August 23, 2013

Queens Integrated Med. Care P.C. v New York Cent. Mut. Fire Ins. Co. (2013 NY Slip Op 51400(U))

https://www.beynensonlaw.com/case-law/queens-integrated-med-care-p-c-v-new-york-cent-mut-fire-ins-co-2013ny-slip-op-51400u/

Court: Appellate Term, First Department
Decided: August 23, 2013
Citation: 2013 NY Slip Op 51400(U) · 40 Misc 3d 138(A)
Posture: Summary judgment
Outcome: Provider prevailed
Issues: Medical necessity
Legal questions: Lack of medical necessity (see the maps)

Cite as

Queens Integrated Med. Care P.C. v New York Cent. Mut. Fire Ins. Co., 40 Misc 3d 138(A), 2013 NY Slip Op 51400(U) (App Term, 1st Dept 2013)

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.

The parties' conflicting medical expert opinions raised a triable issue concerning the necessity of physical therapy and related services. The provider sought assigned first-party no-fault benefits, and the insurer appealed only the portion of the order denying its motion for summary judgment dismissing the complaint. The Appellate Term, First Department, affirmed that portion because the competing opinions left medical necessity unresolved.

Reported in New York Official Reports at Queens Integrated Med. Care P.C. v New York Cent. Mut. Fire Ins. Co. (2013 NY Slip Op 51400(U))

[*1]

Queens Integrated Med. Care P.C. v New York Cent. Mut. Fire Ins. Co.

2013 NY Slip Op 51400(U) [40 Misc 3d 138(A)]

Decided on August 23, 2013

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This opinion is uncorrected and will not be published in the printed Official Reports.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 August 23, 2013

SUPREME COURT, APPELLATE TERM, FIRST DEPARTMENT

PRESENT: Torres, J.P., Schoenfeld, Shulman,JJ
570903/12.

Queens Integrated Medical Care P.C., a/a/o Guerline Benjamin, Plaintiff-Respondent,
against
New York Central Mutual Fire Insurance Company, Defendant-Appellant.

Defendant, as limited by its brief, appeals from that portion of an order of the Civil Court of the City of New York, Bronx County (Gerald Lebovits, J.), entered July 9, 2012, which denied, in part, its motion for summary judgment dismissing the complaint.

Per Curiam.

Order (Gerald Lebovits, J.), entered July 9, 2012, insofar as appealed from, affirmed, with $10 costs.

We agree that the conflicting medical expert opinions adduced by the parties sufficed to raise a triable issue as to the medical necessity of the physical therapy and related services underlying plaintiff’s first-party no-fault claim.

THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.
Decision Date: August 23, 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.

Lack of medical necessity

Open the full map

Did the insurer’s proof establish lack of medical necessity, and did the provider’s evidence rebut it?

This decision: Provider's evidence rebutted the insurer's showing (triable issue, or necessity found at trial)

Affirmed denial of the insurer's summary judgment motion because the parties' conflicting medical expert opinions raised a triable issue as to the medical necessity of the physical therapy and related services.

Unrebutted, insurer prevailsProvider's rebuttal sufficientInsurer raised triable issueInsurer's proof insufficientTrial error, new trialThis decision

Of the 73 decisions on this question in the First Department courts and the Court of Appeals, 10 (this one included) are in the same category.

Similar decisions

Advanced Orthopedics, PLLC v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50418(U))The parties' conflicting medical expert opinions raised a triable issue of fact concerning medical necessity.
Queens Brooklyn Med. Rehab, P.C. v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 50978(U))The provider's appeal from a conditional discovery order became academic after a subsequent order dismissed the action.
Quality Comprehensive Med. Care, P.C. v New York Cent. Mut. Fire Ins. Co. (2019 NY Slip Op 51734(U))The insurer proved a fee-schedule limit of $425.88 per claim but failed to establish lack of medical necessity.
Metropolitan Diagnostic Med. Care, P.C. v New York Cent. Mut. Fire Ins. Co. (2015 NY Slip Op 50383(U))The provider's physician affirmation raised a triable issue as to whether the services were medically necessary.
Multi-Specialty Pain Mgt. PC v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 51677(U))The insurer established proper mailing of IME notices and the assignor's nonappearance, and the provider raised no triable issue.