December 1, 2009

Points of Health Acupuncture, P.C. v GEICO Ins. Co. (2009 NY Slip Op 52445(U))

Headnote

The relevant facts considered by the court in this case involved an action by a healthcare provider to recover assigned first-party no-fault benefits. The main issue decided was whether the documents annexed to plaintiff's moving papers were admissible, and whether the defendant had established the timely mailing of denial of claim forms. The holding of the case was that the affidavit submitted by plaintiff's supervisor of medical billing was sufficient to establish the admissibility of the documents, and the defendant had failed to establish the timely mailing of the denial of claim forms. As a result, the defendant was precluded from interposing its defense of lack of medical necessity, and the Civil Court properly granted plaintiff's motion for summary judgment.

Reported in New York Official Reports at Points of Health Acupuncture, P.C. v GEICO Ins. Co. (2009 NY Slip Op 52445(U))

Points of Health Acupuncture, P.C. v GEICO Ins. Co. (2009 NY Slip Op 52445(U)) [*1]

Points of Health Acupuncture, P.C. v GEICO Ins. Co.

2009 NY Slip Op 52445(U) [25 Misc 3d 140(A)]

Decided on December 1, 2009

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This opinion is uncorrected and will not be published in the printed Official Reports.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 December 1, 2009

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : WESTON, J.P., RIOS and STEINHARDT, JJ
2008-1807 K C.

Points of Health Acupuncture, P.C. a/a/o ELIZABETH CARABALLO, Respondent, – –
against
GEICO Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Dawn Marie Jimenez, J.), entered July 11, 2008. The order granted plaintiff’s motion for summary judgment.

ORDERED that the order is affirmed without costs.

In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from an order of the Civil Court granting plaintiff’s motion for summary judgment.

Contrary to defendant’s contention, the affidavit submitted by plaintiff’s supervisor of medical billing in support of the motion was sufficient to establish that the documents annexed to plaintiff’s moving papers were admissible pursuant to CPLR 4518 (see Art of Healing Medicine, P.C. v Travelers Home & Mar. Ins. Co., 55 AD3d 644 [2008]; Dan Med., P.C. v New York Cent. Mut. Fire Ins. Co., 14 Misc 3d 44 [App Term, 2d & 11th Jud Dists 2006]). In addition, as the affidavit executed by defendant’s claim representative stated that she began working for defendant after the denial of claim forms at issue were allegedly mailed by defendant, and defendant did not otherwise establish actual mailing of the denial of claim forms or its standard office practice and procedure for the mailing of denial of claim forms during the pertinent time period, defendant failed to establish that its denial of claim forms were timely mailed (see Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [2001]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]). Accordingly, as defendant was precluded from interposing its
defense of lack of medical necessity (see Presbyterian Hosp. in City of NY v Maryland Cas. Co., 90 NY2d 274, 282 [1997]), the Civil Court properly granted plaintiff’s motion for summary judgment. [*2]

Weston, J.P., Rios and Steinhardt, JJ., concur.
Decision Date: December 01, 2009