October 11, 2011

Lynbrook Med., P.C. v GEICO Gen. Ins. Co. (2011 NY Slip Op 51841(U))

Headnote

The main issues in this case were whether the denial of claim forms, which denied the plaintiffs' claims on the grounds of lack of medical necessity and that payment had been made in accordance with the workers' compensation fee schedule, had been timely mailed, and whether the grounds for the denials were conclusory, vague or without merit as a matter of law. The court considered the evidence presented by both parties and found that the denial of claim forms had been timely mailed, and that the plaintiffs failed to show that the grounds for the denials were conclusory, vague or without merit. As a result, the court affirmed the denial of the plaintiffs' motion for summary judgment and denied the defendant's cross-motion for summary judgment dismissing the complaint. Therefore, the holding of the case was that the defendant's denial of claim forms were valid, and the plaintiffs failed to show their entitlement to judgment as a matter of law.

Reported in New York Official Reports at Lynbrook Med., P.C. v GEICO Gen. Ins. Co. (2011 NY Slip Op 51841(U))

Lynbrook Med., P.C. v GEICO Gen. Ins. Co. (2011 NY Slip Op 51841(U)) [*1]

Lynbrook Med., P.C. v GEICO Gen. Ins. Co.

2011 NY Slip Op 51841(U) [33 Misc 3d 127(A)]

Decided on October 11, 2011

Appellate Term, Second Department

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

As corrected in part through November 4, 2011; it will not be published in the printed Official Reports.

Decided on October 11, 2011

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : PESCE, P.J., RIOS and STEINHARDT, JJ
2009-2145 K C.

Lynbrook Medical, P.C. and NEW LIFE MEDICAL, P.C. as Assignees of XIOMARA CAMACHO, Appellants,
against
GEICO General Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Robin S. Garson, J.), entered August 18, 2009. The order, insofar as appealed from as limited by the brief, denied plaintiffs’ motion for summary judgment.

ORDERED that the order, insofar as appealed from, is affirmed, without costs.

In this action by providers to recover assigned first-party no-fault benefits, plaintiffs moved for summary judgment. Defendant opposed the motion and cross-moved for summary judgment dismissing the complaint. By order entered August 18, 2009, insofar as appealed from, the Civil Court denied plaintiffs’ motion for summary judgment.

Defendant established that the denial of claim forms, which denied plaintiffs’ claims on the grounds of lack of medical necessity and that payment had been made in accordance with the workers’ compensation fee schedule, had been timely mailed in accordance with defendant’s standard office practices and procedures (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]). Inasmuch as plaintiffs failed to show that the grounds for the denials were conclusory, vague or without merit as a matter of law, plaintiffs failed to make a prima facie showing of their entitlement to judgment as a matter of law (see Westchester Med. Ctr. v Nationwide Mut. Ins. Co., 78 AD3d 1168 [2010]). As a result, we need not consider the sufficiency of defendant’s paper’s submitted in opposition to the motion (see id.). Accordingly, the order, insofar as appealed from, is affirmed.

Pesce, P.J., Rios and Steinhardt, JJ., concur.
Decision Date: October 11, 2011