Reported in New York Official Reports at Healing Health Prods., Inc. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 24145)
| Healing Health Prods., Inc. v New York Cent. Mut. Fire Ins. Co. |
| 2014 NY Slip Op 24145 [44 Misc 3d 59] |
| Accepted for Miscellaneous Reports Publication |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| As corrected through Wednesday, September 10, 2014 |
[*1]
| Healing Health Products, Inc., as Assignee of Devonn Palmer, Respondent, v New York Central Mutual Fire Insurance Company, Appellant |
Supreme Court, Appellate Term, Second Department, 2d, 11th and 13th Judicial Districts, May 22, 2014
APPEARANCES OF COUNSEL
Nightingale Law, P.C., Glen Cove (Michael S. Nightingale of counsel), for appellant.
The Rybak Firm, PLLC, Brooklyn (Damin J. Toell of counsel), for respondent.
{**44 Misc 3d at 60} OPINION OF THE COURT
Ordered that the order is affirmed, with $25 costs.
In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint, arguing that the action is premature since plaintiff had not responded to its verification requests. The Civil Court denied defendant’s motion, finding that a triable issue of fact existed as to whether the requests had been received by plaintiff.
As a preliminary matter, we note that, contrary to the apparent positions of both parties on appeal, the order appealed from does not limit the issues for trial pursuant to CPLR 3212 (g) (see generally A.B. Med. Servs., PLLC v Utica Mut. Ins. Co., 32 Misc 3d 63 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2011]).
Since a claim need not be paid or denied until all demanded verification is provided (see Westchester County Med. Ctr. v New York Cent. Mut. Fire Ins. Co., 262 AD2d 553, 554 [1999]), any action to recover payment is premature when the provider has failed to respond to a request for verification (see Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492, 493 [2005]). Here, in support of its motion, defendant made a prima facie showing that it had timely mailed three initial and three follow-up requests for verification to plaintiff, with carbon copies mailed to plaintiff’s attorney, in accordance with its standard mailing practices and procedures (see Insurance Department Regulations [11 NYCRR] §§ 65-3.5 [b]; 65-3.6 [b]; St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). This gave rise to a rebuttable presumption that the requests had been received by both plaintiff and its attorney{**44 Misc 3d at 61} (see Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [2001]).
It is undisputed that plaintiff did not respond to the requests. However, in opposition to [*2]defendant’s motion, plaintiff submitted an affidavit executed by its owner in which he described plaintiff’s practices and procedures that result in all mail being recorded in plaintiff’s computer system on the date of receipt, as well as being physically filed in the appropriate “patient” file. Plaintiff’s owner stated that he had reviewed the computer file and the physical file for the “patient” at issue, and that plaintiff has no record of having received verification requests for the claims at issue.
For the purpose of determining whether a no-fault insurer’s time to pay or deny a claim has been tolled (see Insurance Department Regulations [11 NYCRR] § 65-3.8 [a] [1]), a request for written verification that the insurer communicates to the applicant by mail is complete upon its delivery to the United States Postal Service (cf. CPLR 2103 [b] [2]). Thus, contrary to the finding of the Civil Court, the operative question in this case is not whether the requests were received by plaintiff, but whether defendant mailed them. Here, by rebutting the presumption of receipt, plaintiff raised a triable issue of fact as to whether the verification requests had been properly mailed to plaintiff in the first place.
Defendant correctly asserts that plaintiff did not make a prima facie showing that its attorney had not received the carbon copies of the verification requests that allegedly had been sent to counsel’s office. However, contrary to defendant’s argument, receipt of such letters did not give rise to a duty on the part of plaintiff’s counsel to forward these requests to plaintiff since, on their face, they purport to duplicate letters simultaneously sent to plaintiff (but cf. New York Hosp. Med. Ctr. of Queens v State Farm Mut. Auto. Ins. Co., 293 AD2d 588, 590-591 [2002]; Great Wall Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co., 22 Misc 3d 136[A], 2009 NY Slip Op 50294[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2009]).
