March 12, 2015

Metropolitan Diagnostic Med. Care, P.C. v New York Cent. Mut. Fire Ins. Co. (2015 NY Slip Op 50383(U))

https://www.beynensonlaw.com/case-law/metropolitan-diagnostic-med-care-p-c-v-new-york-cent-mut-fire-ins-co-2015-ny-slip-op-50383u/

Court: Appellate Term, Second Department
Decided: March 12, 2015
Citation: 2015 NY Slip Op 50383(U) · 47 Misc 3d 130(A)
Posture: Summary judgment
Outcome: Provider prevailed
Later treatment: Followed in 1 later decision (see Cited by)
Issues: Medical necessity
Legal questions: Lack of medical necessity (see the maps)

Cite as

Metropolitan Diagnostic Med. Care, P.C. v New York Cent. Mut. Fire Ins. Co., 47 Misc 3d 130(A), 2015 NY Slip Op 50383(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015)

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 provider's physician affirmation raised a triable issue as to whether the services were medically necessary. The provider appealed an order granting the insurer summary judgment dismissing its action for assigned first-party no-fault benefits. The Appellate Term, Second Department, found the affirmation submitted in opposition sufficient to defeat the insurer's motion, reversed the order, and denied summary judgment. It declined the provider's request to limit the issues for trial under CPLR 3212 (g).

Reported in New York Official Reports at Metropolitan Diagnostic Med. Care, P.C. v New York Cent. Mut. Fire Ins. Co. (2015 NY Slip Op 50383(U))

[*1]

Metropolitan Diagnostic Med. Care, P.C. v New York Cent. Mut. Fire Ins. Co.

2015 NY Slip Op 50383(U) [47 Misc 3d 130(A)]

Decided on March 12, 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This opinion is uncorrected and will not be published in the printed Official Reports.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 March 12, 2015

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

PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2012-2477 K C

Metropolitan Diagnostic Medical Care, P.C. as Assignee of TARESHE ALLISON, Appellant,
against
New York Central Mutual Fire Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Dawn Jimenez Salta, J.), entered September 10, 2012. The order granted defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order is reversed, with $30 costs, and defendant’s motion for summary judgment dismissing the complaint is denied.

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

We agree with plaintiff’s contention on appeal that the physician’s affirmation submitted by plaintiff in opposition to defendant’s motion was sufficient to demonstrate the existence of a triable issue of fact as to whether the services provided were medically necessary. Consequently, defendant’s motion should have been denied (see Zuckerman v City of New York, 49 NY2d 557 [1980]). We decline plaintiff’s request to limit the issues for trial (see CPLR 3212 [g]).

Accordingly, the order is reversed and defendant’s motion for summary judgment dismissing the complaint is denied.

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

Decision Date: March 12, 2015

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)

Denied the insurer's summary judgment motion because the provider's physician's affirmation was sufficient to raise a triable issue of fact as to whether the services were medically necessary.

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

Of the 612 decisions on this question in the Second Department courts and the Court of Appeals, 95 (this one included) are in the same category.

Cited by

A label shows how the later decision treated this one.

S & R Med., P.C. v GEICO Gen. Ins. Co. (2016 NY Slip Op 51013(U)) FollowedThe provider's request for findings limiting the issues for trial under CPLR 3212 (g) was declined on appeal.

Similar decisions

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.
New York Diagnostic Med. Care, P.C. v GEICO Gen. Ins. Co. (2013 NY Slip Op 50419(U))The provider's doctor's affidavit raised a factual issue on medical necessity, defeating the insurer's cross motion for summary judgment.
IDF Diagnostic Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2015 NY Slip Op 51213(U))The insurer's medical necessity motion was denied because requested discovery was not supplied in time for the provider to oppose it.
North Bronx Med. Health Care v NY Cent. Mut. Ins. Co. (2012 NY Slip Op 51658(U))The provider's medical affirmation failed to rebut the insurer's IME and peer review conclusions that the disputed services were unnecessary.
Bronx Mega Care Med, PLLC v Federal Ins. Co. (2015 NY Slip Op 51060(U))The provider's doctor's affirmation failed to meaningfully address or rebut the insurer's IME conclusions on medical necessity.