May 15, 2012

Alfa Med. Supplies v GEICO Gen. Ins. Co. (2012 NY Slip Op 50934(U))

https://www.beynensonlaw.com/case-law/alfa-med-supplies-v-geico-gen-ins-co-2012-ny-slip-op-50934u/

Court: Appellate Term, Second Department
Decided: May 15, 2012
Citation: 2012 NY Slip Op 50934(U) · 35 Misc 3d 142(A)
Posture: Summary judgment
Outcome: Insurer prevailed
Issues: Medical necessity
Legal questions: Lack of medical necessity (see the maps)

Cite as

Alfa Med. Supplies v GEICO Gen. Ins. Co., 35 Misc 3d 142(A), 2012 NY Slip Op 50934(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2012)

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.

An insurer need not attach the medical records reviewed by its peer reviewer to its summary judgment motion. The Appellate Term, Second Department, affirmed the judgment dismissing the provider's assigned no-fault claims after denial of the provider's motion and grant of the insurer's cross motion. The Civil Court had found timely denials based on lack of medical necessity and no rebuttal of the insurer's evidence. The appellate court rejected the provider's objection to the absence of underlying medical records. It also rejected the challenge to the report's electronically stamped facsimile signature because the record showed that the chiropractor who performed the review had permissibly placed the signature on the report.

Reported in New York Official Reports at Alfa Med. Supplies v GEICO Gen. Ins. Co. (2012 NY Slip Op 50934(U))

[*1]

Alfa Med. Supplies v GEICO Gen. Ins. Co.

2012 NY Slip Op 50934(U) [35 Misc 3d 142(A)]

Decided on May 15, 2012

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This opinion is uncorrected and will not be published in the printed Official Reports.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 May 15, 2012

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

PRESENT: : PESCE, P.J., RIOS and ALIOTTA, JJ
2011-58 K C.

Alfa Medical Supplies as Assignee of ANTONIO SANTOS, Appellant, —
against
GEICO General Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Margaret A. Pui Yee Chan, J.), entered June 15, 2010, deemed from a judgment of the same court entered November 3, 2010 (see CPLR 5501 [c]). The judgment, entered pursuant to the June 15, 2010 order denying plaintiff’s motion for summary judgment and granting defendant’s cross motion for summary judgment, dismissed the complaint.

ORDERED that the judgment is affirmed, without costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order denying its motion for summary judgment and granting defendant’s cross motion for summary judgment dismissing the complaint. The Civil Court found that defendant had established that it had timely denied the claims in question on the ground that the supplies at issue were not medically necessary, and that plaintiff had failed to rebut defendant’s evidence. A judgment was subsequently entered, from which the appeal is deemed to have been taken (see CPLR 5501 [c]).

Contrary to plaintiff’s argument on appeal, defendant was not required to annex to its motion papers copies of the medical records which had been reviewed by defendant’s peer [*2]reviewer (see Elmont Open MRI & Diagnostic Radiology, P.C. v New York Cent. Mut. Fire Ins. Co., 30 Misc 3d 126[A], 2010 NY Slip Op 52222[U] [App Term, 9th & 10th Jud Dists 2010]; Urban Radiology, P.C. v Tri-State Consumer Ins. Co., 27 Misc 3d 140[A], 2010 NY Slip Op 50987[U] [App Term, 2d, 11th & 13th Jud Dists 2010]). Furthermore, while plaintiff argues that the peer review report contained an electronic stamped facsimile of the peer reviewer’s signature and, as a result, the report was inadmissible, the record indicates that the facsimile signature was permissibly placed on the report by the chiropractor who had performed the peer review (see Quality Health Prods. v Geico Gen. Ins. Co., 34 Misc 3d 129[A], 2011 NY Slip Op 52299[U] [App Term, 2d, 11th & 13th Jud Dists 2011]; Eden Med., P.C. v Eveready Ins. Co., 26 Misc 3d 140[A], 2010 NY Slip Op 50265[U] [App Term, 2d, 11th & 13th Jud Dists 2010]).

As plaintiff’s remaining contentions on appeal are similarly without merit, the judgment is affirmed.

Pesce, P.J., Rios and Aliotta, JJ., concur.
Decision Date: May 15, 2012

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 proof established lack of medical necessity and the provider failed to rebut it

Affirmed dismissal on the unrebutted peer review, holding the reviewed records need not be annexed and the facsimile signature was admissible because the reviewing chiropractor placed it on the report.

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

Cited in this decision

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

Elmont Open MRI & Diagnostic Radiology, P.C. v New York Cent. Mut. Fire Ins. Co. (2010 NY Slip Op 52222(U)) FollowedA peer reviewer may assume the truth of treatment records to assess medical necessity without using those records for a hearsay purpose.
Urban Radiology, P.C. v Tri-State Consumer Ins. Co. (2010 NY Slip Op 50987(U)) FollowedThe insurer established premature claims for unanswered verification and lack of medical necessity for the remaining claims.
Quality Health Prods. v Geico Gen. Ins. Co. (2011 NY Slip Op 52299(U)) FollowedThe insurer's peer review was admissible because its facsimile signature was placed by the reviewing doctor or at the doctor's direction.
Eden Med., P.C. v Eveready Ins. Co. (2010 NY Slip Op 50265(U)) FollowedThe provider's unsupported assertion that a peer review report bore a stamped facsimile signature raised no factual issue.

Similar decisions

Alfa Med. Supplies v Progressive Northeastern Ins. Co. (2010 NY Slip Op 51733(U))The insurer established full payment of one claim and an unrebutted medical necessity defense to the remaining claim.
Alfa Medical Supplies, Inc.. v Auto One Ins. Co. (2011 NY Slip Op 51851(U))A peer review report is not inadmissible merely because the reviewer considered medical records from other providers.
Alur Med. Supply, Inc. v GEICO Ins. Co. (2008 NY Slip Op 51867(U))The insurer's unrebutted peer review established lack of medical necessity for two claims, but it failed to prove another charge excessive.
Alfa Med. Supplies, Inc. v GEICO Gen. Ins. Co. (2010 NY Slip Op 51332(U))The insurer's unrebutted peer reviews defeated the provider's summary judgment motion on the three medical-supply claims under review.
Queens Med. Supply, Inc. v Geico Gen. Ins. Co. (2011 NY Slip Op 52284(U))The peer review report was admissible because its facsimile signature was placed by the reviewing doctor or at the doctor's direction.