August 24, 2012

North Bronx Med. Health Care v NY Cent. Mut. Ins. Co. (2012 NY Slip Op 51658(U))

Headnote

The court considered an appeal from an order of the Civil Court of the City of New York, Queens County, which denied the branches of the defendant's motion seeking summary judgment dismissing the complaint insofar as it sought to recover upon claims for $1,712.58, $49.26, and $67.60. The main issue decided was whether the provider was entitled to recover assigned first-party no-fault benefits for the specific claims listed. The holding of the case was that the order was reversed, and the branches of the defendant's motion seeking summary judgment dismissing the claims for $1,712.58, $49.26, and $67.60 were granted, as the plaintiff failed to meaningfully rebut the conclusions set forth in the IME report and the peer review report submitted by the defendant.

Reported in New York Official Reports at North Bronx Med. Health Care v NY Cent. Mut. Ins. Co. (2012 NY Slip Op 51658(U))

North Bronx Med. Health Care v NY Cent. Mut. Ins. Co. (2012 NY Slip Op 51658(U)) [*1]

North Bronx Med. Health Care v NY Cent. Mut. Ins. Co.

2012 NY Slip Op 51658(U) [36 Misc 3d 149(A)]

Decided on August 24, 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This opinion is uncorrected and will not be published in the printed Official Reports.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 August 24, 2012

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

PRESENT: : PESCE, P.J., RIOS and ALIOTTA, JJ
2011-1064 Q C.

North Bronx Medical Health Care as Assignee of ELESIA FULLERTON, Respondent, —
against
NY Central Mutual Ins. Co., Appellant.

Appeal from an order of the Civil Court of the City of New York, Queens County (Richard G. Latin, J.), entered March 24, 2011. The order, insofar as appealed from, denied the branches of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims for $1,712.58, $49.26 and $67.60.

ORDERED that the order, insofar as appealed from, is reversed, without costs, and the branches of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims for $1,712.58, $49.26 and $67.60 are granted.

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 branches of defendant’s motion seeking summary judgment dismissing the complaint insofar as it sought to recover upon claims for $1,712.58, $49.26 and $67.60.

In support of its motion, defendant submitted an affirmed independent medical examination (IME) report and an affirmed peer review report, each of which set forth a factual basis and a medical rationale for the respective doctor’s determination that there was a lack of medical necessity for the services at issue. In opposition, plaintiff submitted an affirmation from [*2]a doctor which failed to meaningfully refer to, let alone rebut, the conclusions set forth in the IME report and the peer review report (see Pan Chiropractic, P.C. v Mercury Ins. Co., 24 Misc 3d 136[A], 2010 NY Slip Op 51495[U] [App Term, 2d, 11th & 13th Jud Dists 2009]). As plaintiff has not challenged the Civil Court’s finding, in effect, that defendant is otherwise entitled to judgment on the relevant claims, the order is reversed and the branches of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims for $1,712.58, $49.26 and $67.60 are granted (see 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]).

Pesce, P.J., Rios and Aliotta, JJ., concur.
Decision Date: August 24, 2012