June 11, 2012

Midtown Med. Assoc., P.C. v Clarendon Natl. Ins. Co. (2012 NY Slip Op 51071(U))

Headnote

The relevant facts considered by the court in this case were that Midtown Medical Associates, P.C. was seeking to recover first-party no-fault benefits that had been assigned to them by Simeon Johnson. Clarendon National Insurance Co. appealed from the denial of their motion for summary judgment dismissing the complaint on the grounds of lack of medical necessity for the services provided. The main issue decided by the court was whether the affirmed peer review report submitted by Clarendon National Insurance Co. had clearly established a sufficient medical rationale and factual basis to demonstrate a lack of medical necessity for the services at issue. The court held that as the peer review report failed to clearly establish a sufficient medical rationale and factual basis to demonstrate a lack of medical necessity for the services at issue, the denial of Clarendon National Insurance Co.'s motion for summary judgment was proper. Therefore, the order denying the motion for summary judgment was affirmed.

Reported in New York Official Reports at Midtown Med. Assoc., P.C. v Clarendon Natl. Ins. Co. (2012 NY Slip Op 51071(U))

Midtown Med. Assoc., P.C. v Clarendon Natl. Ins. Co. (2012 NY Slip Op 51071(U)) [*1]

Midtown Med. Assoc., P.C. v Clarendon Natl. Ins. Co.

2012 NY Slip Op 51071(U) [35 Misc 3d 147(A)]

Decided on June 11, 2012

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This opinion is uncorrected and will not be published in the printed Official Reports.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 June 11, 2012

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

PRESENT: : RIOS, J.P., PESCE and ALIOTTA, JJ
2011-775 RI C.

MIDTOWN MEDICAL ASSOCIATES, P.C. as Assignee of SIMEON JOHNSON, Respondent, —
against
CLARENDON NATIONAL INSURANCE CO., Appellant.

Appeal from an order of the Civil Court of the City of New York, Richmond County (Orlando Marrazzo, Jr., J.), entered February 24, 2011. The order, insofar as appealed from, denied defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order, insofar as appealed from, is affirmed, without 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 its motion for summary judgment dismissing the complaint on the ground of lack of medical necessity.

As the affirmed peer review report submitted by defendant failed to clearly establish a sufficient medical rationale and factual basis to demonstrate a lack of medical necessity for the services at issue (compare Delta Diagnostic Radiology, P.C. v Integon Natl. Ins. Co., 24 Misc 3d 136[A], 2009 NY Slip Op 51502[U] [App Term, 2d, 11th & 13th Jud Dists 2009]; Delta Diagnostic Radiology, P.C. v American Tr. Ins. Co., 18 Misc 3d 128[A], 2007 NY Slip Op 52455[U] [App Term, 2d & 11th Jud Dists 2007]), defendant’s motion was properly denied. Accordingly, the order, insofar as appealed from, is affirmed. [*2]

Rios, J.P., Pesce and Aliotta, JJ., concur.
Decision Date: June 11, 2012