November 1, 2019

GC Chiropractic, P.C. v Integon Natl. Ins. Co. (2019 NY Slip Op 51800(U))

https://www.beynensonlaw.com/case-law/gc-chiropractic-p-c-v-integon-natl-ins-co-2019-ny-slip-op-51800u/

Court: Appellate Term, Second Department
Decided: November 1, 2019
Citation: 2019 NY Slip Op 51800(U) · 65 Misc 3d 146(A)
Posture: Summary judgment
Outcome: Provider prevailed
Issues: Discovery and procedure

Cite as

GC Chiropractic, P.C. v Integon Natl. Ins. Co., 65 Misc 3d 146(A), 2019 NY Slip Op 51800(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2019)

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.

The insurer was denied summary judgment because the provider had not received requested medical records needed to oppose the motion. The insurer sought dismissal of the assigned no-fault action for lack of medical necessity. The provider invoked CPLR 3212 (f) and cross-moved under CPLR 3124 to compel discovery. It demonstrated that it had requested the records relied on by the insurer's peer reviewer but had not received them in time to oppose summary judgment. The Appellate Term, Second Department, reversed the order granting dismissal and denying discovery. It denied the insurer's motion and granted the provider's cross motion to compel the requested discovery.

Reported in New York Official Reports at GC Chiropractic, P.C. v Integon Natl. Ins. Co. (2019 NY Slip Op 51800(U))

[*1]

GC Chiropractic, P.C. v Integon Natl. Ins. Co.

2019 NY Slip Op 51800(U) [65 Misc 3d 146(A)]

Decided on November 1, 2019

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This opinion is uncorrected and will not be published in the printed Official Reports.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 1, 2019

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

PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, BERNICE D. SIEGAL, JJ
2018-1173 K C

GC Chiropractic, P.C., as Assignee of Edith Carver, Appellant,
against
Integon National Ins. Co., Respondent.

Gary Tsirelman, P.C. (Devon Riley Christian of counsel), for appellant. Law Offices of Moira Doherty, P.C., for respondent (no brief filed).

Appeal from an order of the Civil Court of the City of New York, Kings County (Rosemarie Montalbano, J.), entered May 7, 2018. The order granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross motion to compel discovery.

ORDERED that the order is reversed, with $30 costs, defendant’s motion for summary judgment dismissing the complaint is denied and plaintiff’s cross motion to compel discovery is granted.

In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint on the ground of lack of medical necessity. Plaintiff opposed the motion on the ground that defendant had failed to respond to discovery demands and that defendant’s responses were necessary to oppose defendant’s motion (see CPLR 3212 [f]). Plaintiff also cross-moved to compel defendant to provide the requested discovery (see CPLR 3124). The Civil Court granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross motion seeking to compel discovery.

In opposition to defendant’s motion, and in support of its cross motion to compel [*2]discovery, plaintiff demonstrated that it had requested from defendant, but had not received in time to oppose defendant’s motion (see CPLR 3212 [f]), the medical records relied upon by defendant’s peer reviewer. In light of the foregoing, defendant is not entitled to summary judgment dismissing the complaint (see IDF Diagnostic Med., P.C. v New York Cent. Mut. Fire Ins. Co., 48 Misc 3d 138[A], 2015 NY Slip Op 51213[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]; see also Alrof, Inc. v Progressive Ins. Co., 34 Misc 3d 29 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2011]).

Accordingly, the order is reversed, defendant’s motion for summary judgment dismissing the complaint is denied and plaintiff’s cross motion to compel discovery is granted.

PESCE, P.J., ALIOTTA and SIEGAL, JJ., concur.

ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 01, 2019

Cited in this decision

A label shows how this decision treated the case it cites.

IDF Diagnostic Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2015 NY Slip Op 51213(U)) FollowedThe insurer's medical necessity motion was denied because requested discovery was not supplied in time for the provider to oppose it.
Alrof, Inc. v Progressive Ins. Co. (2011 NY Slip Op 21419)An insurer need not prove medical records reliable when its expert assumes their contents true in disputing medical necessity.

Similar decisions

Total Chiropractic, P.C. v Integon Natl. Ins. Co. (2021 NY Slip Op 50443(U))The insurer's affidavit failed to establish proper mailing of IME notices, and the provider failed to show entitlement to summary judgment.
Intuitive Chiropractic, P.C. v REdland Ins. Co. (2013 NY Slip Op 51461(U))The insurer's sworn peer review established lack of medical necessity, and the provider failed to rebut that showing.
Great Health Care Chiropractic, P.C. v Interboro Ins. Co. (2013 NY Slip Op 51737(U))An insurer defending a no-fault action on medical necessity grounds is entitled to depose the provider's treating chiropractor.
New Life Med., P.C. v GEICO Ins. Co. (2012 NY Slip Op 51061(U))The provider's practitioner failed to meaningfully rebut two peer review reports establishing lack of medical necessity.
Sufficient Chiropractic Care, P.C. v Global Liberty Ins. Co. (2021 NY Slip Op 50879(U))The insurer's summary judgment motion was granted because the provider's affidavit failed to rebut the showing of lack of medical necessity.