September 9, 2011

Triangle R Inc. v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 51663(U))

https://www.beynensonlaw.com/case-law/triangle-r-inc-v-new-york-cent-mut-fire-ins-co-2011-ny-slip-op-51663u/

Court: Appellate Term, First Department
Decided: September 9, 2011
Citation: 2011 NY Slip Op 51663(U)
Posture: Summary judgment
Outcome: Insurer prevailed
Later treatment: Followed in 3 later decisions (see Cited by)
Issues: Medical necessity
Legal questions: Lack of medical necessity (see the maps)

Cite as

Triangle R Inc. v New York Cent. Mut. Fire Ins. Co., 2011 NY Slip Op 51663(U) (App Term, 1st Dept 2011)

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 provider's unsworn medical report failed to rebut the insurer's showing that the medical supplies were unnecessary. The Appellate Term, First Department, reversed the order, insofar as appealed from, granted the insurer's motion for summary judgment, and dismissed the complaint for assigned no-fault benefits. The insurer's submissions established prima facie that the supplies furnished to the assignor lacked medical necessity. The provider relied on an undated report that was not properly sworn under CPLR 2106 and 2109 and therefore should not have been considered. Following CPT Med. Servs., P.C. v New York Cent. Mut. Fire Ins. Co., the court further concluded that, even if considered, the report was insufficient to raise a triable issue.

Reported in New York Official Reports at Triangle R Inc. v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 51663(U))

[*1]

Triangle R Inc. v New York Cent. Mut. Fire Ins. Co.

2011 NY Slip Op 51663(U)

Decided on September 9, 2011

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This opinion is uncorrected and will not be published in the printed Official Reports.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 September 9, 2011

APPELLATE TERM OF THE SUPREME COURT, FIRST DEPARTMENT

PRESENT: Torres, J.P., Shulman, Hunter, Jr., JJ
570308/11.

Triangle R Inc. a/a/o Michael Torres, Plaintiff-Respondent, – –
against
New York Central Mutual Fire Insurance Company, Defendant-Appellant.

Defendant appeals, as limited by its brief, from that portion of an order of the Civil Court of the City of New York, Bronx County (Raul Cruz, J.), entered October 20, 2010, which denied its motion for summary judgment dismissing the complaint.

Per Curiam.

Order (Raul Cruz, J.), entered October 20, 2010, insofar as appealed from, reversed, with $10 costs, defendant’s motion for summary judgment granted and complaint dismissed. The Clerk is directed to enter judgment accordingly.

In this action by plaintiff to recover assigned first-party no-fault benefits, defendant’s submissions sufficed to establish prima facie that the medical supplies provided by plaintiff to its assignor were not medically necessary (see Enko Enters. Intl., Inc. v Clarendon Natl. Ins. Co., 30 Misc 3d 127[A], 2010 NY Slip Op 52267[U] [2010]; Innovative Chiropractic, P.C. v Travelers Ins. Co., 25 Misc 3d 140[A], 2009 NY Slip Op 52447[U] [2009]). In opposition, plaintiff failed to raise a triable issue of fact. The undated medical report relied upon by plaintiff was not properly sworn (see CPLR 2106, 2109), and should not have been considered (see CPT Med. Servs., P.C. v New York Cent. Mut. Fire Ins. Co., 18 Misc 3d 87, 88 [2007]). Moreover, even if considered, the report was insufficient to defeat summary judgment (id.).

THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.
Decision Date: September 09, 2011

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: Insurer's proof established lack of medical necessity and the provider failed to rebut it

Held the insurer's submissions established prima facie lack of medical necessity of the supplies, and the provider's undated, unsworn medical report could not be considered and in any event was insufficient to raise a triable issue.

Unrebutted, insurer prevailsProvider's rebuttal sufficientInsurer raised triable issueInsurer's proof insufficientTrial error, new trialThis decisionCites it or cited by itCited or followed

Of the 73 decisions on this question in the First Department courts and the Court of Appeals, 29 (this one included) are in the same category. One decision in other departments that cites or is cited by this one is on the full map.

Cited in this decision

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

Innovative Chiropractic, P.C. v Travelers Ins. Co. (2009 NY Slip Op 52447(U)) FollowedThe treating chiropractor's conclusory affidavit failed to rebut the insurer's peer review on the provider's fifth cause of action.
CPT Med. Servs., P.C. v New York Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 27526) FollowedThe provider's attorney affirmation and unsworn medical report failed to rebut the insurer's evidence of lack of medical necessity.

Cited by

A label shows how the later decision treated this one.

Cortland Med. Supply, Inc. v 21st Century Centennial Ins. Co. (2014 NY Slip Op 51886(U)) FollowedThe insurer's peer review established lack of medical necessity, and the provider's attorney affirmation raised no triable issue.
Omega 18 Inc. v Global Liberty Ins. Co. of N.Y. (2020 NY Slip Op 50235(U)) FollowedThe insurer's affirmed peer review established that the prescribed medical supplies were unnecessary or redundant.
Five Boro Med. Equip., Inc. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 51888(U)) FollowedThe insurer established lack of medical necessity for two supply claims but failed to establish timely denial of a third claim.

Similar decisions

Triangle R, Inc. v GEICO Ins. Co. (2010 NY Slip Op 52060(U))The insurer's sworn peer review established lack of medical necessity for the equipment, and the provider did not rebut it.
Triangle R, Inc. v Tri-State Consumer Ins. Co. (2013 NY Slip Op 50256(U))The provider's denial of receipt did not rebut proof of timely mailed verification requests, and its unanswered claims were premature.
Triangle R Inc. v Praetorian Ins. Co. (2010 NY Slip Op 52041(U))An insurer need not pay or deny a no-fault claim until it receives all relevant requested verification.
SI Med. & Surgical Supply, P.C. v American Tr. Ins. Co. (2012 NY Slip Op 50054(U))The insurer's peer reviews established lack of medical necessity for the supplies, and the provider did not rebut that showing.
Theracare & Wellness, P.T., P.C. v Great N. Ins. Co. (2016 NY Slip Op 51429(U))The insurer's unrebutted IME report established a lack of medical necessity for the treatment at issue.