July 23, 2021

Parisien v Tri State Consumers Ins. Co. (2021 NY Slip Op 50728(U))

Headnote

The relevant facts the court considered in this case were that the defendant, Tri State Consumers Ins. Co., had moved for summary judgment to dismiss a complaint by a provider to recover assigned first-party no-fault benefits, on the grounds that the services lacked medical necessity and exceeded the amount permitted by the workers' compensation fee schedule. The plaintiff, Jules Francois Parisien, M.D., as Assignee, had cross-moved for summary judgment. Defendant submitted an affirmed report from a doctor who had performed an independent medical examination (IME) of the plaintiff's assignor before the services at issue had been rendered, concluding a lack of medical necessity for further treatment. The Civil Court denied defendant's motion but held that defendant had timely denied plaintiff's claims. The main issue decided in this case was whether the services at issue lacked medical necessity and whether the amount sought exceeded the amount permitted by the workers' compensation fee schedule. The holding of the case was that the defendant's motion for summary judgment dismissing the complaint was ultimately granted, as defendant had established a lack of medical necessity for further treatment through the IME report, which was not rebutted by plaintiff. As a result, the defendant's motion for summary judgment dismissing the complaint was granted, and the order was reversed.

Reported in New York Official Reports at Parisien v Tri State Consumers Ins. Co. (2021 NY Slip Op 50728(U))

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

Jules Francois Parisien, M.D., as Assignee of Northern, Gilbert, Respondent,
against
Tri State Consumers Ins. Co., Appellant.

Law Office of Jason Tenenbaum, P.C. (Shaaker Bhuiyan and Roman Kravchenko of Cousnel), for appellant. The Rybak Firm, PLLC (Damin J. Toell and Karina Barska of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Rosemarie Montalbano, J.), entered September 20, 2019. 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 reversed, with $30 costs, and defendant’s motion for summary judgment dismissing the complaint is granted.

In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint on the grounds that the services at issue lacked medical necessity and that the amount sought exceeded the amount permitted by the workers’ compensation fee schedule. Plaintiff cross-moved for summary judgment. Insofar as is relevant to this appeal, the Civil Court denied defendant’s motion but held, in effect, pursuant to CPLR 3212 (g), that defendant had established that it had timely denied plaintiff’s claims.

In support of its motion, defendant submitted an affirmed report from the doctor who had performed an independent medical examination (IME) of plaintiff’s assignor before the services at issue had been rendered. The IME report set forth a factual basis and medical rationale for the doctor’s conclusion that there was a lack of medical necessity for further treatment. Defendant’s prima facie showing was not rebutted by plaintiff. In view of the foregoing, and as plaintiff has not challenged the Civil Court’s finding, in effect, that defendant is otherwise entitled to judgment, defendant’s motion for summary judgment dismissing the complaint is granted (see Delta Diagnostic Radiology, P.C. v Integon Natl. Ins. Co., 24 Misc 3d 136[A], 2009 NY Slip Op [*2]51502[U] [App Term, 2d Dept, 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 Dept, 2d & 11th Jud Dists 2007]; A. Khodadadi Radiology, P.C. v NY Cent. Mut. Fire Ins. Co., 16 Misc 3d 131[A], 2007 NY Slip Op 51342[U] [App Term, 2d Dept, 2d & 11th Jud Dists 2007]). In light of the foregoing, we reach no other issue.

Accordingly, the order, insofar as appealed from, is reversed and defendant’s motion for summary judgment dismissing the complaint is granted.

ELLIOT, J.P., TOUSSAINT and GOLIA, JJ., concur.

ENTER:
Paul Kenny
Chief Clerk
Decision Date: July 23, 2021