Accordingly, the order is affirmed.
Weston, J.P., Aliotta and Solomon, JJ., concur.
Reported in New York Official Reports at Utica Natl. Ins. Co. of Tex. v Clennan (2014 NY Slip Op 50806(U))
| Utica Natl. Ins. Co. of Tex. v Clennan |
| 2014 NY Slip Op 50806(U) [43 Misc 3d 140(A)] |
| Decided on May 7, 2014 |
| 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 May 7, 2014
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 9th and 10th JUDICIAL DISTRICTS
PRESENT: : NICOLAI, P.J., MARANO and GARGUILO, JJ.
2013-1650 S C
against
Colin Clennan, Appellant.
Appeal from an order of the District Court of Suffolk County, First District (Vincent J. Martorana, J.), dated May 23, 2013. The order, insofar as appealed from and as limited by the brief, granted the branch of plaintiff’s motion seeking summary judgment to the extent of granting plaintiff summary judgment on the issue of liability.
ORDERED that the order, insofar as appealed from, is affirmed, without costs.
Plaintiff commenced this subrogation action to recover the sum of $3,042.26, the amount it had paid its insured for damage to her vehicle after the bicycle which defendant had been operating allegedly struck and damaged her vehicle, which was legally parked on the street in front of her residence. Plaintiff alleged in its complaint that the occurrence had been caused by defendant’s negligence, without any negligence on the part of the subrogor. Defendant, in his verified answer, generally denied the allegations of the complaint, but admitted that, on the date in question, he had been operating his bicycle on the street where the subrogor’s residence was located. In addition, he interposed a counterclaim seeking no-fault benefits due as a result of the accident, alleging that “[o]n or about June 8, 2011, Plaintiff [sic], then on a bicycle, collided with the vehicle owned by Plaintiff’s assignor [sic]”; that the cause of the accident was how the vehicle was parked; and that, as a result of the accident, he had suffered, among other things, physical injury. He also stated that he had submitted to plaintiff medical bills for his treatment, and that plaintiff had denied payment. Plaintiff, as an affirmative defense to the counterclaim, stated that no-fault benefits were properly denied because the accident had not arisen out of the subrogor’s “use or operation of a motor vehicle.”
Thereafter, plaintiff moved for, among other things, an order granting it summary judgment, setting the matter down for an inquest as against defendant, and dismissing defendant’s counterclaim. Defendant cross-moved for summary judgment dismissing the complaint. The District Court, in an order dated May 23, 2013, found that the evidence submitted by plaintiff established a prima facie case with respect to defendant’s liability, and that defendant had failed to demonstrate that there was a genuine factual issue as to liability. Consequently, summary judgment was granted to plaintiff on the issue of liability. Since defendant had raised an issue of fact as to the amount of damages sustained by the subrogor’s vehicle as a result of the collision, the court ordered a trial of damages, in accordance with CPLR 3212 (c). Judgment was granted to plaintiff dismissing defendant’s counterclaim, as it was undisputed that the subrogor’s vehicle had been parked at the time of the collision and, therefore, defendant’s injuries did not result from the “use and operation of a motor [*2]vehicle” (Insurance Law § 5102 [b]). Defendant appeals, as limited by the brief, from so much of the order as granted the branch of plaintiff’s motion seeking summary judgment on the issue of liability. We affirm.
Plaintiff established its prima facie entitlement to summary judgment on the issue of liability by submitting evidence demonstrating that defendant’s bicycle struck its subrogor’s legally parked vehicle. Such evidence included: defendant’s verified answer with counterclaim, in which he stated that on the date in question, he “then on a bicycle, collided with the vehicle owned by Plaintiff’s assignor [sic]”; defendant’s application for no-fault benefits (an NF-2 form), signed by defendant, in which he stated, in the space left for a description of the accident that, at the time and place of the accident, “bicycle hit parked car”; and the affidavit of its subrogor stating that she had parked her vehicle directly in front of the entrance to her residence the afternoon before the incident, that she had locked the vehicle, that no one had used the vehicle, and that the following morning, she had seen that it had been damaged. In opposition, defendant failed to submit competent evidence to rebut the inference of negligence by offering a non-negligent explanation for the contact with a stationary motor vehicle. Defendant’s argument that there was no admissible proof of a collision between him and the subrogor’s vehicle is refuted by the submissions referred to above.
