November 26, 2013

ABA Chiropractic, P.C. v Geico Gen. Ins. Co. (2013 NY Slip Op 52002(U))

https://www.beynensonlaw.com/case-law/aba-chiropractic-p-c-v-geico-gen-ins-co-2013-ny-slip-op52002u/

Court: Appellate Term, Second Department
Decided: November 26, 2013
Citation: 2013 NY Slip Op 52002(U) · 41 Misc 3d 140(A)
Posture: Summary judgment
Outcome: Provider prevailed
Issues: Medical necessity Discovery and procedure
Legal questions: Lack of medical necessity (see the maps)

Cite as

ABA Chiropractic, P.C. v Geico Gen. Ins. Co., 41 Misc 3d 140(A), 2013 NY Slip Op 52002(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2013)

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 cross motion for summary judgment on medical necessity was denied on appeal because a triable issue remained. The Appellate Term, Second Department, reversed the order, insofar as appealed from, finding a factual issue concerning the medical necessity of the billed services under Zuckerman v City of New York. It declined the provider's request to limit the issues for trial under CPLR 3212 (g).

Reported in New York Official Reports at ABA Chiropractic, P.C. v Geico Gen. Ins. Co. (2013 NY Slip Op 52002(U))

[*1]

ABA Chiropractic, P.C. v Geico Gen. Ins. Co.

2013 NY Slip Op 52002(U) [41 Misc 3d 140(A)]

Decided on November 26, 2013

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This opinion is uncorrected and will not be published in the printed Official Reports.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 November 26, 2013

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ
2011-2505 K C.

ABA Chiropractic, P.C. as Assignee of YOLANDA RIVERA, Appellant, —
against
GEICO General Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Dawn Jimenez Salta, J.), entered August 10, 2011. The order, insofar as appealed from as limited by the brief, granted defendant’s cross motion for summary judgment dismissing the complaint.

ORDERED that the order, insofar as appealed from, is reversed, with $30 costs, and defendant’s cross motion for summary judgment dismissing the complaint is denied.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment and defendant cross-moved for summary judgment dismissing the complaint on the ground that the services at issue were not medically necessary. Plaintiff appeals, as limited by its brief, from so much of an order of the Civil Court as granted defendant’s cross motion for summary judgment dismissing the complaint.

Upon a review of the record, we find that there is a triable issue of fact regarding the medical necessity of the services at issue (see Zuckerman v City of New York, 49 NY2d 557 [1980]). Accordingly, the order, insofar as appealed from, is reversed and defendant’s motion for summary judgment dismissing the complaint is denied. We decline plaintiff’s request to limit the issues for trial (see CPLR 3212 [g]).

Pesce, P.J., Aliotta and Solomon, JJ., concur.
Decision Date: November 26, 2013

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: Provider's evidence rebutted the insurer's showing (triable issue, or necessity found at trial)

Reversed summary judgment for the insurer, holding on review of the record that a triable issue of fact existed regarding the medical necessity of the services.

Unrebutted, insurer prevailsProvider's rebuttal sufficientInsurer raised triable issueInsurer's proof insufficientTrial error, new trialThis decision

Of the 617 decisions on this question in the Second Department courts and the Court of Appeals, 94 (this one included) are in the same category.

Similar decisions

Atlantic Chiropractic, P.C. v Geico Ins. Co. (2017 NY Slip Op 51253(U))The provider's summary judgment was reversed because the insurer raised factual issues concerning timely denials and medical necessity.
Medical Assoc., P.C. v Geico Gen. Ins. Co. (2014 NY Slip Op 51829(U))The provider's summary judgment motion was denied on appeal because medical necessity presented a triable issue of fact.
Axis Chiropractic, PLLC v GEICO Gen. Ins. Co. (2012 NY Slip Op 51702(U))The insurer established timely denials and an unrebutted lack of medical necessity for the chiropractic services at issue.
American Chiropractic Care, P.C. v Praetorian Ins. Co. (2014 NY Slip Op 50346(U))The provider's treating chiropractor's sworn letter raised a factual issue on medical necessity despite the insurer's peer review.
New Life Med., P.C. v Geico Ins. Co. (2012 NY Slip Op 50346(U))The provider's practitioner's affidavit failed to meaningfully rebut the insurer's peer review conclusions that the services were medically unnecessary.