May 22, 2006

Vladimir Zlatnick, M.D., P.C. v Travelers Indem. Co. (2006 NY Slip Op 50963(U))

Headnote

After a nonjury trial, the Civil Court, Bronx County, awarded the plaintiff provider $2,573.17 in first-party no-fault benefits for tests rendered to its assignor. The insurer appealed, arguing the tests were not medically necessary. The Appellate Term found that the evidence supported the trial court's finding that the tests were medically necessary. It reasoned that, even assuming a peer review report could by itself make a prima facie showing of lack of medical necessity, the insurer's report was conclusory and lacked a detailed basis and medical rationale. The plaintiff's neurological expert's credited testimony was in any event sufficient, and the judgment was affirmed.

Reported in New York Official Reports at Vladimir Zlatnick, M.D., P.C. v Travelers Indem. Co. (2006 NY Slip Op 50963(U))

[*1]
Vladimir Zlatnick, M.D., P.C. v Travelers Indem. Co.
2006 NY Slip Op 50963(U) [12 Misc 3d 128(A)]
Decided on May 22, 2006
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This opinion is uncorrected and will not be published in the printed Official Reports.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 May 22, 2006
APPELLATE TERM OF THE SUPREME COURT, FIRST DEPARTMENT

PRESENT: McCOOE, J.P. DAVIS, GANGEL JACOB, JJ
.

Vladimir Zlatnick, M.D., P.C., a/a/o Angela Reynolds, Plaintiff-Respondent, No.570914/05

against

Travelers Indemnity Company, Defendant-Appellant.


Defendant appeals from a judgment of the Civil Court, Bronx County (Raul Cruz, J.), entered July 6, 2005, after a nonjury trial, in favor of plaintiff in the sum of $2,573.17.


PER CURIAM:

Judgment (Raul Cruz, J.), entered July 6, 2005, affirmed, with $25 costs.

The evidence, fairly considered, supports the trial court’s determination that the tests underlying this first party no-fault benefits action were medically necessary. Even assuming, without deciding, that a peer review report may suffice, without more, to establish a prima facie showing of lack of medical necessity, the report relied upon by defendant, conclusory in nature and lacking a detailed basis and medical rationale for the denial of benefits, was clearly insufficient to sustain defendant’s evidentiary burden. In any event, the fully credited testimony of plaintiff’s neurological expert was sufficient to support plaintiff’s burden of persuasion on the issue.

This constitutes the decision and order of the court.
I concurI concurI concur


Decision Date: May 22, 2006