December 24, 2003

Damadian Mri In Garden City v Liberty Mut. Ins. Co. (2003 NY Slip Op 51702(U))

https://www.beynensonlaw.com/case-law/damadian-mri-in-garden-city-v-liberty-mut-ins-co-2003-ny-slip-op-51702u/

Court: Appellate Term, Second Department
Decided: December 24, 2003
Citation: 2003 NY Slip Op 51702(U)
Posture: Summary judgment
Outcome: Provider prevailed
Issues: Timeliness and preclusion Medical necessity Provider's prima facie case
Legal questions: Claimant's prima facie case on motions (see the maps)

Cite as

Damadian Mri In Garden City v Liberty Mut. Ins. Co., 2003 NY Slip Op 51702(U) (App Term, 2d Dept, 9th & 10th Jud Dists 2003)

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 that fails to deny a no-fault claim within 30 days of receipt is precluded from asserting lack of medical necessity. The Appellate Term, Second Department, affirmed denial of the insurer's discovery motion and grant of the provider's summary judgment cross motion. The provider's submitted claim established its prima facie case for the reasons stated in the companion appeal decided the same day, Damadian MRI in Elmhurst v Liberty Mut. Ins. Co., No. 2002-999 S C. The insurer's untimely denial triggered preclusion under Insurance Law § 5106 (a) and 11 NYCRR 65-3.8 (c). The matter was remanded for interest and attorney fees under 11 NYCRR 65-3.9 (a) and 65-3.10 (a).

Reported in New York Official Reports at Damadian Mri In Garden City v Liberty Mut. Ins. Co. (2003 NY Slip Op 51702(U))

[*1]

Damadian MRI In Garden City v Liberty Mut. Ins. Co.

2003 NY Slip Op 51702(U)

Decided on December 24, 2003

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This opinion is uncorrected and will not be published in the Official Reports.

Decided on December 24, 2003

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM : 9th and 10th JUDICIAL DISTRICTS

PRESENT:WINICK, J.P., LIFSON and SKELOS, JJ.
NO. 2002-750 S C

DAMADIAN MRI IN GARDEN CITY, P.C., as Assignee of KEVIN BROWN, Respondent,
against
LIBERTY MUTUAL INSURANCE COMPANY, Appellant.

Appeal by defendant from an order of the District Court, Suffolk County (P. Barton, J.), entered March 22, 2002, denying its motion to compel responses to its discovery demands and granting plaintiffs cross motion for summary judgment in the principal sum of $1,571.80.

Order unanimously affirmed without costs and matter remanded to the court below for the calculation of statutory interest and an assessment of attorney’s fees.

In this action to recover first-party no-fault medical benefits for treatment rendered to its assignor, plaintiff cross-moved for summary judgment. For the reasons set forth in Damadian MRI in Elmhurst. P.C. v Liberty Mut. Ins. Co. (No. 2002-999 S C, [decided herewith]), plaintiffs proof of its claim as submitted to defendant sufficed to establish its prima facie case in summary judgment. Inasmuch as defendant, failed to timely deny plaintiffs no-fault claim within 30 days of receipt (Insurance Law § 5106 [a]; 11 NYCRR 65-3.8[c]), it is precluded from raising the defense of lack of medical necessity (see Central Gen. Hosp. v Chubb Group of Ins. Cos. as., 90 NY2d 195, 199 [1997]).

Accordingly, plaintiffs cross motion was properly granted and the matter is remanded to the court below for a calculation of the statutory interest and an assessment of attorney’s fees due on $1,571.80 (Insurance Law § 5106 [a]; 11 NYCRR 65-3.9 [a]; 65-3.10 [a]; see St. Clare’s Hosp. v Allstate Ins. Co., 215 AD2d 641 [1995].
Decision Date: December 24, 2003

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.

Claimant's prima facie case on motions

Open the full map

On summary judgment or another pretrial motion, what must a no-fault claimant show to establish its prima facie case?

This decision: Claimant's proof held to make out its prima facie case

Held, for the reasons stated in a companion decision, that the provider's proof of its claim as submitted to the insurer sufficed to establish its prima facie case on summary judgment.

Proof sufficientMailing/receipt not shownOverdue not shownBusiness-record foundation lackingOther element missingThis decisionCites it or cited by itCited or followed

Of the 1,063 decisions on this question in the Second Department courts and the Court of Appeals, 511 (this one included) are in the same category.

Cited by

S & M Supply Inc. v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 51250(U))The insurer's founded belief in a staged collision defeated summary judgment, although its EUO nonappearance defense was precluded.

Similar decisions

Damadian Mri In Garden City v Windsor Group Ins. (2004 NY Slip Op 50262(U))The provider failed to establish entitlement to summary judgment because its assignment named an assignee whose identity remained uncertain.
Delta Diagnostic Radiology, P.C. v Allstate Ins. Co. (2006 NY Slip Op 52034(U))The insurer failed to prove timely mailing of its denial and was precluded from asserting lack of medical necessity.
Elmont Open MRI & Diagnostic Radiology, P.C. v GEICO Ins. Co. (2006 NY Slip Op 51185(U))A medical necessity denial must state the factual basis and medical rationale with sufficient particularity, even when timely issued.
Comprehensive MRI of N.Y., P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50128(U))Conflicting medical expert opinions raised a triable issue of fact concerning the medical necessity of the provider's services.
All County Open MRI & Diagn. Radiology P.C. v Travelers Ins. Co. (2006 NY Slip Op 50318(U))A peer review citing insufficient information cannot support denial without proof that the insurer sought that information through verification.