., 20 Misc 3d 141(A), 2008 NY Slip Op 51616(U) (App Term, 1st Dept 2008)

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 failed to raise a medical-necessity issue because it submitted neither the IME report underlying its denials nor other supporting proof. The provider established entitlement to partial summary judgment through proof that the prescribed billing forms were mailed and received and that benefits were overdue under Insurance Law § 5106 (a) and 11 NYCRR 65-3.8 (a) (1). The Appellate Term, First Department, reversed the order denying the provider's motion, granted partial summary judgment, and directed entry of judgment.

Reported in New York Official Reports at Mollins v Allstate Ins. Co. (2008 NY Slip Op 51616(U))

[*1]

Mollins v Allstate Ins. Co.

2008 NY Slip Op 51616(U) [20 Misc 3d 141(A)]

Decided on July 28, 2008

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This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on July 28, 2008

APPELLATE TERM OF THE SUPREME COURT, FIRST DEPARTMENT

PRESENT: McKEON, P.J., SCHOENFELD, HEITLER JJ
570716/07.

Jeff Mollins, DC, a/a/o Lashone Adams, Plaintiff-Appellant, – –
against
Allstate Insurance Company, Defendant-Respondent.

Plaintiff appeals from an order of the Civil Court of the City of New York, New York County (Manuel Mendez, J.), entered October 12, 2006, which, inter alia, denied its motion for partial summary judgment in the principal sum of $2,527.50.

Per Curiam.

Order (Manuel Mendez, J.), entered October 12, 2006, reversed, with $10 costs, and plaintiff’s motion for partial summary judgment in the principal sum of $2,527.50 granted. The Clerk is directed to enter judgment accordingly.

In this action to recover first party no-fault benefits, plaintiff made a prima facie showing of entitlement to partial judgment by submitting evidentiary proof that the prescribed statutory billing forms had been mailed and received, and that payment of no-fault benefits was overdue (see Insurance Law § 5106[a]; 11 NYCRR 65-3.8[a][1]; Mary Immaculate Hosp. v Allstate Ins. Co., 5 AD3d 742 [2004]; Fair Price Med. Supply, Inc. v St. Paul Travelers Inc. Co., 16 Misc 3d 8 [2007]). In opposition, defendant failed to raise a triable issue since it did not submit the IME report upon which its denials were based or any other evidentiary proof to support its defense of lack of medical necessity (see Vista Surgical Supplies, Inc. Travelers Ins. Co., 50 AD3d 778 [2008]; Response Med. Equip. v General Assur. Co., 13 Misc 3d 129[A], 2006 NY Slip Op 51765[U] [2006]).
THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.
I concurI concurI concur
Decision Date: July 28, 2008

Legal questions (2)

Questions 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

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

This decision: Insurer's medical-necessity proof failed (conclusory, no factual basis or rationale, inadmissible, not credited)

Held the insurer failed to raise a triable issue on lack of medical necessity because it did not submit the IME report on which its denials were based or any other evidentiary proof.

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 73 decisions on this question in the First Department courts and the Court of Appeals, 22 (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.

Claimant's prima facie case on motions

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On summary judgment or another pretrial motion, what must a no-fault claimant show to establish its prima facie case?

This decision: Claimant's proof held to make out its prima facie case (rules on the question, but another ground decided the case)

Held the provider made a prima facie showing by evidentiary proof that the statutory billing forms were mailed and received and that payment was overdue.

Proof sufficientMailing/receipt not shownOverdue not shownOther element missingThis decisionCites it or cited by itCited or followed

Of the 52 decisions on this question in the First Department courts and the Court of Appeals, 45 (this one included) are in the same category. 2 decisions in other departments that cite or are cited by this one are on the full map.

Cited in this decision

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

Mary Immaculate Hosp. v Allstate Ins. Co. (2004 NY Slip Op 02359)The hospitals established entitlement to summary judgment by proving that statutory billing forms were mailed and received and payment was overdue.
Fair Price Med. Supply, Inc. v St. Paul Travelers Ins. Co. (2007 NY Slip Op 27173)The insurer's verified interrogatory answers established receipt and partial payment of the claims and defeated its proof-of-billing objection.
Vista Surgical Supplies, Inc. v Travelers Ins. Co. (2008 NY Slip Op 03199) FollowedThe insurer's peer review reports were inadmissible because their facsimile signatures lacked evidence of placement or authorization.
Response Med. Equip. v General Assur. Co. (2006 NY Slip Op 51765(U)) FollowedA provider's attorney has no independent cause of action for statutory attorney's fees.

Cited by

NJ/NY Pain Mgt. v Allstate Ins. Co. (2014 NY Slip Op 51569(U))The insurer failed to raise a medical necessity issue because it submitted neither the IME report supporting its denial nor other evidence.

Similar decisions

Mollins v State Farm Gen. Ins. Co. (2009 NY Slip Op 50763(U))The insurer's unsworn chiropractor's report was inadmissible and failed to raise a triable issue of medical necessity.
Mollins v Motor Veh. Acc. Indem. Corp. (2007 NY Slip Op 50138(U))MVAIC's unsworn chiropractor's report was inadmissible and failed to raise a triable issue on medical necessity.
Midisland Med., PLLC v Allstate Ins. Co. (2008 NY Slip Op 51861(U))The provider obtained summary judgment on three claims because one peer review was insufficient and two denials lacked timely-mailing proof.
A.M. Med. Servs., P.C. v New York Cent. Mut. Ins. (2006 NY Slip Op 51662(U))The insurer proved mailing of one medical necessity denial but failed to prove verification mailing for four other claims.
NY Comprehensive Med., P.C. v Maryland Cas. Co. (2008 NY Slip Op 50521(U))The provider's summary judgment cross motion failed because conflicting medical affirmations raised a triable issue of medical necessity.