November 4, 2011

Foster Diagnostic Imaging, P.C. v Clarendon Natl. Ins. Co. (2011 NY Slip Op 52074(U))

Headnote

The court considered the motion for summary judgment by the defendant, who submitted a sworn peer review report showing a lack of medical necessity for the services at issue in an action by a provider to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant's motion for summary judgment dismissing the complaint should be granted. The court held that the defendant's showing that the services were not medically necessary was not rebutted by the plaintiff, and the Civil Court's implicit finding that the defendant had timely denied the claim based on a lack of medical necessity was not challenged by the plaintiff. Therefore, the defendant's motion for summary judgment dismissing the complaint was granted.

Reported in New York Official Reports at Foster Diagnostic Imaging, P.C. v Clarendon Natl. Ins. Co. (2011 NY Slip Op 52074(U))

Foster Diagnostic Imaging, P.C. v Clarendon Natl. Ins. Co. (2011 NY Slip Op 52074(U)) [*1]

Foster Diagnostic Imaging, P.C. v Clarendon Natl. Ins. Co.

2011 NY Slip Op 52074(U) [33 Misc 3d 138(A)]

Decided on November 4, 2011

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This opinion is uncorrected and will not be published in the printed Official Reports.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 November 4, 2011

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : PESCE, P.J., WESTON and RIOS, JJ
2010-2313 K C.

Foster Diagnostic Imaging, P.C. as Assignee of MIKHAIL GRINSHPUN, Respondent,
against
Clarendon National Ins. Co., Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Alice Fisher Rubin, J.), entered April 29, 2010. The order denied defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order is reversed, without costs, and defendant’s motion for summary judgment dismissing the complaint is granted.

In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from an order denying its motion for summary judgment dismissing the complaint.

In support of its motion, defendant submitted, among other things, a sworn peer review report which set forth the factual basis and medical rationale for the chiropractor’s determination that there was a lack of medical necessity for the services at issue. Defendant’s showing that such services were not medically necessary was not rebutted by plaintiff. In light of the foregoing, and the Civil Court’s implicit CPLR 3212 (g) finding that defendant had timely denied the claim based on a lack of medical necessity, a finding which plaintiff does not challenge, defendant’s motion for summary judgment dismissing the complaint should have been granted (see Delta Diagnostic Radiology, P.C. v Integon Natl. Ins. Co., 24 Misc 3d 136[A], 2009 NY Slip Op 51502[U] [App Term, 2d, 11th & 13th Jud Dists 2009]; Delta Diagnostic Radiology, P.C. v American Tr. Ins. Co., 18 Misc 3d 128[A], 2007 NY Slip Op 52455[U] [App Term, 2d & 11th Jud Dists 2007]; A. Khodadadi Radiology, P.C. v NY Cent. Mut. Fire Ins. Co., 16 Misc 3d 131[A], 2007 NY Slip Op 51342[U] [App Term, 2d & 11th Jud Dists 2007]).

Accordingly, the order is reversed and defendant’s motion for summary judgment dismissing the complaint is granted. [*2]

Pesce, P.J., Weston and Rios, JJ., concur.
Decision Date: November 04, 2011