May 1, 2015

Lenox Hill Radiology & MIA, P.C. v Great N. Ins. Co. (2015 NY Slip Op 50680(U))

Headnote

The relevant facts the court considered were whether the denial of claim forms had been timely and properly mailed, as well as established medical necessity for the services in question. The main issue decided was whether the defendant's motion for summary judgment dismissing the complaint should be granted based on lack of medical necessity. The holding of the case was that the order denying the defendant's motion for summary judgment was affirmed, as the plaintiff provided a sufficient doctor's affirmation in opposition to raise a triable issue of fact as to whether the services were medically necessary.

Reported in New York Official Reports at Lenox Hill Radiology & MIA, P.C. v Great N. Ins. Co. (2015 NY Slip Op 50680(U))

Lenox Hill Radiology & MIA, P.C. v Great N. Ins. Co. (2015 NY Slip Op 50680(U)) [*1]

Lenox Hill Radiology & MIA, P.C. v Great N. Ins. Co.

2015 NY Slip Op 50680(U) [47 Misc 3d 143(A)]

Decided on May 1, 2015

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This opinion is uncorrected and will not be published in the printed Official Reports.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 May 1, 2015

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

PRESENT: : GARGUILO, J.P., MARANO and CONNOLLY, JJ.
2013-2049 N C

Lenox Hill Radiology and MIA, P.C. as Assignee of SAMIR GEMAYEL, Respondent,
against
Great Northern Insurance Company Doing Business as CHUBB GROUP OF INSURANCE COMPANIES, Appellant.

Appeal from an order of the District Court of Nassau County, First District (Fred J. Hirsh, J.), dated July 31, 2013. The order denied defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order is affirmed, without costs.

In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from an order of the District Court which denied defendant’s motion for summary judgment dismissing the complaint.

Defendant established that the denial of claim forms, which denied the claims on the ground of lack of medical necessity, had been timely and properly mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). While the affirmed peer review report by defendant’s doctor set forth a factual basis and medical rationale for the doctor’s opinion that there was a lack of medical necessity for the services at issue, plaintiff proffered a doctor’s affirmation in opposition, which affirmation was sufficient to raise a triable issue of fact as to whether the services were medically necessary (see Zuckerman v City of New York, 49 NY2d 557 [1980]). Consequently, defendant’s motion for summary judgment dismissing the complaint was properly denied.

Accordingly, the order is affirmed.

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

Decision Date: May 01, 2015