April 26, 2011

We Do Care Med. Supply, P.C. v American Tr. Ins. Co. (2011 NY Slip Op 50783(U))

Headnote

The court considered the appeal from an order of the Civil Court of the City of New York, Queens County, which denied the defendant's cross motion for summary judgment dismissing the complaint in an action to recover assigned first-party no-fault benefits. The main issue in the case was whether the medical supplies provided to the plaintiff's assignor were medically necessary. The court found that the defendant had timely denied the claim based on a lack of medical necessity, and that the defendant's showing that the supplies were not medically necessary was not rebutted by the plaintiff. Therefore, the defendant's cross motion for summary judgment dismissing the complaint was granted, reversing the order of the Civil Court. The holding of the case was that the defendant's cross motion for summary judgment should have been granted, as the plaintiff did not challenge the finding that the defendant had timely denied the claim based on a lack of medical necessity.

Reported in New York Official Reports at We Do Care Med. Supply, P.C. v American Tr. Ins. Co. (2011 NY Slip Op 50783(U))

We Do Care Med. Supply, P.C. v American Tr. Ins. Co. (2011 NY Slip Op 50783(U)) [*1]

We Do Care Med. Supply, P.C. v American Tr. Ins. Co.

2011 NY Slip Op 50783(U) [31 Misc 3d 140(A)]

Decided on April 26, 2011

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This opinion is uncorrected and will not be published in the printed Official Reports.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 April 26, 2011

SUPREME COURT OF THE STATE OF NEW YORK

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

PRESENT: : PESCE, P.J., WESTON and GOLIA, JJ
.

We Do Care Medical Supply, P.C. as Assignee of FREDDIE WATKINS, Respondent, NO~ 2010-771 Q C
against
American Transit Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Queens County (Carmen R. Velasquez, J.), entered February 25, 2010. The order, insofar as appealed from, denied defendant’s cross motion for summary judgment dismissing the complaint.

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

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment and defendant cross-moved for summary judgment dismissing the complaint. The Civil Court found that plaintiff had established its prima facie case, that defendant had demonstrated that it had timely denied plaintiff’s claim and that the sole issue for trial was the medical necessity of the supplies provided to plaintiff’s assignor. Defendant appeals from so much of the order as denied its cross motion for summary judgment dismissing the complaint.

In support of its cross motion, defendant submitted, among other things, an independent medical examination report which set forth a factual basis and a medical rationale for the doctor’s determination that there was a lack of medical necessity for the medical supplies at issue. Defendant’s showing that such supplies were not medically necessary was not rebutted by plaintiff.

In light of the foregoing, and the Civil Court’s implicit CPLR 3212 (g) finding that defendant had timely denied the claim based on a lack of medical necessity, a finding which plaintiff does not challenge, defendant’s cross 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 [*2]Cent. Mut. Fire Ins. Co., 16 Misc 3d 131[A], 2007 NY Slip Op 51342[U] [App Term, 2d & 11th Jud Dists 2007]).

Pesce, P.J., Weston and Golia, JJ., concur.
Decision Date: April 26, 2011