December 31, 2014

Cortland Med. Supply, Inc. v 21st Century Centennial Ins. Co. (2014 NY Slip Op 51886(U))

https://www.beynensonlaw.com/case-law/cortland-med-supply-inc-v-21st-century-centennial-ins-co-2014-ny-slipop-51886u/

Court: Appellate Term, First Department
Decided: December 31, 2014
Citation: 2014 NY Slip Op 51886(U) · 46 Misc 3d 136(A)
Posture: Summary judgment
Outcome: Insurer prevailed
Later treatment: Contrasted (cf., but see) in 1 and followed in 1 later decisions (see Cited by)
Issues: Medical necessity
Legal questions: Lack of medical necessity · Proof of mailing (see the maps)

Cite as

Cortland Med. Supply, Inc. v 21st Century Centennial Ins. Co., 46 Misc 3d 136(A), 2014 NY Slip Op 51886(U) (App Term, 1st Dept 2014)

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 peer review established lack of medical necessity, and the provider's attorney affirmation raised no triable issue. The Appellate Term, First Department, affirmed summary judgment dismissing the provider's claim for medical supplies. Affidavits from mailing-center and claims-administrator employees describing office mailing procedures, together with a mailing certificate, established timely and proper denial. The orthopedic peer review supplied a sufficient factual basis and medical rationale for nonnecessity. The provider offered no medical evidence or other competent proof in opposition. Its remaining contentions were unpreserved or without merit.

Reported in New York Official Reports at Cortland Med. Supply, Inc. v 21st Century Centennial Ins. Co. (2014 NY Slip Op 51886(U))

[*1]

Cortland Med. Supply, Inc. v 21st Century Centennial Ins. Co.

2014 NY Slip Op 51886(U) [46 Misc 3d 136(A)]

Decided on December 31, 2014

Appellate Term, First 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This opinion is uncorrected and will not be published in the printed Official Reports.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 31, 2014

SUPREME COURT, APPELLATE TERM, FIRST DEPARTMENT
PRESENT: Lowe, III, P.J., Schoenfeld, Hunter, Jr., JJ.
570781/14

Cortland Med. Supply, Inc., a/a/o Cristian Yax Garcia Plaintiff-Appellant,
against
21st Century Centennial Ins. Co. Defendant-Respondent.

Plaintiff appeals from an order of the Civil Court of the City of New York, New York County (Jennifer G. Schecter, J.), entered September 18, 2013, which granted defendant’s motion for summary judgment dismissing the complaint.

Per Curiam.

Order (Jennifer G. Schecter, J.), entered September 18, 2013, affirmed with $10 costs.

The defendant-insurer made a prima facie showing of entitlement to judgment as a matter of law by demonstrating that it timely and properly denied plaintiff’s claim for no-fault first-party benefits, through the affidavits of employees of its mailing center and of the entity which administers its no-fault claims, detailing their respective office mailing procedures, accompanied by a certificate of mailing (see Nassau Ins. Co. v Murray, 46 NY2d 828, 829 [1978]; Badio v Liberty Mut. Fire Ins. Co., 12 AD3d 229,330 [2004]), and the peer review report of its orthopedic doctor, which set forth a sufficient factual basis and medical rationale for her stated conclusion that the medical supplies provided by plaintiff to its assignor were not medically necessary (see Triangle R. Inc. v New York Cent. Mut. Fire Ins. Co., 32 Misc 3d 143[A], 2011 NY Slip Op 51663[U] [App Term, 1st Dept 2011]). Plaintiff’s opposition, consisting of an attorney’s affirmation unaccompanied by any medical evidence or other competent proof, was insufficient to raise a triable issue as to medical necessity (see Munoz v Hollingsworth, 18 AD3d 278, 279 [2005]; CPT Med. Servs., P.C. v NY Cent. Mut. Fire Ins. Co., 18 Misc 3d 87 [2007]).

Plaintiff’s remaining contentions are either unpreserved for appellate review or without merit.

THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.

I concur I concur I concur
Decision Date: December 31, 2014

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

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 summary judgment for the insurer because the peer review set forth a factual basis and medical rationale and the provider offered only an attorney's affirmation without medical evidence.

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 73 decisions on this question in the First Department courts and the Court of Appeals, 29 (this one included) are in the same category. 2 decisions in other departments that cite or are cited by this one are on the full map.

Proof of mailing

Open the full map

Did a party’s evidence establish that it mailed a no-fault claim, denial, verification request or examination notice?

This decision: The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (rules on the question, but another ground decided the case)

Held the insurer established timely and proper mailing of its denial through affidavits of mailing-center and claims-administrator employees describing their office mailing procedures, accompanied by a certificate of mailing.

Insurer proved mailingInsurer failed to proveProvider proved mailingProvider failed to proveTriable issue on mailingMixed rulingsThis decision

Of the 160 decisions on this question in the First Department courts and the Court of Appeals, 109 (this one included) are in the same category.

Cited in this decision

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

Triangle R Inc. v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 51663(U)) FollowedThe provider's unsworn medical report failed to rebut the insurer's showing that the medical supplies were unnecessary.
CPT Med. Servs., P.C. v New York Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 27526)The provider's attorney affirmation and unsworn medical report failed to rebut the insurer's evidence of lack of medical necessity.

Cited by

A label shows how the later decision treated this one.

Allstate Ins. Co. v Buffalo Neurosurgery Group (2019 NY Slip Op 03749) Contrasted (cf., but see)The insurer established a fee-schedule defense but failed to show that the assignor's spinal fusion surgery was medically unnecessary.
Global Liberty Ins. Co. v W. Joseph Gorum, M.D., P.C. (2016 NY Slip Op 06680) FollowedThe insurer's affirmed peer review supported a default judgment despite lacking an original signature.
Omega 18 Inc. v Global Liberty Ins. Co. of N.Y. (2020 NY Slip Op 50235(U))The insurer's affirmed peer review established that the prescribed medical supplies were unnecessary or redundant.

Similar decisions

Five Boro Med. Equip., Inc. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 51888(U))The insurer established lack of medical necessity for two supply claims but failed to establish timely denial of a third claim.
Ortho-Med Surgical Supply, Inc. v Progressive Cas. Ins. Co. (2010 NY Slip Op 50997(U))The provider failed to rebut the insurer's medical necessity showing or demonstrate that discovery was needed to raise a triable issue.
Five Boro Med. Equip., Inc. v A. Cent. Ins. Co. (2016 NY Slip Op 50412(U))The insurer's incomplete peer review failed to support two denials, and the provider's medical affidavit raised factual issues on two other claims.
Amherst Med. Supply, LLC v New York Cent. Mut. Fire Ins. Co. (2013 NY Slip Op 50586(U))The insurer's peer review lacked a factual basis or medical rationale for finding the prescribed supplies unnecessary.
Amherst Med. Supply, LLC v A. Cent. Ins. Co. (2013 NY Slip Op 51800(U))The insurer's peer review lacked a factual basis or medical rationale for finding the medical supplies unnecessary.