Bronze Acupuncture, P.C. v Mercury Ins. Co. (2009 NY Slip Op 51219(U))

Reported in New York Official Reports at Bronze Acupuncture, P.C. v Mercury Ins. Co. (2009 NY Slip Op 51219(U))

Bronze Acupuncture, P.C. v Mercury Ins. Co. (2009 NY Slip Op 51219(U)) [*1]
Bronze Acupuncture, P.C. v Mercury Ins. Co.
2009 NY Slip Op 51219(U) [24 Misc 3d 126(A)]
Decided on June 12, 2009
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This opinion is uncorrected and will not be published in the printed Official Reports.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 June 12, 2009

SUPREME COURT OF THE STATE OF NEW YORK

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


PRESENT: : PESCE, P.J., GOLIA and STEINHARDT, JJ
2008-639 Q C.
Bronze Acupuncture, P.C. as assignee of LAVEL FOLKS, Respondent,

against

Mercury Ins. Co., Appellant.

Appeal from an order of the Civil Court of the City of New York, Queens County (Diane A. Lebedeff, J.), dated February 21, 2008. The order, insofar as appealed from as limited by the brief, denied so much of defendant’s motion as sought summary judgment with respect to four bills ($111.38, $55.69, $122.88 and $61.44) for services rendered between November 28, 2006 and January 13, 2007.

Order, insofar as appealed from, reversed without costs and so much of defendant’s motion as sought summary judgment with respect to four bills ($111.38, $55.69, $122.88 and $61.44) for services rendered between November 28, 2006 and January 13, 2007 granted.

In this action by a provider to recover assigned first-party no-fault benefits, the Civil Court denied defendant’s motion which, insofar as is relevant to this appeal, sought summary judgment with respect to four bills ($111.38, $55.69, $122.88 and $61.44) for services rendered between November 28, 2006 and January 13, 2007, finding that the “only issue remaining for trial is medical necessity. Both plaintiff and defendant established their prima facie case.” The instant appeal by defendant ensued.

Contrary to plaintiff’s contention, the affidavit of defendant’s claim representative established that the denial of claim forms, which denied the subject claims on the ground of lack of medical necessity based upon an independent medical examination (IME) report, were timely mailed in accordance with defendant’s standard office practice or procedure used to ensure that items are properly addressed and mailed (see Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [2001]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]).

The papers submitted by defendant in support of its motion, including the affirmed IME [*2]report and an affidavit executed by the acupuncturist who performed the IME, established, prima facie, a lack of medical necessity for the services at issue. The opposing affidavit submitted by plaintiff’s treating acupuncturist merely stated that she disagreed with the results of the IME report without setting forth any facts to support her conclusion. Consequently, the opposition papers failed to raise a triable issue of fact as to medical necessity. As a result, defendant’s motion for summary judgment dismissing the claims at issue should have been granted (see Continental Med., P.C. v Mercury Cas. Co., 22 Misc 3d 134[A], 2009 NY Slip Op 50234[U] [App Term, 2d, 11th & 13th Jud Dists 2009]; CPT Med. Servs., P.C. v New York Cent. Mut. Fire Ins. Co., 18 Misc 3d 87, 88 [App Term, 1st Dept 2008]).

Pesce, P.J., Golia and Steinhardt, JJ., concur.
Decision Date: June 12, 2009

Focus Radiology, P.C. v New York Cent. Mut. Ins. Co. (2009 NY Slip Op 51218(U))

Reported in New York Official Reports at Focus Radiology, P.C. v New York Cent. Mut. Ins. Co. (2009 NY Slip Op 51218(U))

Focus Radiology, P.C. v New York Cent. Mut. Ins. Co. (2009 NY Slip Op 51218(U)) [*1]
Focus Radiology, P.C. v New York Cent. Mut. Ins. Co.
2009 NY Slip Op 51218(U) [24 Misc 3d 126(A)]
Decided on June 12, 2009
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 June 12, 2009

SUPREME COURT OF THE STATE OF NEW YORK

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


PRESENT: : WESTON, J.P., GOLIA and STEINHARDT, JJ
2008-350 RI C.
Focus Radiology, P.C. as assignee of ANTONIA METTELUS, Respondent,

against

New York Central Mutual Insurance Co., Appellant.

Appeal from an order of the Civil Court of the City of New York, Richmond County (Johnny Lee Baynes, J.), entered November 29, 2007. The order denied defendant’s motion to dismiss the complaint pursuant to CPLR 3211 or, in the alternative, for summary judgment determining that defendant’s denial of claim form was timely mailed.

Order modified by adding thereto the provision that the acknowledgment of service annexed to defendant’s moving papers is deemed timely filed; as so modified, affirmed without costs.

In this action by a provider to recover assigned first-party no-fault benefits, defendant moved pursuant to CPLR 3211 to dismiss the action without prejudice because plaintiff failed to file the summons with proof of service as required by former section 409 of the New York City Civil Court Act or, in the alternative, for summary judgment determining that defendant’s denial of claim form was timely mailed. In opposition, plaintiff asked for nunc pro tunc relief pursuant to CCA former 411. The Civil Court denied defendant’s motion. This appeal by defendant ensued.

