February 19, 2020

Omega 18 Inc. v Global Liberty Ins. Co. of N.Y. (2020 NY Slip Op 50235(U))

Headnote

The court considered the evidence presented by both the plaintiff and the defendant in a first-party no-fault action. The defendant, an insurance company, submitted a peer review report from its physician, which concluded that the medical supplies provided to the plaintiff's assignor were not medically necessary. The report stated that the assignor was already receiving other therapies for her injuries and that the equipment in question was either unnecessary or redundant. The plaintiff's opposition, which consisted of an attorney's affirmation, prescription, and claim forms, did not include medical evidence or other competent proof of medical necessity. The main issue decided by the court was whether the defendant insurer was entitled to judgment as a matter of law dismissing the complaint. The court held that the defendant had made a prima facie showing of entitlement to judgment as a matter of law based on the evidence presented. As a result, the court reversed the lower court's order and granted the defendant's motion for summary judgment, ultimately dismissing the complaint. In summary, the court considered the evidence of medical necessity presented by both parties, ultimately holding that the defendant had made a prima facie showing of entitlement to judgment as a matter of law, and therefore dismissing the complaint.

Reported in New York Official Reports at Omega 18 Inc. v Global Liberty Ins. Co. of N.Y. (2020 NY Slip Op 50235(U))

Omega 18 Inc. a/a/o Mena Jenny, Plaintiff-Respondent,
against
Global Liberty Insurance Company of New York, Defendant-Appellant.

Defendant appeals from so much of an order of the Civil Court of the City of New York, Bronx County (Naita A. Semaj, J.), entered April 2, 2019, that denied, in part, its motion for summary judgment dismissing the complaint.

Per Curiam.

Order (Naita A. Semaj, J.), entered April 2, 2019, insofar as appealed from, reversed, without costs, motion granted, and the complaint dismissed. The Clerk is directed to enter judgment accordingly.

The defendant insurer made a prima facie showing of entitlement to judgment as a matter of law dismissing the underlying first-party no-fault action. The proof submitted by defendant, including the affirmed peer review report of its physician, set forth a factual basis and medical rationale for the conclusion that the medical supplies plaintiff provided to its assignor, including a portable whirlpool, heat lamp and massager, were not medically necessary (see Triangle R Inc. v New York Cent. Mut. Fire Ins. Co., 32 Misc 3d 143[A], 2011 NY Slip Op 51663[U] [App Term, 1st Dept 2011]). The report explained that the assignor was already receiving physical, acupuncture and chiropractic therapy for her injuries and that the equipment at issue was either unnecessary or redundant (see Enko Enters. Intl., Inc. v Clarendon Natl. Ins. Co., 30 Misc 3d 127[A], 2010 NY Slip Op 52267[U] [App Term, 1st Dept 2010]).

Plaintiff’s opposition, consisting of an attorney’s affirmation, prescription and various claim forms, was unaccompanied by any medical evidence or other competent proof of medical necessity, and failed to raise a triable issue (see TC Acupuncture, P.C. v Tri-State Consumer Ins. Co., 52 Misc 3d 131[A], 2016 NY Slip Op 50978[U] [App Term, 1st Dept 2016]; Karina K. Acupuncture, P.C. v AIG Centennial Ins. Co., 51 Misc 3d 132[A], 2016 NY Slip Op 50415[U] [App Term, 1st Dept 2016]; Cortland Med. Supply, Inc. v 21st Century Centennial Ins. Co., 46 Misc 3d 136[A], 2014 NY Slip Op 51886[U] [App Term, 1st Dept 2014]).

THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.

I concur I concur I concur
Decision Date: February 19, 2020