December 7, 2012

VE Med. Care, P.C. v Praetorian Ins. Co. (2012 NY Slip Op 52262(U))

Headnote

The court considered a provider's claim to recover assigned first-party no-fault benefits, and the defendant insurance company moved for summary judgment to dismiss the complaint. In support of its motion, the insurance company submitted affirmed peer review reports and an independent medical examination report, which determined that there was a lack of medical necessity for the services rendered. The Civil Court denied the defendant's motion, stating that the matter shall proceed to trial on the issue of medical necessity. However, the appellate court reversed the decision, ruling in favor of the defendant, as the plaintiff failed to rebut the conclusions set forth in the defendant's reports. The holding of the case was that the defendant's motion for summary judgment dismissing the complaint was granted.

Reported in New York Official Reports at VE Med. Care, P.C. v Praetorian Ins. Co. (2012 NY Slip Op 52262(U))

VE Med. Care, P.C. v Praetorian Ins. Co. (2012 NY Slip Op 52262(U)) [*1]

VE Med. Care, P.C. v Praetorian Ins. Co.

2012 NY Slip Op 52262(U) [37 Misc 3d 140(A)]

Decided on December 7, 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This opinion is uncorrected and will not be published in the printed Official Reports.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 December 7, 2012

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

PRESENT: : RIOS, J.P., ALIOTTA and SOLOMON, JJ
2011-589 K C.

VE Medical Care, P.C. as Assignee of DIANA QUIROZ, Respondent, — Decided
against
Praetorian Ins. Co., Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Katherine A. Levine, J.), dated October 15, 2010. The order, insofar as appealed from, denied defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order, insofar as appealed from, is reversed, with $30 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 moved for summary judgment dismissing the complaint. The Civil Court denied defendant’s motion, finding, among other things, that defendant had established its prima facie case and that the “matter shall proceed to trial on the issue of medical necessity.”

In support of its motion, defendant submitted, among other things, affirmed peer review reports and an independent medical examination report, which set forth factual bases and medical rationales for the reviewers’ determinations that there was a lack of medical necessity for the services rendered. In opposition to the motion, plaintiff failed to rebut the conclusions set forth in defendant’s reports. In view of the foregoing, and as plaintiff has not challenged the Civil Court’s finding, in effect, that defendant is otherwise entitled to judgment, the order, insofar as appealed from, is reversed and defendant’s motion for summary judgment dismissing the [*2]complaint is 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]).

Rios, J.P., Aliotta and Solomon, JJ., concur.
Decision Date: December 07, 2012