March 12, 2007

Support Billing & Mgt. Co. v Allstate Ins. Co. (2007 NY Slip Op 50496(U))

https://www.beynensonlaw.com/case-law/support-billing-mgt-co-v-allstate-ins-co-2007-ny-slip-op-50496u/

Court: Appellate Term, Second Department
Decided: March 12, 2007
Citation: 2007 NY Slip Op 50496(U) · 15 Misc 3d 126(A)
Posture: Summary judgment
Outcome: Provider prevailed
Later treatment: Contrasted (cf., but see) in 2 later decisions (see Cited by)
Issues: Medical necessity
Legal questions: Lack of medical necessity (see the maps)

Cite as

Support Billing & Mgt. Co. v Allstate Ins. Co., 15 Misc 3d 126(A), 2007 NY Slip Op 50496(U) (App Term, 2d Dept, 2d & 11th Jud Dists 2007)

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 peer review reports were inadmissible because it did not show that the reviewing doctor placed the stamped signatures on them. The Civil Court denied the provider's summary judgment motion based on a medical necessity issue raised by two peer review reports. The provider challenged their stamped facsimile signatures both below and on appeal. Under CPLR 2106, the reports did not constitute admissible proof absent evidence that the doctor affixed those signatures. The Appellate Term, Second Department, reversed and granted the provider summary judgment on both claims because the insurer supplied no proof of a meritorious defense. The matter was remanded for statutory interest and attorney fees under Insurance Law § 5106 and its implementing regulations.

Reported in New York Official Reports at Support Billing & Mgt. Co. v Allstate Ins. Co. (2007 NY Slip Op 50496(U))

[*1]

Support Billing & Mgt. Co. v Allstate Ins. Co.

2007 NY Slip Op 50496(U) [15 Misc 3d 126(A)]

Decided on March 12, 2007

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This opinion is uncorrected and will not be published in the printed Official Reports.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 March 12, 2007

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 2nd and 11th JUDICIAL DISTRICTS

PRESENT:: PESCE, P.J., RIOS and BELEN, JJ
2005-1967 K C.

Support Billing & Management Co. a/a/o Michael Santiago, Appellant,
against
Allstate Insurance Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Kathy J. King, J.), entered October 4, 2005. The order denied plaintiff’s motion for summary judgment.

Order reversed without costs, plaintiff’s motion for summary judgment granted and matter remanded to the court below for a calculation of statutory interest and an assessment of attorney’s fees.

In this action to recover assigned first-party no-fault benefits, the court below denied plaintiff’s motion for summary judgment on the ground that there was an issue of fact as to medical necessity based upon two peer review reports. In the court below and on appeal, plaintiff argues, inter alia, that the peer review reports annexed to
defendant’s opposition papers were insufficient to establish an issue of fact because the peer review reports, purportedly executed in accordance with CPLR 2106, bore stamped facsimile signatures of the doctor who performed the peer reviews. We find that the peer review reports were not in admissible form since they only contained a stamped facsimile of the doctor’s signature which defendant failed to establish was placed thereon by the doctor (see CPLR 2106; Dowling v Mosey, 32 AD3d 1190 [2006]; Vista Surgical Supplies, Inc. v Travelers Ins. Co., 14 Misc 3d 128[A], 2006 NY Slip Op 52502[U] [App Term, 2d & 11th Jud Dists]; Sandymark Realty Corp. v Creswell, 67 Misc 2d 630, 632 [1971]; cf. General Construction Law § 46). In the absence of proof by defendant of a meritorious defense, plaintiff is entitled to summary judgment on both of its claims. Accordingly, the matter is remanded to the court below for a calculation of statutory interest and assessment of attorney’s fees pursuant to Insurance Law § 5106 and the regulations promulgated thereunder.

Pesce, P.J., Rios and Belen, JJ., concur. [*2]
Decision Date: March 12, 2007

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 medical-necessity proof failed (conclusory, no factual basis or rationale, inadmissible, not credited)

Held the insurer's peer review reports inadmissible because they bore only stamped facsimile signatures not shown to have been placed by the doctor, so no triable issue on medical necessity was raised and the provider won summary judgment.

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

Of the 617 decisions on this question in the Second Department courts and the Court of Appeals, 109 (this one included) are in the same category.

Cited in this decision

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

Vista Surgical Supplies, Inc. v Travelers Ins. Co. (2006 NY Slip Op 52502(U)) FollowedThe insurer's peer reviews bearing stamped facsimile signatures were inadmissible under CPLR 2106 on the record presented.

Cited by

A label shows how the later decision treated this one.

Velen Med. Supply, Inc. v GEICO Ins. Co. (2009 NY Slip Op 50735(U)) Contrasted (cf., but see)The insurer's affirmed peer review raised a medical-necessity issue, and the provider waived its objection to the stamped signature.
Alur Med. Supply, Inc. v GEICO Ins. Co. (2008 NY Slip Op 51867(U)) Contrasted (cf., but see)The insurer's unrebutted peer review established lack of medical necessity for two claims, but it failed to prove another charge excessive.
Complete Orthopedic Supplies, Inc. v State Farm Ins. Co. (2007 NY Slip Op 27192)A fee schedule dispute remained triable because the insurer established neither a proper scheduled fee nor a comparable fee for the goods.

Similar decisions

V.S. Med. Servs., P.C. v Allstate Ins. Co. (2007 NY Slip Op 50400(U))The provider failed to prove claim submission because its corporate officer's affidavit lacked a sufficient business-records foundation.
Westchester Neurodiagnostic, P.C. v Allstate Ins. Co. (2009 NY Slip Op 51385(U))The insurer failed to establish that its medical necessity defense was preserved by timely mailing of the denial.
Med-Tech Prods., Inc. v Statewide Ins. Co. (2012 NY Slip Op 50584(U))The provider's challenge to allegedly stamped signatures on peer reviews required a hearing to determine the reports' admissibility.
Careplus Med. Supply, Inc. v Allstate Ins. Co. (2009 NY Slip Op 51398(U))The provider failed to establish a prima facie case because its billing manager's affidavit did not authenticate the supporting records.
Amaze Med. Supply Inc. v Allstate Ins. Co. (2004 NY Slip Op 50833(U))The insurer failed to defeat partial summary judgment with an inadmissible chiropractor's peer review and late medical-necessity denials.