April 29, 2005

A.B. Med. Servs. PLLC v GEICO Cas. Ins. Co. (2005 NYSlipOp 50650(U))

https://www.beynensonlaw.com/case-law/a-b-med-servs-pllc-v-geico-cas-ins-co-2005-nyslipop-50650u/

Court: Appellate Term, Second Department
Decided: April 29, 2005
Citation: 2005 NY Slip Op 50650(U)
Posture: Summary judgment
Outcome: Provider prevailed
Later treatment: Followed in 1 later decision (see Cited by)
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

A.B. Med. Servs. PLLC v GEICO Cas. Ins. Co., 2005 NY Slip Op 50650(U) (App Term, 2d Dept, 2d & 11th Jud Dists 2005)

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 medical services provider's summary judgment motion was granted because the insurer supplied no admissible medical necessity opposition. The Appellate Term, Second Department, reversed the appealed denial, remanded for interest and attorney fees under Insurance Law § 5106 (a), and dismissed the acupuncture and transportation providers' appeals because they raised no issue. It reached no other issue.

Reported in New York Official Reports at A.B. Med. Servs. PLLC v GEICO Cas. Ins. Co. (2005 NYSlipOp 50650(U))

[*1]

A.B. Med. Servs. PLLC v GEICO Cas. Ins. Co.

2005 NYSlipOp 50650(U)

Decided on April 29, 2005

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This opinion is uncorrected and will not be published in the printed Official Reports.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 April 29, 2005

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 2nd and 11th JUDICIAL DISTRICTS

PRESENT: PESCE, P.J., RIOS and BELEN, JJ.
2004-914 K C

A.B. Medical Services PLLC SOMUN ACUPUNCTURE P.C. SQUARE SYNAGOGUE TRANSPORTATION INC. a/a/o MOTHELIEN BAPTISTE, Appellants,
against
GEICO Casualty Insurance Co., Respondent.

Appeal by plaintiffs, as limited by their brief, from so much of an order of the Civil Court, Kings County (R. Garson, J.), entered on May 20, 2004, as denied the motion by plaintiff A.B. Medical Services PLLC for summary judgment.

Order insofar as appealed from unanimously reversed without costs, motion for summary judgment granted in favor of A.B. Medical Services PLLC in the principal sum of $3,971.20 and matter remanded to the court below for a calculation of statutory interest and an assessment of attorney’s fees.

Appeal as taken by plaintiffs Somun Acupuncture P.C., and Square Synagogue Transportation Inc. unanimously dismissed. [*2]

In this action to recover assigned first-party no-fault benefits, plaintiff A.B. Medical Services PLLC established a prima facie entitlement to summary judgment by proof that it submitted completed claim forms setting forth the fact and the amount of the loss sustained, and that payment of no-fault benefits was overdue (see Insurance Law § 5106 [a]; Mary Immaculate Hosp. v Allstate Ins. Co., 5 AD3d 742 [2004]; Amaze Med. Supply v Eagle Ins. Co., 2 Misc 3d 128[A], 2003 NY Slip Op 51701[U] [App Term, 2d & 11th Jud Dists]). Defendant failed to provide proof in admissible form to raise a triable issue of fact as to its defense of lack of medical necessity of the services rendered (A.B. Med. Servs. PLLC v NewYork Cent. Mut. Fire Ins. Co., 3 Misc 3d 136[A], 2004 NY Slip Op 50507[U] [App Term, 2d & 11th Jud Dists]). Accordingly, the motion by A.B. Medical Servs. PLLC should have been granted in the sum of $3,971.20 and [*3]
the matter is remanded to the court below for a calculation of statutory interest and an assessment of attorney’s fees.

Inasmuch as no issue is raised by the remaining appellants, the appeal with respect to them is dismissed (Praeger v Praeger,162 AD2d 671 [1990]).

We reach no other issue.
Decision Date: April 29, 2005

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 offer proof in admissible form raising a triable issue on its lack-of-medical-necessity defense, so the provider's motion should have been granted.

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, 109 (this one included) are in the same category.

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 established a prima facie case by proof that it submitted completed claim forms and that payment was overdue.

Proof sufficientMailing/receipt not shownOverdue not shownBusiness-record foundation lackingOther element missingThis decisionCites it or cited by itCited or followed

Of the 1,065 decisions on this question in the Second Department courts and the Court of Appeals, 513 (this one included) are in the same category.

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) FollowedThe hospitals established entitlement to summary judgment by proving that statutory billing forms were mailed and received and payment was overdue.
Amaze Med. Supply v Eagle Ins. Co. (2003 NY Slip Op 51701(U)) FollowedA provider's completed claim forms establish its prima facie case without additional medical proof when the insurer is precluded.
A.B. Med. Servs. v N. Y. Cent. Mut. Fire Ins. Co. (2004 NY Slip Op 50507(U)) FollowedAn insurer opposing summary judgment on medical necessity must submit admissible proof even if unaffirmed reports supported a timely denial.

Cited by

A label shows how the later decision treated this one.

West Tremont Med. Diagnostic, P.C. v Geico Ins. Co. (2006 NY Slip Op 51871(U)) FollowedA diagnostic provider performing prescribed MRIs remains subject to a lack-of-medical-necessity defense.

Similar decisions

A.B. Med. Servs. PLLC v American Tr. Ins. Co. (2005 NY Slip Op 51893(U))The insurer waived defenses based on incomplete assignments by failing to object within 10 days of receipt.
A.B. Med. Servs. PLLC v Liberty Mut. Ins. Co. (2005 NYSlipOp 50453(U))An unsworn peer review report did not raise a triable issue against the acupuncture provider's prima facie showing.
A.B. Med. Servs. PLLC v State Farm Mut. Auto. Ins. Co. (2005 NYSlipOp 50432(U))The providers failed to establish prima facie entitlement to partial summary judgment because they omitted the necessary claim forms.
A.B. Med. Servs. PLLC v Allstate Ins. Co. (2005 NYSlipOp 51270(U))The insurer failed to prove timely mailing of its denials, entitling the providers to partial summary judgment on the claims they moved upon.
A.B. Med. Servs. v GEICO Ins. (2003 NY Slip Op 23949)A provider need not prove medical necessity at the claim stage or on a subsequent motion for summary judgment.