June 29, 2009

Krishna v Liberty Mut. Ins. Co. (2009 NY Slip Op 51312(U))

Headnote

The court considered the denial of the plaintiff's no-fault claim by the defendant, Liberty Mutual Insurance Co., based on the results of an independent peer review. The main issue decided was whether the defendant's NF-10 form sufficiently apprised the plaintiff of the factual basis for the denial. The court held that the NF-10 form did provide enough information to inform the plaintiff of the basis for the denial, in accordance with 11 NYCRR 65-3.8[b][4]. Additionally, the court found that the initial peer review report relied upon by the defendant, along with additional documentation received from the plaintiff, raised a triable issue as to the medical necessity of the services and tests performed by the plaintiff. Therefore, the court affirmed the amended order of the Civil Court, denying the plaintiff's motion for summary judgment.

Reported in New York Official Reports at Krishna v Liberty Mut. Ins. Co. (2009 NY Slip Op 51312(U))

Krishna v Liberty Mut. Ins. Co. (2009 NY Slip Op 51312(U)) [*1]

Krishna v Liberty Mut. Ins. Co.

2009 NY Slip Op 51312(U) [24 Misc 3d 128(A)]

Decided on June 29, 2009

Appellate Term, First 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This opinion is uncorrected and will not be published in the printed Official Reports.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 June 29, 2009

APPELLATE TERM OF THE SUPREME COURT, FIRST DEPARTMENT

PRESENT: McKeon, P.J., Schoenfeld, J.
570223/08

Ranga C. Krishna, M.D. a/a/o Salvatore Miciotta, Plaintiff-Appellant,
against
Liberty Mutual Insurance Co., Defendant-Respondent.

Plaintiff appeals from an amended order of the Civil Court of the City of New York, New York County (Manuel J. Mendez, J.), entered May 4, 2007, which denied his motion for summary judgment.

Per Curiam.

Order (Manuel J. Mendez, J.), entered May 4, 2007, affirmed, with $10 costs.

Defendant’s NF-10 form, which stated that plaintiff’s no-fault claim was denied based on the results of an independent peer review, sufficiently apprised plaintiff of the factual basis for the denial (see 11 NYCRR 65-3.8[b][4]; New York Univ. Hosp. Rusk Inst. v Government Employees Ins. Co., 39 AD3d 832 [2007]). The initial peer review report relied upon by defendant, as amplified upon defendant’s receipt of additional documentation from plaintiff regarding his claim, set forth sufficient facts to raise a triable issue as to the medical necessity of the health services and diagnostic tests performed by plaintiff.

THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.
I concur

Decision Date: June 29, 2009