December 18, 2009

Preferred Med. Imaging, P.C. v Countrywide Ins. Co. (2009 NY Slip Op 52577(U))

https://www.beynensonlaw.com/case-law/preferred-med-imaging-p-c-v-countrywide-ins-co-2009-ny-slip-op52577u/

Court: Appellate Term, First Department
Decided: December 18, 2009
Citation: 2009 NY Slip Op 52577(U) · 25 Misc 3d 144(A)
Posture: Article 75 petition
Outcome: Provider prevailed
Issues: CPLR article 75 (arbitration awards) Provider's prima facie case Medical necessity
Legal questions: Claimant's prima facie case on motions (see the maps)

Cite as

Preferred Med. Imaging, P.C. v Countrywide Ins. Co., 25 Misc 3d 144(A), 2009 NY Slip Op 52577(U) (App Term, 1st Dept 2009)

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.

An arbitration award requiring a provider to establish medical necessity is contrary to settled law. The Appellate Term, First Department, affirmed the order vacating the award and granting the provider unpaid no-fault benefits. The arbitrator had placed the medical necessity burden on the provider, and the master arbitrator sustained that conclusion. Applying Matter of State Farm Mut. Auto. Ins. Co. v Lumbermens Mut. Cas. Co., the court found the award unsupported by a reasonable hypothesis and contrary to settled law. Mary Immaculate Hosp. v Allstate Ins. Co. and Metro. Radiological Imaging, P.C. v Country-Wide Ins. Co. supported rejection of that burden. The insurer's remaining contentions were without merit.

Reported in New York Official Reports at Preferred Med. Imaging, P.C. v Countrywide Ins. Co. (2009 NY Slip Op 52577(U))

[*1]

Preferred Med. Imaging, P.C. v Countrywide Ins. Co.

2009 NY Slip Op 52577(U) [25 Misc 3d 144(A)]

Decided on December 18, 2009

Appellate Term, First 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This opinion is uncorrected and will not be published in the printed Official Reports.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 18, 2009

APPELLATE TERM OF THE SUPREME COURT, FIRST DEPARTMENT

PRESENT: McKeon, P.J., Heitler, Hunter, JJ
570628/09.

Preferred Medical Imaging, P.C. a/a/o Nathaniel Leach, Petitioner-Respondent,
against
Countrywide Insurance Company, Respondent-Appellant.

Respondent Countrywide Insurance Company appeals from an order of the Civil Court of the City of New York, New York County (Eileen A. Rakower, J.), dated April 27, 2006, which granted the petition to vacate an arbitration award and awarded petitioner Preferred Medical Imaging, P.C. unpaid no-fault benefits in the principal sum of $912.

Per Curiam.

Order (Eileen A. Rakower, J.), dated April 27, 2006, affirmed, without costs.

Civil Court properly vacated the arbitration award issued in an arbitration proceeding commenced by the provider, Preferred Medical Imaging, P.C., to recover first-party no-fault benefits, since the court correctly concluded that the award was not “supported by a reasonable hypothesis and was … contrary to what could be fairly described as settled law” (Matter of State Farm Mut. Auto. Ins. Co. v Lumbermens Mut. Cas. Co., 18 AD3d 762, 763 [2005], citing Matter of Motor Veh. Acc. Indem. Corp. v Aetna Cas. & Sur. Co., 89 NY2d 214, 224 [1996]). The arbitrator’s conclusion, which was sustained by the master arbitrator, that the provider was required to establish the medical necessity of the services rendered was contrary to settled law (see e.g. Mary Immaculate Hosp v Allstate Ins. Co., 5 AD3d 742 [2004]; see also Metro. Radiological Imaging, P.C. v Country-Wide Ins. Co., 19 Misc 3d 130[A] [2008]).Respondent-appellant Countrywide Insurance Company’s remaining contentions are without merit.

We note respondent-appellant’s three and a half year delay in perfecting this appeal.

THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.
Decision Date: December 18, 2009

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.

Claimant's prima facie case on motions

Open the full map

On summary judgment or another pretrial motion, what must a no-fault claimant show to establish its prima facie case?

This decision: Claimant's proof held to make out its prima facie case

Held the arbitrator's requirement that the provider establish the medical necessity of its services was contrary to settled law, since a provider need not prove medical necessity, and upheld vacatur of the award.

Proof sufficientMailing/receipt not shownOverdue not shownOther element missingThis decision

Of the 50 decisions on this question in the First Department courts and the Court of Appeals, 44 (this one included) are in the same category. 2 decisions in other departments that cite or are cited by this one are on the full map.

Cited in this decision

A label shows how this decision treated the case it cites.

Matter of State Farm Mut. Auto. Ins. Co. v Lumbermens Mut. Cas. Co. (2005 NY Slip Op 04234) FollowedAn interinsurer priority-of-payment award survived vacatur because it had a reasonable basis in the failure to prove another driver's negligence.
Mary Immaculate Hosp. v Allstate Ins. Co. (2004 NY Slip Op 02359)The hospitals established entitlement to summary judgment by proving that statutory billing forms were mailed and received and payment was overdue.
Metropolitan Radiological Imaging, P.C. v Country-Wide Ins. Co. (2008 NY Slip Op 50539(U))A provider's prima facie no-fault showing does not require additional evidence establishing medical necessity.

Similar decisions

Superior Med. Equip. & Supply, Inc. v Country-Wide Ins. Co. (2007 NY Slip Op 51993(U))An award must be confirmed under CPLR 7511 (e) when a petition to vacate it is denied.
Preferred Med. Imaging, P.C. v Hudson Ins. Co. (2007 NY Slip Op 50685(U))The provider's claim forms lacked a sufficient business-records foundation, so its prima facie summary judgment showing failed.
South Queens Imaging P.C. v Nationwide Mut. Ins. Co. (2005 NYSlipOp 50608(U))The insurer's unsworn IME and peer review reports failed to raise a triable issue of medical necessity.
Manhattan Med. Imaging, P.C. v GEICO Ins. Co. (2010 NY Slip Op 51737(U))The insurer's timely denial and supported peer review raised a triable issue of medical necessity, defeating provider summary judgment.
NY Comprehensive Med., P.C. v Maryland Cas. Co. (2008 NY Slip Op 50521(U))The provider's summary judgment cross motion failed because conflicting medical affirmations raised a triable issue of medical necessity.