December 17, 2014

Medical Assoc., P.C. v Geico Gen. Ins. Co. (2014 NY Slip Op 51829(U))

Headnote

The Civil Court of the City of New York, Kings County granted the plaintiff's motion for summary judgment and denied the defendant's cross motion for summary judgment dismissing the complaint. The case involved a provider seeking to recover assigned first-party no-fault benefits. The defendant timely denied the claim based on a lack of medical necessity, but the court found a triable issue of fact regarding the medical necessity of the services at issue. As a result, the court modified the order to provide that the plaintiff's motion for summary judgment is denied. The decision was made on December 17, 2014.

Reported in New York Official Reports at Medical Assoc., P.C. v Geico Gen. Ins. Co. (2014 NY Slip Op 51829(U))

Medical Assoc., P.C. v Geico Gen. Ins. Co. (2014 NY Slip Op 51829(U)) [*1]

Medical Assoc., P.C. v Geico Gen. Ins. Co.

2014 NY Slip Op 51829(U) [46 Misc 3d 131(A)]

Decided on December 17, 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This opinion is uncorrected and will not be published in the printed Official Reports.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 December 17, 2014

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2012-2000 K C

Medical Associates, P.C. as Assignee of DMITRY KHAIMOV, Respondent,
against
Geico General Ins. Co., Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Robin Kelly Sheares, J.), entered May 29, 2012. The order granted plaintiff’s motion for summary judgment and denied defendant’s cross motion for summary judgment dismissing the complaint.

ORDERED that the order is modified by providing that plaintiff’s motion for summary judgment is denied; as so modified, 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 Civil Court which granted plaintiff’s motion for

summary judgment and denied defendant’s cross motion for summary judgment dismissing the complaint.

Defendant’s moving papers established that defendant had timely denied the claim at issue (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]) based on a lack of medical necessity. However, upon a review of the record, we find that there is a triable issue of fact regarding the medical necessity of the services at issue (see Zuckerman v City of New York, 49 NY2d 557 [1980]).

Accordingly, the order is modified by providing that plaintiff’s motion for summary judgment is denied.

Pesce, P.J., Aliotta and Solomon, JJ., concur.

Decision Date: December 17, 2014