July 13, 2015

Huntington Regional Chiropractic, P.C. v Truck Ins. Exch. (2015 NY Slip Op 51068(U))

Headnote

The court considered the issue of whether there was a lack of medical necessity for the services provided in a first-party no-fault benefits claim. The defendant submitted two independent medical examination reports, one from a chiropractor and one from an orthopedist, which concluded that there was a lack of medical necessity for the services. However, the medical affidavits submitted by the plaintiffs in opposition were deemed sufficient to raise a triable issue of fact as to the medical necessity of the claims at issue. Ultimately, the court reversed the order and denied the branches of the defendant's motion seeking summary judgment dismissing the plaintiffs' first through eighteenth and twenty-first through thirty-sixth causes of action. Therefore, the holding of the case was in favor of the plaintiffs, allowing their claims to proceed to trial.

Reported in New York Official Reports at Huntington Regional Chiropractic, P.C. v Truck Ins. Exch. (2015 NY Slip Op 51068(U))

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

Huntington Regional Chiropractic, P.C. as Assignee of TANIA HERNANDEZ Also Known as TANIA R. HERNANDEZ and ORTHOMED CARE, P.C. as Assignee of TANIA R. HERNANDEZ, Appellants, July 13, 2015
against
Truck Insurance Exchange, Respondent.

Appeal from an order of the District Court of Nassau County, Third District (Michael A. Ciaffa, J.), dated January 23, 2014. The order, insofar as appealed from, granted the branches of defendant’s motion seeking summary judgment dismissing plaintiffs’ first through eighteenth, and twenty-first through thirty-sixth causes of action.

ORDERED that the order, insofar as appealed from, is reversed, without costs, and the branches of defendant’s motion seeking summary judgment dismissing plaintiffs’ first through eighteenth, and twenty-first through thirty-sixth causes of action are denied.

In this action by providers to recover assigned first-party no-fault benefits, plaintiffs appeal from so much of an order as granted the branches of defendant’s motion seeking summary judgment dismissing plaintiffs’ first through eighteenth, and twenty-first through thirty-sixth causes of action.

In support of its motion, defendant submitted, among other things, two independent medical examination reports, one from a chiropractor and one from an orthopedist, which set forth a factual basis and a medical rationale for the examiners’ determination that there was a lack of medical necessity for the respective services provided (see Total Equip., LLC v Praetorian Ins. Co., 34 Misc 3d 145[A], 2012 NY Slip Op 50155[U] [App Term, 9th & 10th Jud Dists 2012]). However, the medical affidavits submitted by plaintiffs in opposition were sufficient to raise a triable issue of fact as to the medical necessity of the claims at issue (see Huntington Med. Plaza, P.C. v Travelers Indem. Co., 43 Misc 3d 129[A], 2014 NY Slip Op 50527[U] [App Term, 2d, 11th & 13th Jud Dists 2014]; Brooklyn Chiropractic & Sports Therapy, P.C. v A. Cent. Ins. Co., 39 Misc 3d 148[A], 2013 NY Slip Op 50904[U] [App Term, 9th & 10th Jud Dists 2013]).

Accordingly, the order, insofar as appealed from, is reversed, and the branches of defendant’s motion seeking summary judgment dismissing plaintiffs’ first through eighteenth and twenty-first through thirty-sixth causes of action are denied.

Tolbert, J.P., Marano and Connolly, JJ., concur.

Decision Date: July 13, 2015