Accordingly, the order, insofar as appealed from, is affirmed.
Nicolai, P.J., Marano and Garguilo, JJ., concur.
Decision Date: May 07, 2014
Reported in New York Official Reports at EMC Health Prods., Inc. v Geico Ins. Co. (2014 NY Slip Op 50786(U))
| EMC Health Prods., Inc. v Geico Ins. Co. |
| 2014 NY Slip Op 50786(U) [43 Misc 3d 139(A)] |
| Decided on April 30, 2014 |
| 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. |
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2012-1208 K C
against
Geico Ins. Co., Appellant.
Appeal from an order of the Civil Court of the City of New York, Kings County (Carolyn E. Wade, J.), entered March 13, 2012. The order, insofar as appealed from and as limited by the brief, upon denying plaintiff’s motion for summary judgment, made, in effect, CPLR 3212 (g) findings in plaintiff’s favor.
ORDERED that the order, insofar as appealed from, is affirmed, with $25 costs.
In this action by a provider to recover assigned first-party no-fault benefits, insofar as is relevant to this appeal, the Civil Court, upon denying plaintiff’s motion for summary judgment, made, in effect, CPLR 3212 (g) findings in plaintiff’s favor, limiting the issues for trial to medical necessity.
On appeal, defendant fails to articulate a sufficient basis to strike the Civil Court’s CPLR 3212 (g) findings in plaintiff’s favor. Defendant’s denials admitted the receipt of the bills at issue (see East Acupuncture, P.C. v Electric Ins. Co., 16 Misc 3d 128[A], 2007 NY Slip Op 51281[U] [App Term, 2d & 11th Jud Dists 2007] Oleg Barshay, D.C., P.C. v State Farm Ins. Co., 14 Misc 3d 74 [App Term, 2d & 11th Jud Dists 2006]), and plaintiff was not required to establish a CPLR 4518 foundation for the bills (see Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 114 AD3d 33 [2013]). Defendant also argues, in effect, that the order improperly found that plaintiff had established, for all purposes in the action, that defendant had issued denials that were untimely or were conclusory, vague, or without merit as a matter of law (see Westchester Med. Ctr. v Nationwide Mut. Ins. Co., 78 AD3d 1168 [2010] Ave T MPC Corp. v Auto One Ins. Co., 32 Misc 3d 128[A], 2011 NY Slip Op 51292[U] [App Term, 2d, 11th & 13th Jud Dists 2011]). However, this is an incorrect reading of the order (see Avicenna Med. Arts, P.L.L.C. v GEICO Ins. Co., 41 Misc 3d 140[A], 2013 NY Slip Op 52010[U] [App Term, 2d, 11th & 13th Jud Dists 2013]). Had the court found, for example, that plaintiff had established that it was incontrovertible, for all purposes in the action, that defendant’s denials were without merit as a matter of law, the court would have granted summary judgment to plaintiff. Instead, the order directed that a trial be held. Consequently, regardless of the wording of the order, it is clear that it was not the court’s intent to find that plaintiff had established, for all purposes in the action, that defendant had issued denials that were untimely or were conclusory, vague, or without merit as a matter of law.
Accordingly, the order, insofar as appealed from, is affirmed.
Pesce, P.J., Aliotta and Solomon, JJ., concur.
Decision Date: April 30, 2014
Reported in New York Official Reports at Mount Sinai Hosp. of Queens v Country Wide Ins. Co. (2014 NY Slip Op 50780(U))
| Mount Sinai Hosp. of Queens v Country Wide Ins. Co. |
| 2014 NY Slip Op 50780(U) [43 Misc 3d 139(A)] |
| Decided on April 30, 2014 |
| 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. |
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 9th and 10th JUDICIAL DISTRICTS
PRESENT: : IANNACCI, J.P., MARANO and TOLBERT, JJ.
