December 8, 2011

All Is. Med. Care, P.C. v State Farm Mut. Auto. Ins. Co. (2011 NY Slip Op 52227(U))

Headnote

The relevant facts the court considered were that a medical care provider was seeking to recover first-party no-fault benefits from an automobile insurance company. The only issue for trial was whether the services rendered to the plaintiff's assignor on December 23, 1999 were medically necessary. The court heard testimony from the defendant's doctor, who opined that the medical services provided were not medically necessary, and a peer review report concluded that there was a lack of medical necessity. The plaintiff did not call any witnesses in rebuttal. The main issue decided was whether the services rendered were medically necessary. The holding of the court was that the evidence provided by the defendant's doctor and the peer review report was sufficient to establish that the services rendered were not medically necessary, and therefore the judgment dismissing the complaint was affirmed.

Reported in New York Official Reports at All Is. Med. Care, P.C. v State Farm Mut. Auto. Ins. Co. (2011 NY Slip Op 52227(U))

All Is. Med. Care, P.C. v State Farm Mut. Auto. Ins. Co. (2011 NY Slip Op 52227(U)) [*1]

All Is. Med. Care, P.C. v State Farm Mut. Auto. Ins. Co.

2011 NY Slip Op 52227(U) [33 Misc 3d 142(A)]

Decided on December 8, 2011

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This opinion is uncorrected and will not be published in the printed Official Reports.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 December 8, 2011

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 9th and 10th JUDICIAL DISTRICTS

PRESENT: : MOLIA, J.P., TANENBAUM and LaCAVA, JJ
2010-1133 N C.

All Island Medical Care, P.C. as Assignee of PAULINA GONZALEZ, Appellant,
against
State Farm Mutual Automobile Insurance Company, Respondent.

Appeal from a decision of the District Court of Nassau County, First District (Michael A. Ciaffa, J.), dated January 29, 2009, deemed from a judgment of the same court entered April 19, 2010 (see CPLR 5520 [c]). The judgment, after a nonjury trial, 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, the parties stipulated that the only issue for trial would be whether the services rendered to plaintiff’s assignor on December 23, 1999 were medically necessary. After a nonjury trial, the District Court issued a decision awarding judgment in defendant’s favor. Plaintiff appeals from this decision. A judgment was subsequently entered, from which we deem the appeal to have been taken (see CPLR 5520 [c]).

At trial, defendant’s doctor testified that, in his opinion, the medical services provided by plaintiff were not medically necessary. His peer review report concluding that there was a lack of medical necessity was also entered into evidence. This evidence was sufficient to establish that the services rendered were not medically necessary. Plaintiff called no witnesses in rebuttal. [*2]In view of the foregoing, the judgment dismissing the complaint is affirmed (see Speciality Surgical Servs. v Travelers Ins. Co., 27 Misc 3d 134[A], 2010 NY Slip Op 50715[U] [App Term, 9th & 10th Jud Dists 2010]).

Molia, J.P., Tanenbaum and LaCava, JJ., concur.
Decision Date: December 08, 2011