January 13, 2012

Sky Med. Supply, Inc. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 50050(U))

Headnote

The court considered the appeal from an order of the Civil Court of the City of New York, Kings County denying defendant's motion for summary judgment dismissing the complaint. The main issue was whether the denial of claim form, which denied the claim at issue on the ground of lack of medical necessity, had been timely mailed and whether defendant had provided sufficient evidence to support its determination that the medical supplies at issue were not medically necessary. The court held that defendant's affidavit, along with the chiropractor/acupuncturist's peer review report, established a factual basis and medical rationale for the determination that there was a lack of medical necessity for the supplies, and that the plaintiff did not rebut this showing. As a result, the court reversed the order and granted the defendant's motion for summary judgment dismissing the complaint.

Reported in New York Official Reports at Sky Med. Supply, Inc. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 50050(U))

Sky Med. Supply, Inc. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 50050(U)) [*1]

Sky Med. Supply, Inc. v New York Cent. Mut. Fire Ins. Co.

2012 NY Slip Op 50050(U) [34 Misc 3d 140(A)]

Decided on January 13, 2012

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This opinion is uncorrected and will not be published in the printed Official Reports.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 January 13, 2012

SUPREME COURT OF THE STATE OF NEW YORK

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

PRESENT: : GOLIA, J.P., WESTON and RIOS, JJ
2009-1721 K C.

Sky Medical Supply, Inc. as Assignee of WENDY FISHER, Respondent,
against
New York Central Mutual Fire Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Robin S. Garson, J.), entered June 8, 2009. The order denied defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order is reversed, without costs, and defendant’s motion for summary judgment dismissing the complaint is granted.

In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from an order denying its motion for summary judgment dismissing the complaint.

The affidavit submitted by defendant in support of its motion for summary judgment was sufficient to establish that defendant’s denial of claim form, which denied the claim at issue on the ground of lack of medical necessity, had been timely mailed in accordance with defendant’s standard office practices and procedures (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]). Defendant also submitted, among other [*2]things, an affidavit by its chiropractor/acupuncturist, together with her peer review report, which set forth a factual basis and medical rationale for her determination that there was a lack of medical necessity for the medical supplies at issue. Defendant’s showing that the supplies were not medically necessary was not rebutted by plaintiff. In light of the foregoing, defendant’s motion for summary judgment dismissing the complaint should have been granted (see Delta Diagnostic Radiology, P.C. v Integon Natl. Ins. Co., 24 Misc 3d 136[A], 2009 NY Slip Op 51502[U] [App Term, 2d, 11th & 13th Jud Dists 2009]; Delta Diagnostic Radiology, P.C. v American Tr. Ins. Co., 18 Misc 3d 128[A], 2007 NY Slip Op 52455[U] [App Term, 2d & 11th Jud Dists 2007]; A. Khodadadi Radiology, P.C. v NY Cent. Mut. Fire Ins. Co., 16 Misc 3d 131[A], 2007 NY Slip Op 51342[U] [App Term, 2d & 11th Jud Dists 2007]).

Golia, J.P., Weston and Rios, JJ., concur.
Decision Date: January 13, 2012