2012-2297 N C
against
Country Wide Insurance Company, Respondent.
[*1]
Appeal from an order of the District Court of Nassau County, First District (Andrea Phoenix, J.), dated June 4, 2012. The order granted defendant’s cross motion for summary judgment dismissing the complaint and implicitly denied plaintiff’s motion for summary judgment.
ORDERED that the order is affirmed, without costs.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the District Court which granted defendant’s cross motion for summary judgment dismissing the complaint and implicitly denied plaintiff’s motion for summary judgment.
In support of its cross motion, defendant proffered an affidavit by its no-fault litigation supervisor which was sufficient to establish that defendant’s denial of claim form had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]) and that plaintiff had submitted its claim to defendant more than 45 days after the date the services had been rendered to plaintiff’s assignor (see Insurance Department Regulations [11 NYCRR] § 65-1.1). Defendant’s denial of claim form adequately advised plaintiff of the basis for the denial, and it further informed plaintiff that the late submission of the claim would be excused if plaintiff provided a reasonable justification for the lateness (see Insurance Department Regulations [11 NYCRR] § 65-3.3 [e]). Plaintiff failed to proffer a reason for the late submission. Consequently, the District Court properly determined that defendant was entitled to summary judgment dismissing the complaint.
Accordingly, the order is affirmed.
Iannacci, J.P., Marano and Tolbert, JJ., concur.
Decision Date: April 30, 2014
Reported in New York Official Reports at New Way Med. Supply Corp. v Geico Ins. Co. (2014 NY Slip Op 50776(U))
| New Way Med. Supply Corp. v Geico Ins. Co. |
| 2014 NY Slip Op 50776(U) [43 Misc 3d 138(A)] |
| Decided on April 30, 2014 |
| 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. |
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2012-1188 K C
against
Geico Ins. Co., Appellant.
[*1]
Appeal from an order of the Civil Court of the City of New York, Kings County (Harriet L. Thompson, J.), entered March 26, 2012. The order, insofar as appealed from, upon denying plaintiff’s motion for summary judgment, made, in effect, CPLR 3212 (g) findings in plaintiff’s favor, and denied defendant’s cross motion for summary judgment dismissing the complaint.
ORDERED that the order, insofar as appealed from, is affirmed, with $25 costs.
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 on the ground that it had timely and properly denied the claim at issue based on a lack of medical necessity. Insofar as is relevant to this appeal, the Civil Court, upon denying plaintiff’s motion, made CPLR 3212 (g) findings in plaintiff’s favor, denied defendant’s cross motion, and held that the only remaining issue for trial was medical necessity.
For the reasons stated in EMC Health Prods., Inc. as Assignee of Brian Byers v Geico Ins. Co. (___ Misc 3d ___, 2014 NY Slip Op _____ [Appeal No. 2012-1208 K C], decided herewith), we find that defendant failed to articulate a sufficient basis to strike the Civil Court’s CPLR 3212 (g) findings in plaintiff’s favor. Moreover, upon a review of the record, we find that there is a triable issue of fact regarding the medical necessity of the services at issue.
Accordingly, the order, insofar as appealed from, is affirmed.
Pesce, P.J., Aliotta and Solomon, JJ., concur.
Decision Date: April 30, 2014
Reported in New York Official Reports at High Quality Med. Supplies, Inc. v Praetorian Ins. Co. (2014 NY Slip Op 50775(U))
| High Quality Med. Supplies, Inc. v Praetorian Ins. Co. |
| 2014 NY Slip Op 50775(U) [43 Misc 3d 138(A)] |
| Decided on April 30, 2014 |
| 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. |
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2012-492 K C
against
Praetorian Ins. Co., Appellant.
[*1]
Appeal from an order of the Civil Court of the City of New York, Kings County (Reginald A. Boddie, J.), entered October 20, 2011. The order, insofar as appealed from, upon denying plaintiff’s motion for summary judgment, made CPLR 3212 (g) findings in plaintiff’s favor, and denied defendant’s cross motion for summary judgment dismissing the complaint.
