September 21, 2016

Metro Psychological Servs., P.C. v Auto One Ins. Co. (2016 NY Slip Op 51376(U))

https://www.beynensonlaw.com/case-law/metro-psychological-servs-p-c-v-auto-one-ins-co-2016-ny-slip-op51376u/

Court: Appellate Term, Second Department
Decided: September 21, 2016
Citation: 2016 NY Slip Op 51376(U) · 53 Misc 3d 131(A)
Posture: Summary judgment
Outcome: Provider prevailed
Issues: Medical necessity
Legal questions: Lack of medical necessity (see the maps)

Cite as

Metro Psychological Servs., P.C. v Auto One Ins. Co., 53 Misc 3d 131(A), 2016 NY Slip Op 51376(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2016)

Posture, outcome, issues and treatment by other decisions are Beynenson Law’s classification. Treatment labels are assigned by a language model reading the citing decision; negative and appeal-history labels are checked by a second reader.

Summary

Editorial summary by Beynenson Law, not part of the court’s decision.

The insurer's summary judgment motion was denied because a triable issue remained concerning medical necessity. The Appellate Term, Second Department, affirmed the order, insofar as appealed from, agreeing after review of the record that the necessity of the services presented a factual issue. The court also noted that the insurer's request to compel the provider's deposition remained pending and undecided.

Reported in New York Official Reports at Metro Psychological Servs., P.C. v Auto One Ins. Co. (2016 NY Slip Op 51376(U))

[*1]

Metro Psychological Servs., P.C. v Auto One Ins. Co.

2016 NY Slip Op 51376(U) [53 Misc 3d 131(A)]

Decided on September 21, 2016

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This opinion is uncorrected and will not be published in the printed Official Reports.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 September 21, 2016

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

PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2014-1015 K C

Metro Psychological Services, P.C., as Assignee of SEYMON FEYGIN, Respondent,
against
Auto One Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Harriet L. Thompson, J.), entered February 11, 2014. The order, insofar as appealed from, denied the branch of defendant’s motion seeking summary judgment dismissing the complaint.

ORDERED that the order, insofar as appealed from, is affirmed, with $25 costs.

In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from so much of an order of the Civil Court as denied the branch of defendant’s motion seeking summary judgment dismissing the complaint.

Upon a review of the record, we agree with the Civil Court’s determination 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]).

We note that the Civil Court failed to determine the branch of defendant’s motion seeking to compel plaintiff to appear for a deposition, and, thus, that branch of defendant’s motion remains pending and undecided (see Creese v Long Is. Light. Co., 98 AD3d 708, 711 [2012]; W.W. Med., P.C. v Allstate Ins. Co., 41 Misc 3d 130[A], 2013 NY Slip Op 51743[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2013]).

Accordingly, the order, insofar as appealed from, is affirmed.

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

Decision Date: September 21, 2016

Legal questions

A question of no-fault law this decision rules on, from our Legal Questions pages. Bars count the decisions on the question by year and court, coloured by category; circles are this decision and the decisions on the question it cites or that cite it. Point at a bar or circle for details. The categories and summaries are Beynenson Law’s classification, made by a language model and checked by a second reading.

Lack of medical necessity

Open the full map

Did the insurer’s proof establish lack of medical necessity, and did the provider’s evidence rebut it?

This decision: Provider's evidence rebutted the insurer's showing (triable issue, or necessity found at trial)

Upheld denial of the insurer's summary judgment motion because a triable issue of fact existed regarding the medical necessity of the services.

Unrebutted, insurer prevailsProvider's rebuttal sufficientInsurer raised triable issueInsurer's proof insufficientTrial error, new trialThis decision

Of the 617 decisions on this question in the Second Department courts and the Court of Appeals, 94 (this one included) are in the same category.

Cited in this decision

A label shows how this decision treated the case it cites.

W.W. Med., P.C. v Allstate Ins. Co. (2013 NY Slip Op 51743(U)) FollowedA provider's tax returns generally are discoverable only on a strong showing that indispensable information is unavailable elsewhere.

Similar decisions

Metro Psychological Servs., P.C. v Allstate Ins. Co. (2019 NY Slip Op 50748(U))The insurer failed to establish timely mailing of its denials, and the provider failed to establish entitlement to payment as a matter of law.
Five Boro Psychological Servs., P.C. v GEICO Gen. Ins. Co. (2012 NY Slip Op 51447(U))The insurer established timely denials and an unrebutted lack of medical necessity through affirmed peer review reports.
Metropolitan Diagnostic Med. Care, P.C. v New York Cent. Mut. Fire Ins. Co. (2015 NY Slip Op 50383(U))The provider's physician affirmation raised a triable issue as to whether the services were medically necessary.
Metropolitan Diagnostic Med. Care, P.C. v American Tr. Ins. Co. (2016 NY Slip Op 50699(U))The provider failed to establish either an untimely denial or a timely denial that was legally insufficient.
Quality Psychological Servs., P.C. v Auto One Ins. Co. (2011 NY Slip Op 52281(U))The insurer's IME nonappearance defense was precluded because its affidavit failed to establish timely mailing of the denial.