February 8, 2007

East Coast Acupuncture Servs., P.C. v American Tr. Ins. Co. (2007 NY Slip Op 50213(U))

Headnote

The court considered the peer review report relied upon by the defendant in denying the plaintiff's first party no-fault claims, as well as the independent medical examination (IME) report of the defendant's neurologist. The main issue decided was whether the peer review report and IME report provided an adequate factual basis and medical rationale for the determinations made by the defendant. The holding of the court was that the peer review report was insufficient to defeat the plaintiff's prima facie showing of entitlement to summary judgment for the $1,796.18 and $340 first party no-fault claims. Additionally, the IME report raised an issue of fact as to the medical necessity of the acupuncture treatments billed for in connection with a $765 claim. Therefore, the court modified the order to grant the plaintiff partial summary judgment on its claims in the sums of $1,796.18 and $340, and affirmed the decision.

Reported in New York Official Reports at East Coast Acupuncture Servs., P.C. v American Tr. Ins. Co. (2007 NY Slip Op 50213(U))

East Coast Acupuncture Servs., P.C. v American Tr. Ins. Co. (2007 NY Slip Op 50213(U)) [*1]

East Coast Acupuncture Servs., P.C. v American Tr. Ins. Co.

2007 NY Slip Op 50213(U) [14 Misc 3d 135(A)]

Decided on February 8, 2007

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This opinion is uncorrected and will not be published in the printed Official Reports.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 February 8, 2007

APPELLATE TERM OF THE SUPREME COURT, FIRST DEPARTMENT

PRESENT: McKEON, P.J., DAVIS, SCHOENFELD, JJ
570443/06.

East Coast Acupuncture Services, P.C.,a/a/o Ali Ahmed, Plaintiff-Appellant, – –
against
American Transit Insurance Company, Defendant-Respondent.

Defendant appeals from an order of the Civil Court of the City of New York, New York County (Eileen Rakower, J.), dated August 15, 2005, which denied its motion for summary judgment.

Order (Eileen Rakower, J.), dated August 15, 2005, modified to grant plaintiff partial summary judgment on its claims in the sums of $1,796.18 and $340; and as so modified, affirmed, without costs.

The peer review report relied upon by defendant in denying plaintiff’s $1,796.18 and $340 first party no-fault claims did not set forth an adequate factual basis and medical rationale for the reviewer’s determinations, and thus, was insufficient to defeat plaintiff’s prima facie showing of entitlement to summary judgment (see Park Neurological Servs. P.C. v GEICO Ins., 4 Misc 3d 95 [2004]).

With respect to plaintiff’s $765 claim, the independent medical examination (IME) report of defendant’s neurologist was sufficient to raise an issue of fact as to the medical necessity of the acupuncture treatments billed for in connection with this claim.

This constitutes the decision and order of the court.
I concurI concurI concur

Decision Date: February 08, 2007