ORDERED that the order, insofar as appealed from, is affirmed, with $25 costs.
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 on the ground that it had timely and properly denied the claims at issue based on a lack of medical necessity. Insofar as is relevant to this appeal, the Civil Court, upon denying plaintiff’s motion, made CPLR 3212 (g) findings in plaintiff’s favor, and denied defendant’s cross motion.
On appeal, defendant fails to articulate a sufficient basis to strike the Civil Court’s CPLR 3212 (g) findings in plaintiff’s favor (see EMC Health Prods. as Assignee of Brian Byers v Geico Ins. Co., ___ Misc 3d ___, 2014 NY Slip Op _____ [Appeal No. 2012-1208 K C], decided herewith). Moreover, upon a review of the record, we find that there is a triable issue of fact regarding the medical necessity of the supplies at issue. As a result, defendant is not entitled to summary judgment dismissing the complaint.
Accordingly, the order, insofar as appealed from, is affirmed.
Pesce, P.J., Aliotta and Solomon, JJ., concur.
Decision Date: April 30, 2014
Reported in New York Official Reports at J.C. Healing Touch Rehab, P.C. v Eveready Ins. Co. (2014 NY Slip Op 50774(U))
| J.C. Healing Touch Rehab, P.C. v Eveready Ins. Co. |
| 2014 NY Slip Op 50774(U) [43 Misc 3d 138(A)] |
| Decided on April 30, 2014 |
| 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. |
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2012-378 K C
against
Eveready Ins. Co., Appellant.
Appeal from an order of the Civil Court of the City of New York, Kings County (Pamela L. Fisher, J.), entered October 31, 2011. The order, insofar as appealed from, upon denying plaintiff’s motion for summary judgment, made, in effect, CPLR 3212 (g) findings in plaintiff’s favor, and denied defendant’s cross motion for summary judgment dismissing the complaint.
[*1]ORDERED that the order, insofar as appealed from, is affirmed, with $25 costs.
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 on the ground that it had timely and properly denied the claims at issue based on a lack of medical necessity. Insofar as is relevant to this appeal, the Civil Court, upon denying plaintiff’s motion, made, in effect, CPLR 3212 (g) findings in plaintiff’s favor, denied defendant’s cross motion, and held that the only remaining issue for trial was whether the verification requested by defendant was outstanding.
For the reasons stated in EMC Health Prods., Inc. as Assignee of Brian Byers v Geico Ins. Co. (___ Misc 3d ___, 2014 NY Slip Op _____ [Appeal No. 2012-1208 K C], decided herewith), we find that defendant failed to articulate a sufficient basis to strike the Civil Court’s implicit CPLR 3212 (g) findings in plaintiff’s favor. Moreover, upon a review of the record, we find that the Civil Court correctly found that there is a triable issue of fact as to whether the verification requested by defendant was outstanding (see Westchester Med. Ctr. v A Cent. Ins. Co., 114 AD3d 937 [2014] Wyckoff Hgts. Med. Ctr. v Government Empls. Ins. Co., 114 AD3d 855 [2014]).
Accordingly, the order, insofar as appealed from, is affirmed.
Pesce, P.J., Aliotta and Solomon, JJ., concur.
Decision Date: April 30, 2014
Reported in New York Official Reports at Promed Durable Equip., Inc. v Geico Ins. (2014 NY Slip Op 50773(U))
| Promed Durable Equip., Inc. v Geico Ins. |
| 2014 NY Slip Op 50773(U) [43 Misc 3d 138(A)] |
| Decided on April 30, 2014 |
| 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. |
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2012-94 K C
against
Geico Insurance, Appellant.
[*1]
Appeal from an order of the Civil Court of the City of New York, Kings County (Katherine A. Levine, J.), entered November 21, 2011. The order, insofar as appealed from, upon denying plaintiff’s motion for summary judgment, made, in effect, CPLR 3212 (g) findings in plaintiff’s favor, and denied defendant’s cross motion for summary judgment dismissing the complaint.
