July 12, 2019

Quality Custom Med. Supply, Inc. v American Country Ins. Co. (2019 NY Slip Op 51165(U))

Headnote

The court considered an action by a medical supply provider to recover assigned first-party no-fault benefits, in which the defendant moved for summary judgment dismissing the complaint based on lack of medical necessity. The Civil Court granted the defendant's motion, leading to an appeal by the plaintiff. The defendant's proof was found to be sufficient to establish a presumption that the denial of claim form had been properly mailed, and the peer review report submitted by the defendant provided a factual basis and medical rationale for the determination of a lack of medical necessity for the supplies at issue. The plaintiff failed to submit any medical evidence to rebut the conclusions of the peer review report. As a result, the judgment granting the defendant's motion for summary judgment was affirmed.

Reported in New York Official Reports at Quality Custom Med. Supply, Inc. v American Country Ins. Co. (2019 NY Slip Op 51165(U))

Quality Custom Med. Supply, Inc. v American Country Ins. Co. (2019 NY Slip Op 51165(U)) [*1]

Quality Custom Med. Supply, Inc. v American Country Ins. Co.

2019 NY Slip Op 51165(U) [64 Misc 3d 137(A)]

Decided on July 12, 2019

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This opinion is uncorrected and will not be published in the printed Official Reports.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 July 12, 2019

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

PRESENT: : MICHAEL L. PESCE, P.J., MICHELLE WESTON, THOMAS P. ALIOTTA, JJ
2017-1188 K C

Quality Custom Medical Supply, Inc., as Assignee of Ranisha McMeo, Appellant,
against
American Country Ins. Co., Respondent.

Gary Tsirelman, P.C. (Darya Klein of counsel), for appellant. Rossillo & Licata, P.C., for respondent (no brief filed).

Appeal from an order of the Civil Court of the City of New York, Kings County (Harriet L. Thompson, J.), entered December 7, 2016, deemed from a judgment of that court entered March 13, 2017 (see CPLR 5501 [c]). The judgment, entered pursuant to the December 7, 2016 order, granted defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the judgment is affirmed, with $25 costs.

In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint on the ground of lack of medical necessity. By order entered December 7, 2016, the Civil Court granted defendant’s motion. This appeal by plaintiff ensued. A judgment was subsequently entered on March 13, 2017, from which the appeal is deemed to have been taken (see CPLR 5501 [c]).

Contrary to plaintiff’s contention, defendant’s proof was sufficient to give rise to a presumption that the denial of claim form had been properly mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). In addition, the peer review report submitted by defendant sufficiently set forth a factual basis and medical rationale for the peer reviewer’s determination that there was a lack of medical necessity for the supplies at issue and plaintiff failed to submit any medical evidence to rebut the conclusions set forth in the peer review report. Plaintiff’s remaining contentions lack merit.

Accordingly, the judgment is affirmed.

PESCE, P.J., WESTON and ALIOTTA, JJ., concur.

ENTER:
Paul Kenny
Chief Clerk
July 12, 2019
Decision Date: July 12, 2019