April 30, 2014

Promed Durable Equip., Inc. v Geico Ins. (2014 NY Slip Op 50771(U))

Headnote

The court considered an action by a provider to recover assigned first-party no-fault benefits, where the plaintiff moved for summary judgment and the defendant cross-moved for summary judgment dismissing the complaint based on a lack of medical necessity. The Civil Court made findings in the plaintiff's favor and held that the only remaining issue for trial was medical necessity. The main issue decided was whether there was a triable issue of fact regarding the medical necessity of the services at issue. The holding was that there was a triable issue of fact regarding the medical necessity of the services, and the order was affirmed. The defendant failed to articulate a sufficient basis to strike the Civil Court's findings in the plaintiff's favor, and the court found that there is a triable issue of fact regarding the medical necessity of the services at issue.

Reported in New York Official Reports at Promed Durable Equip., Inc. v Geico Ins. (2014 NY Slip Op 50771(U))

Promed Durable Equip., Inc. v Geico Ins. (2014 NY Slip Op 50771(U))
Promed Durable Equip., Inc. v Geico Ins.
2014 NY Slip Op 50771(U) [43 Misc 3d 138(A)]
Decided on April 30, 2014
Appellate Term, Second Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
As corrected in part through May 19, 2014; it will not be published in the printed Official Reports.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., ALIOTTA and SOLOMON, JJ.
2012-36 K C
Promed Durable Equipment, Inc. as Assignee of FELICIA HUNT, Respondent,

against

Geico Insurance, Appellant.

[*1]

Appeal from an order of the Civil Court of the City of New York, Kings County (Robin Kelly Sheares, J.), entered October 13, 2011. The order, insofar as appealed from, upon denying plaintiff’s motion for summary judgment, made, in effect, CPLR 3212 (g) findings in plaintiff’s favor, and denied defendant’s cross motion for summary judgment dismissing the complaint.

ORDERED that the order, insofar as appealed from, is affirmed, with $25 costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint on the ground that it had timely and properly denied the claim at issue based on a lack of medical necessity. Insofar as is relevant to this appeal, the Civil Court, upon denying plaintiff’s motion, made, in effect, CPLR 3212 (g) findings in plaintiff’s favor, denied defendant’s cross motion, and held that the only remaining issue for trial was medical necessity.

For the reasons stated in EMC Health Prods., Inc. as Assignee of Brian Byers v Geico Ins. Co. (___ Misc 3d ___, 2014 NY Slip Op _____ [Appeal No. 2012-1208 K C], decided herewith), we find that defendant failed to articulate a sufficient basis to strike the Civil Court’s implicit CPLR 3212 (g) findings in plaintiff’s favor. Moreover, upon a review of the record, we find that there is a triable issue of fact regarding the medical necessity of the services at issue (see Zuckerman v City of New York, 49 NY2d 557 [1980]).

Accordingly, the order is affirmed.

Pesce, P.J., Aliotta and Solomon, JJ., concur.


Decision Date: April 30, 2014