May 14, 2012

Five Boro Psychological Servs., P.C. v GEICO Gen. Ins. Co. (2012 NY Slip Op 51013(U))

Headnote

The main issue in this case was whether a provider was entitled to recover assigned first-party no-fault benefits from an insurance company. The court considered the fact that the insurance company had denied the claims on the grounds that the services provided were not medically necessary, and that the provider had failed to rebut the insurance company's evidence. The court found that the insurance company had established timely denial of the claims and that the provider had not provided sufficient evidence to counter this. As a result, the court affirmed the judgment in favor of the insurance company, dismissing the complaint brought by the provider. The holding of the case was that the insurance company was not required to provide copies of the medical records reviewed by its peer reviewer, as argued by the provider, and that the provider's contentions on appeal were without merit. As a result, the judgment in favor of the insurance company was affirmed.

Reported in New York Official Reports at Five Boro Psychological Servs., P.C. v GEICO Gen. Ins. Co. (2012 NY Slip Op 51013(U))

Five Boro Psychological Servs., P.C. v GEICO Gen. Ins. Co. (2012 NY Slip Op 51013(U)) [*1]

Five Boro Psychological Servs., P.C. v GEICO Gen. Ins. Co.

2012 NY Slip Op 51013(U) [35 Misc 3d 145(A)]

Decided on May 14, 2012

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This opinion is uncorrected and will not be published in the printed Official Reports.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 May 14, 2012

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

PRESENT: : PESCE, P.J., RIOS and ALIOTTA, JJ
2011-1 K C.

Five Boro Psychological Services, P.C. as Assignee of MARGARETTE COPES, Appellant, —
against
GEICO General Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Lisa S. Ottley, J.), entered May 4, 2010. The order, insofar as appealed from, denied plaintiff’s motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint. The appeal is deemed to be from a judgment of the same court entered November 3, 2010 dismissing the complaint (see CPLR 5501 [c]).

ORDERED that the judgment is affirmed, without costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from so much of an order as denied its motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint. The Civil Court found that defendant had established that it had timely denied the subject claims on the ground that the services at issue were not medically necessary, and that plaintiff had failed to rebut defendant’s evidence. A judgment was subsequently entered, from which this appeal is deemed to have been taken (see CPLR 5501 [c]).

Contrary to plaintiff’s argument on appeal, defendant was not required to annex to its motion papers copies of the medical records which were reviewed by defendant’s peer reviewer [*2](see Elmont Open MRI & Diagnostic Radiology, P.C. v New York Cent. Mut. Fire Ins. Co., 30 Misc 3d 126[A], 2010 NY Slip Op 52222[U] [App Term, 9th & 10th Jud Dists 2010]; Urban Radiology, P.C. v Tri-State Consumer Ins. Co., 27 Misc 3d 140[A], 2010 NY Slip Op 50987[U] [App Term, 2d, 11th & 13th Jud Dists 2010]). As plaintiff’s remaining contentions on appeal are similarly without merit, the judgment is affirmed.

Pesce, P.J., Rios and Aliotta, JJ., concur.
Decision Date: May 14, 2012