February 27, 2007

Delta Diagnostic Radiology, P.C. v American Tr. Ins. Co. (2007 NY Slip Op 27234)

Headnote

The main issue in this case was whether the defendant's denial of the claim form for first-party no-fault benefits provided sufficient facts and a medical rationale to support the denial. The court considered the denial form's reference to a negative peer review report, which the plaintiff argued did not provide enough specificity for the denial. The court ultimately held that the denial form was sufficient to apprise the plaintiff of the basis for determining that the medical services provided were medically unnecessary. The court affirmed the lower court's decision to deny the plaintiff's motion for summary judgment, finding that related cases with conflicting decisions should no longer be followed.

Reported in New York Official Reports at Delta Diagnostic Radiology, P.C. v American Tr. Ins. Co. (2007 NY Slip Op 27234)

Delta Diagnostic Radiology, P.C. v American Tr. Ins. Co.

2007 NY Slip Op 27234 [16 Misc 3d 10]

Accepted for Miscellaneous Reports Publication

AT2

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

As corrected through Wednesday, July 18, 2007

[*1]

Delta Diagnostic Radiology, P.C., as Assignee of Vladimir Anichkin, Appellant,
v
American Transit Insurance Co., Respondent.

Supreme Court, Appellate Term, Second Department, June 4, 2007

APPEARANCES OF COUNSEL

Alden Banniettis, Brooklyn (Jeff Henle of counsel), for appellant.

{**16 Misc 3d at 21} OPINION OF THE COURT

Memorandum.

Order affirmed without costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment, inter alia, on the ground that defendant’s NF-10 denial of claim form, which alleged the lack of medical necessity, failed to assert sufficient facts and a medical rationale based thereon to set forth, with the requisite specificity, a proper ground for the denial. The court denied the motion, finding the denial form’s reference to a negative peer review report sufficient to apprise plaintiff of the basis of its determination that the medical services provided were medically unnecessary. Plaintiff appeals, and we affirm (A.B. Med. Servs., PLLC v Liberty Mut. Ins. Co., 39 AD3d 779 [2d Dept 2007]). To the extent that A.B. Med. Servs. PLLC v GEICO Cas. Ins. Co. (12 Misc 3d 30 [App Term, 2d & 11th Jud Dists 2006]) and related cases are to the contrary, they should no longer be followed (see 11 NYCRR 65-3.8 [b] [4]).

Pesce, P.J., Golia and Rios, JJ., concur.