January 14, 2013

Axis Chiropractic, PLLC v Geico Gen. Ins. Co. (2013 NY Slip Op 50067(U))

Headnote

The relevant facts considered by the court were that plaintiff, as an assignee of an individual, was seeking to recover first-party no-fault benefits from defendant. Plaintiff's motion for summary judgment was denied and defendant's cross motion for summary judgment was granted, resulting in the dismissal of the complaint. The main issue decided by the court was whether defendant timely mailed denial of claim forms and whether there was a lack of medical necessity for the services rendered. The holding of the court was that defendant had timely mailed the denial of claim forms and had provided an affirmed independent medical examination report setting forth a basis and medical rationale for the determination of lack of medical necessity. In addition, the court held that plaintiff failed to raise a triable issue of fact by not submitting evidence rebutting the conclusions set forth in the independent medical examination report, and therefore the denial of plaintiff's motion for summary judgment and the granting of defendant's cross motion for summary judgment was proper.

Reported in New York Official Reports at Axis Chiropractic, PLLC v Geico Gen. Ins. Co. (2013 NY Slip Op 50067(U))

Axis Chiropractic, PLLC v Geico Gen. Ins. Co. (2013 NY Slip Op 50067(U)) [*1]

Axis Chiropractic, PLLC v Geico Gen. Ins. Co.

2013 NY Slip Op 50067(U) [38 Misc 3d 134(A)]

Decided on January 14, 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This opinion is uncorrected and will not be published in the printed Official Reports.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 January 14, 2013

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

PRESENT: : PESCE, P.J., WESTON and RIOS, JJ
2011-47 K C.

Axis Chiropractic, PLLC as Assignee of SHANTELLE IZQUIERDO, Appellant, —
against
Geico General Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Pamela L. Fisher, J.), entered February 25, 2010, deemed from a judgment of the same court entered December 7, 2010 (see CPLR 5501 [c]). The judgment, entered pursuant to the February 25, 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, with $25 costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court which denied plaintiff’s motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint. A judgment was subsequently entered, from which the appeal is deemed to have been taken (see CPLR 5501 [c]).

The affidavit submitted by defendant in support of its cross motion for summary judgment established that defendant had timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]) the denial of claim forms at issue, which denied the claims on the ground of lack of medical necessity. Moreover, defendant annexed to its motion papers an affirmed independent medical examination (IME) report which set forth a factual basis and medical rationale for the determination by defendant’s chiropractor that there was a lack of medical necessity for the services rendered (see e.g. Delta Diagnostic Radiology, P.C. v Integon Natl. Ins. Co., 24 Misc 3d 136[A], 2009 NY Slip Op 51502[U] [App Term, 2d, 11th & 13th Jud Dists 2009]; Delta Diagnostic Radiology, P.C. v American Tr. Ins. Co., 18 Misc 3d 128[A], 2007 NY Slip Op 52455[U] [App Term, 2d & 11th Jud Dists 2007]; A. Khodadadi Radiology, P.C. v NY Cent. Mut. Fire Ins. Co., 16 Misc 3d 131[A], 2007 NY Slip Op 51342[U] [App Term, 2d & 11th Jud Dists 2007]).

In opposition to defendant’s cross motion for summary judgment, plaintiff failed to raise a triable issue of fact, since it did not submit an affirmation or an affidavit from a medical professional rebutting the conclusions set forth in the IME report (see Innovative Chiropractic, P.C. v Mercury Ins. Co., 25 Misc 3d 137[A], 2009 NY Slip Op 52321[U] [App Term, 2d, 11th [*2]& 13th Jud Dists 2009]; Pan Chiropractic, P.C. v Mercury Ins. Co., 24 Misc 3d 136[A], 2009 NY Slip Op 51495[U] [App Term, 2d, 11th & 13th Jud Dists 2009]). Consequently, the Civil Court properly denied plaintiff’s motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint.

Accordingly, the judgment is affirmed.

Pesce, P.J., Weston and Rios, JJ., concur.
Decision Date: January 14, 2013