May 6, 2013
Park Slope Med. v Praetorian Ins. Co. (2013 NY Slip Op 50761(U))
https://www.beynensonlaw.com/case-law/park-slope-med-v-praetorian-ins-co-2013-ny-slip-op-50761u/
- Decided
- May 6, 2013
- Citation
- 2013 NY Slip Op 50761(U) · 39 Misc 3d 141(A)
- Posture
- Summary judgment
- Outcome
- Insurer prevailed
- Later treatment
- Followed in 7 later decisions (see Cited by)
- Issues
- Medical necessity
- Legal questions
- Lack of medical necessity (see the maps)
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.
Reported in New York Official Reports at Park Slope Med. v Praetorian Ins. Co. (2013 NY Slip Op 50761(U))
| Park Slope Med. v Praetorian Ins. Co. |
| 2013 NY Slip Op 50761(U) [39 Misc 3d 141(A)] |
| Decided on May 6, 2013 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports. |
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., RIOS and SOLOMON, JJ
2011-1588 K C.
against
Praetorian Ins. Co., Appellant.
Appeal from an order of the Civil Court of the City of New York, Kings County (Lisa S. Ottley, J.), entered March 30, 2011. The order, insofar as appealed from, upon, in effect, granting defendant’s motion for leave to reargue its prior cross motion for summary judgment dismissing the complaint, adhered to the prior determination denying the cross motion.
ORDERED that the order, insofar as appealed from, is reversed, with $30 costs, and defendant’s cross motion for summary judgment dismissing the complaint is granted.
In this action by a provider to recover assigned first-party no-fault benefits, the Civil Court, by order entered March 5, 2010, denied both plaintiff’s motion for summary judgment and defendant’s cross motion for summary judgment, finding that “the sole issue for trial is medical necessity.” Defendant appeals from so much of an order of the Civil Court entered March 30, 2011, as, in effect, upon granting defendant’s motion for leave to reargue its prior cross motion, adhered to the prior determination that defendant was not entitled to summary judgment.
Defendant submitted a sworn peer review report which set forth a factual basis and medical rationale for the doctor’s determination that there was a lack of medical necessity for the [*2]medical supplies at issue, in that the supplies were superfluous, given that the assignor was already receiving three forms of therapy, which the peer reviewer stated was “more than adequate.” In opposition, plaintiff submitted an affirmation by a medical doctor which failed to meaningfully refer to, let alone rebut, the conclusions set forth in the peer review report (see Pan Chiropractic, P.C. v Mercury Ins. Co., 24 Misc 3d 136[A], 2009 NY Slip Op 51495[U] [App Term, 2d, 11th & 13th Jud Dists 2009]). Consequently, defendant’s cross motion should have been granted (see 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 & 11th Jud Dists 2007]).
Accordingly, the order, insofar as appealed from, is reversed and defendant’s cross motion for summary judgment dismissing the complaint is granted.
Pesce, P.J., Rios and Solomon, JJ., concur.
Decision Date: May 06, 2013
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.
Did the insurer’s proof establish lack of medical necessity, and did the provider’s evidence rebut it?
This decision: Insurer's proof established lack of medical necessity and the provider failed to rebut it
Granted the insurer summary judgment because its sworn peer review explained the supplies were superfluous given ongoing therapy, and the provider's physician affirmation failed to meaningfully refer to or rebut it.
Of the 612 decisions on this question in the Second Department courts and the Court of Appeals, 315 (this one included) are in the same category.
Cited in this decision
A label shows how this decision treated the case it cites.
- Pan Chiropractic, P.C. v Mercury Ins. Co. (2009 NY Slip Op 51495(U)) FollowedThe provider's conclusory disagreement with the insurer's supported peer review failed to raise a medical-necessity issue of fact.
- A Khodadadi Radiology, P.C. v NY Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 51342(U)) FollowedThe insurer's unrebutted peer review established that the provider's MRIs lacked medical necessity.
Cited by
A label shows how the later decision treated this one.
- Promed Durable Equip., Inc. v GEICO Ins. (2013 NY Slip Op 23283) FollowedThe provider rebutted one medical-necessity peer review but failed to address another review's finding that supplies were superfluous.
- Promed Durable Equip., Inc. v GEICO Ins. (2013 NY Slip Op 51372(U)) FollowedThe provider failed to rebut the peer review's conclusion that EMS items were superfluous to existing physical therapy and rehabilitation.
- Promed Durable Equip., Inc. v GEICO Ins. (2013 NY Slip Op 51373(U)) FollowedThe provider failed to rebut the peer review's conclusion that EMS items and a back massager were superfluous to existing physical therapy.
- Promed Durable Equip., Inc. v GEICO Ins. (2013 NY Slip Op 51375(U)) FollowedThe provider rebutted one peer review but failed to address another review's conclusion that supplies were superfluous to physical therapy.
- Elite Med. NY, P.C. v American Tr. Ins. Co. (2013 NY Slip Op 51738(U)) FollowedThe insurer established lack of medical necessity for two claims and outstanding verification that rendered the third claim premature.
- Promed Durable Equip., Inc. v Geico Ins. (2014 NY Slip Op 50772(U)) FollowedThe provider failed to rebut a peer review finding that an existing physical therapy plan rendered the disputed supplies unnecessary.
- Promed Durable Equip., Inc. v Geico Ins. (2014 NY Slip Op 50773(U)) FollowedThe provider failed to rebut peer review findings that the EMS items, back massager, and heating pad were superfluous.
- American Tr. Ins. Co. v Right Choice Supply, Inc. (2023 NY Slip Op 23039)A no-fault arbitrator need not apply summary judgment rules requiring a provider's medical evidence to specifically rebut an insurer's peer review.
Similar decisions
- Park Slope Med. & Surgical Supply, Inc. v New York Cent. Mut. Fire Ins. Co. (2009 NY Slip Op 50441(U))The provider's physician affidavit raised a triable issue of medical necessity sufficient to defeat the insurer's cross motion for summary judgment.
- Alev Med. Supply, Inc. v Praetorian Ins. Co. (2013 NY Slip Op 51999(U))The provider's doctor's affirmation failed to rebut the insurer's peer review finding that the medical supplies lacked medical necessity.
- Manhattan Med. Imaging, P.C. v Praetorian Ins. Co. (2011 NY Slip Op 51541(U))The insurer's unrebutted peer review supplied a factual basis and medical rationale establishing lack of medical necessity.
- Park Slope Med. & Surgical Supply, Inc. v GEICO Ins. Co. (2010 NY Slip Op 51771(U))The insurer's timely denial and affirmed peer review raised a triable issue of medical necessity for the supplied equipment.
- Mosad Med., P.C. v Praetorian Ins. Co. (2011 NY Slip Op 51876(U))The provider's doctor's affirmation failed to rebut the insurer's peer review showing that the services lacked medical necessity.