ORDERED that the order, insofar as appealed from, is modified by providing that the branch of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover for supplies furnished on October 17, 2008 is granted to the extent of dismissing so much of the complaint as sought to recover for an “E.M.S.,” “EMS Accessories,” “EMS Supply,” and a back massager, and the branch of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover for supplies furnished on September 19, 2008 is granted to the extent of dismissing so much of the complaint as sought to recover for a “heating pad”; as so modified, the order, insofar as appealed from, is affirmed, without costs.
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 on the ground that it had timely and properly denied the claims at issue based on a lack of medical necessity. Insofar as is relevant to this appeal, the Civil Court, upon denying plaintiff’s motion, made, in effect, CPLR 3212 (g) findings in plaintiff’s favor, denied defendant’s cross motion, and held that the only remaining issue for trial was medical necessity.
On appeal, defendant fails to articulate a sufficient basis to strike the Civil Court’s implicit CPLR 3212 (g) findings in plaintiff’s favor (see EMC Health Prods. as Assignee of Brian Byers v Geico Ins. Co., ___ Misc 3d ___, 2014 NY Slip Op _____ [Appeal No. 2012-1208 K C], decided herewith).
In support of its cross motion, defendant submitted sworn peer review reports which set forth a factual basis and medical rationale for the peer reviewers’ determinations that there was a lack of medical necessity for the supplies at issue. In opposition to defendant’s motion, plaintiff submitted an affirmation by a doctor which was sufficient to raise a triable issue of fact as to whether the supplies, other than the “E.M.S.,” “EMS Accessories,” “EMS Supply” and a back massager furnished on October 17, 2008, and a “heating pad” furnished on September 19, 2008, were medically necessary.
As to the “E.M.S.,” “EMS Accessories,” “EMS Supply” and a back massager
furnished on October 17, 2008, and the “heating pad” furnished on September 19, 2008,
defendant’s peer reviewers concluded that these supplies were superfluous because
plaintiff’s assignor had been receiving physical therapy as well as treatment by a
chiropractor and an acupuncturist. In
Accordingly, the order, insofar as appealed from, is modified by providing that the branch of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover for supplies furnished on October 17, 2008 is granted to the extent of dismissing so much of the complaint as sought to recover for an “E.M.S.,” “EMS Accessories,” “EMS Supply” and a back massager, and the branch of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover for supplies furnished on September 19, 2008 is granted to the extent of dismissing so much of the complaint as sought to recover for a “heating pad.”
Pesce, P.J., Aliotta and Solomon, JJ., concur.
Decision Date: April 30, 2014
Reported in New York Official Reports at Promed Durable Equip., Inc. v Geico Ins. (2014 NY Slip Op 50772(U))
| Promed Durable Equip., Inc. v Geico Ins. |
| 2014 NY Slip Op 50772(U) [43 Misc 3d 138(A)] |
| Decided on April 30, 2014 |
| 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. |
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2012-42 K C
against
Geico Insurance, Appellant.
[*1]
Appeal from an order of the Civil Court of the City of New York, Kings County (Dawn Jimenez Salta, J.), entered November 9, 2011. The order, insofar as appealed from, upon denying plaintiff’s motion for summary judgment, made, in effect, CPLR 3212 (g) findings in plaintiff’s favor, and denied defendant’s cross motion for summary judgment dismissing the complaint.
ORDERED that the order, insofar as appealed from, is modified by providing that the branch of defendant’s cross motion seeking summary judgment dismissing so much
of the complaint as sought to recover for supplies furnished on January 9, 2009 is granted; as so modified, the order, insofar as appealed from, is affirmed, without costs.
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 on the ground that it had timely and properly denied the claims at issue based on a lack of medical necessity. Insofar as is relevant to this appeal, the Civil Court, upon denying plaintiff’s motion, made, in effect, CPLR 3212 (g) findings in plaintiff’s favor, denied defendant’s cross motion, and held that the only remaining issue for trial was medical necessity.
