March 10, 2014

Hillside Open MRI, P.C. v Praetorian Ins. Co. (2014 NY Slip Op 50408(U))

https://www.beynensonlaw.com/case-law/hillside-open-mri-p-c-v-praetorian-ins-co-2014-ny-slip-op50408u/

Court
Appellate Term, Second Department
Decided
March 10, 2014
Citation
2014 NY Slip Op 50408(U) · 42 Misc 3d 149(A)
Posture
Summary judgment
Outcome
Provider prevailed
Issues
Discovery and procedure
Cite as
Hillside Open MRI, P.C. v Praetorian Ins. Co., 42 Misc 3d 149(A), 2014 NY Slip Op 50408(U) (App Term, 2d Dept, 9th & 10th Jud Dists 2014)

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's medical-necessity summary judgment motion was premature because the provider needed outstanding discovery to oppose it. The insurer relied on two peer review reports in seeking dismissal of assigned no-fault claims. The provider showed that it had requested but not received the medical documentation underlying the denials and needed that material to respond. Under CPLR 3212 (f), summary judgment may be denied when essential opposing facts may exist but cannot yet be stated, particularly without a reasonable opportunity for disclosure. The Appellate Term, Second Department, reversed the order, denied the insurer's motion with leave to renew after discovery, and granted the provider's CPLR 3124 cross motion, directing discovery responses within 60 days.

Reported in New York Official Reports at Hillside Open MRI, P.C. v Praetorian Ins. Co. (2014 NY Slip Op 50408(U))

[*1]
Hillside Open MRI, P.C. v Praetorian Ins. Co.
2014 NY Slip Op 50408(U) [42 Misc 3d 149(A)]
Decided on March 10, 2014
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This opinion is uncorrected and will not be published in the printed Official Reports.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 March 10, 2014

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 9th and 10th JUDICIAL DISTRICTS


PRESENT: : NICOLAI, P.J., IANNACCI and TOLBERT, JJ
2012-1617 N C.
Hillside Open MRI, P.C. as Assignee of JEMAR JOHNSON, Appellant,

against

Praetorian Insurance Company, Respondent.

Appeal from an order of the District Court of Nassau County, First District (Terence P. Murphy, J.), entered June 1, 2012. The order granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross motion to compel defendant to respond to plaintiff’s discovery demands.

ORDERED that the order is reversed, without costs, defendant’s motion for summary judgment dismissing the complaint is denied with leave to renew after the completion of discovery, plaintiff’s cross motion to compel defendant to respond to plaintiff’s discovery demands is granted, and defendant is directed to serve responses to plaintiff’s discovery demands within 60 days of the date of this decision and order.

In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint. Plaintiff opposed the motion on the ground that defendant had failed to respond to plaintiff’s 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 District Court granted defendant’s motion and denied plaintiff’s cross motion.

“CPLR 3212 (f) provides, in relevant part, that a court may deny a motion for summary judgment should it appear from affidavits submitted in opposition to the motion that facts essential to justify opposition may exist but cannot then be stated. This is especially so where the opposing party has not had a reasonable opportunity for disclosure prior to the making of the motion” (Jones v American Commerce Ins. Co., 92 AD3d 844, 845 [2012] [internal quotation marks and citations omitted]). Here, in support of its motion for summary judgment dismissing the complaint on the ground of lack of medical necessity, defendant alleged that it had timely denied plaintiff’s claims on that ground based on two peer review reports. In opposition to defendant’s motion, and in support of its cross motion to compel discovery, plaintiff demonstrated that it had requested from defendant, but had not received, the medical documentation underlying defendant’s decision to deny the claims based on lack of medical necessity, and that plaintiff needed such discovery to oppose defendant’s motion (see Metropolitan Diagnostic Med. Care, P.C. v A. Cent. Ins. Co., ___ Misc 3d ___[A], 2013 NY Slip Op 52246[U] [App Term, 2d, 11th & 13th Jud Dists 2013] Alrof, Inc. v Progressive Ins. Co., 34 Misc 3d 29 [App Term, 2d, 11th & 13th Jud Dists 2011] compare Elmont Open MRI & Diagnostic Radiology, P.C. v Travelers Indem. Co., 30 Misc 3d 126[A], 2010 NY Slip Op 52223[U] [App Term, 9th & 10th Jud Dists 2010]). Consequently, defendant’s motion should have been denied with leave to renew following discovery, and plaintiff’s cross motion granted (see Metropolitan Diagnostic Med. Care, P.C. v A. Cent. Ins. Co., ___ Misc 3d ___[A], 2013 NY Slip Op 52246[U]).

Accordingly, the order is reversed, defendant’s motion for summary judgment dismissing [*2]the complaint is denied with leave to renew after the completion of discovery, plaintiff’s cross motion to compel defendant to respond to plaintiff’s discovery demands is granted, and defendant is directed to serve responses to plaintiff’s discovery demands within 60 days of the date of this decision and order.

Nicolai, P.J., Iannacci and Tolbert, JJ., concur.
Decision Date: March 10, 2014

Similar decisions