On appeal, defendant fails to articulate a sufficient basis to strike the Civil Court’s implicit CPLR 3212 (g) findings in plaintiff’s favor (see EMC Health Prods. as Assignee of Brian Byers v Geico Ins. Co., ___ Misc 3d ___, 2014 NY Slip Op _____ [Appeal No. 2012-1208 K C], decided herewith). Moreover, upon a review of the record, we find that there is a triable issue of fact regarding the medical necessity of the supplies furnished on December 12, 2008. Consequently, the branch of defendant’s cross motion seeking to dismiss so much of the complaint as sought to recover for these supplies was properly denied (see Zuckerman v City of New York, 49 NY2d 557 [1980]).
In support of the branch of its cross motion seeking summary judgment dismissing
so much of the complaint as sought to recover for supplies furnished on January 9, 2009,
defendant submitted a peer review report which set forth a factual basis and medical
rationale for the doctor’s determination that there was a lack of medical necessity for
these supplies, on the ground, among others, that the assignor had already been involved
in a physical therapy treatment plan which rendered the supplies unnecessary. In
opposition, plaintiff submitted an affirmation by a doctor which failed to meaningfully
refer to, let alone sufficiently rebut, this determination (see Pan Chiropractic, P.C. v
Mercury Ins. Co., 24 Misc 3d 136[A], 2009 NY Slip Op 51495[U] [App Term,
2d, 11th & 13th Jud Dists 2009]). Since plaintiff has not challenged the Civil
Court’s finding, in effect, that defendant is otherwise entitled to judgment, the branch of
defendant’s cross motion seeking summary judgment dismissing so much of the
complaint as sought to recover for supplies furnished on January 9, 2009 should have
been granted (see Park
Accordingly, the order, insofar as appealed from, is modified by providing that the branch of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover for supplies furnished on January 9, 2009 is granted.
Pesce, P.J., Aliotta and Solomon, JJ., concur.
Decision Date: April 30, 2014
Reported in New York Official Reports at Promed Durable Equip., Inc. v Geico Ins. (2014 NY Slip Op 50771(U))
| Promed Durable Equip., Inc. v Geico Ins. |
| 2014 NY Slip Op 50771(U) [43 Misc 3d 138(A)] |
| Decided on April 30, 2014 |
| Appellate Term, Second Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| As corrected in part through May 19, 2014; it will not be published in the printed Official Reports. |
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2012-36 K C
against
Geico Insurance, Appellant.
[*1]
Appeal from an order of the Civil Court of the City of New York, Kings County (Robin Kelly Sheares, J.), entered October 13, 2011. The order, insofar as appealed from, upon denying plaintiff’s motion for summary judgment, made, in effect, CPLR 3212 (g) findings in plaintiff’s favor, and denied defendant’s cross motion for summary judgment dismissing the complaint.
ORDERED that the order, insofar as appealed from, is affirmed, with $25 costs.
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 on the ground that it had timely and properly denied the claim at issue based on a lack of medical necessity. Insofar as is relevant to this appeal, the Civil Court, upon denying plaintiff’s motion, made, in effect, CPLR 3212 (g) findings in plaintiff’s favor, denied defendant’s cross motion, and held that the only remaining issue for trial was medical necessity.
For the reasons stated in EMC Health Prods., Inc. as Assignee of Brian Byers v Geico Ins. Co. (___ Misc 3d ___, 2014 NY Slip Op _____ [Appeal No. 2012-1208 K C], decided herewith), we find that defendant failed to articulate a sufficient basis to strike the Civil Court’s implicit CPLR 3212 (g) findings in plaintiff’s favor. Moreover, upon a review of the record, we find that there is a triable issue of fact regarding the medical necessity of the services at issue (see Zuckerman v City of New York, 49 NY2d 557 [1980]).
Accordingly, the order is affirmed.
Pesce, P.J., Aliotta and Solomon, JJ., concur.
Decision Date: April 30, 2014