Dismissal of the action without prejudice due to a violation of CCA former 409, which required that a copy of the summons with proof of service be filed within 14 days after service of the summons, is not warranted where, as here, plaintiff requested nunc pro tunc relief (see CCA former 411). Under the circumstances presented, such nunc pro tunc relief should have been granted.

The affidavit submitted by defendant’s claims examiner failed to establish that defendant timely mailed its verification requests and its denial of claim form based upon its standard office practice or procedure designed to ensure that items are properly addressed and mailed (see New [*2]York & Presbyt. Hosp. v Allstate Ins. Co., 29 AD3d 547 [2006]; Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [2001]; Top Choice Med., P.C. v New York Cent. Mut. Fire Ins. Co., 22 Misc 3d 133[A], 2009 NY Slip Op 50230[U] [App Term, 2d, 11th & 13th Jud Dists 2009]; Align for Health Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co., 20 Misc 3d 144[A], 2008 NY Slip Op 51862[U] [App Term, 2d & 11th Jud Dists 2008]; Horton Med., P.C. v New York Cent. Mut. Fire Ins. Co., 20 Misc 3d 142[A], 2008 NY Slip Op 51682[U] [App Term, 2d & 11th Jud Dists 2008]). As a result, defendant did not establish that its denial of claim form was timely. Accordingly, defendant’s motion was properly denied and the order is modified to provide for nunc pro tunc relief.

Weston, J.P., and Steinhardt, J., concur.

Golia, J., dissents in a separate memorandum.
Golia, J., dissents and votes to reverse the order and grant defendant’s motion to dismiss the complaint.

This appeal turns on plaintiff’s failure to comply with the requirements of the New York City Civil Court Act that were in effect at the time the underlying action was commenced.

The Civil Court action was commenced on or about November 10, 2003, and defendant served an answer upon plaintiff dated December 22, 2003.

Despite the fact that former section 409 of the Civil Court Act, which was in effect at the time, required that a copy of the summons with proof of service be filed within 14 days of service, to wit, November 24, 2003, this plaintiff did not file those documents until March 12, 2007, nearly 3¼ years later. This is a rather extensive oversight.

Furthermore, I disagree with the representation presented by the majority that, “In opposition, plaintiff asked for nunc pro tunc relief pursuant to CCA former 411”. In fact, what plaintiff stated in its opposition papers was, “If this court deems it necessary, I would request the filing of the summons and complaint be accepted nunc pro tunc”. This inchoate statement was not even a precatory “request” but, rather, a conditional offer to make such request only “if this court deems it necessary”. This failure to file an application for relief is important because if plaintiff had made an affirmative request for nunc pro tunc relief, then it would have been required to demonstrate why it was entitled to such relief. That would have necessitated an explanation of why it took more than 1,200 days to comply with a simple requirement that should have been done in 14 days.

I do not deem it necessary or even advisable to grant plaintiff’s or its counsel’s unsupported request for nunc pro tunc relief for counsel’s failure to comply with well- established rules, which were disregarded for approximately 3¼ years. I would simply dismiss the complaint without prejudice.
Decision Date: June 12, 2009

J.R. Dugo, D.C., P.C. v New York Cent. Mut. Ins. Co. (2009 NY Slip Op 29261)

Reported in New York Official Reports at J.R. Dugo, D.C., P.C. v New York Cent. Mut. Ins. Co. (2009 NY Slip Op 29261)

J.R. Dugo, D.C., P.C. v New York Cent. Mut. Ins. Co. (2009 NY Slip Op 29261)
J.R. Dugo, D.C., P.C. v New York Cent. Mut. Ins. Co.
2009 NY Slip Op 29261 [24 Misc 3d 68]
Accepted for Miscellaneous Reports Publication
AT2
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
As corrected through Wednesday, September 9, 2009

[*1]

J.R. Dugo, D.C., P.C., as Assignee of Judy Nieves, Respondent,
v
New York Central Mutual Insurance Co., Appellant.

Supreme Court, Appellate Term, Second Department, June 12, 2009

APPEARANCES OF COUNSEL

Gullo & Associates, LLP, Brooklyn (Anthony DeGuerre of counsel), for appellant.

{**24 Misc 3d at 69} OPINION OF THE COURT

Memorandum.

Order modified by adding thereto the provision that the acknowledgment of service annexed to defendant’s moving papers is deemed timely filed; as so modified, affirmed without costs.

In this action by a provider to recover assigned first-party no-fault benefits, defendant moved pursuant to CPLR 3211 to dismiss the action without prejudice because plaintiff failed to file the summons with proof of service as required by former section 409 of the New York City Civil Court Act or, in the alternative, for summary judgment dismissing the complaint on the ground that the action was premature since defendant never received the claim forms at issue. In opposition, plaintiff asked for nunc pro tunc relief pursuant to CCA former 411. The Civil Court denied defendant’s motion. This appeal by defendant ensued.

Dismissal of the action without prejudice due to a violation of CCA former 409, which required that a copy of the summons with proof of service be filed within 14 days after service of the summons, is not warranted where, as here, plaintiff requested nunc pro tunc relief (see CCA former 411). Under the circumstances presented, such nunc pro tunc relief should have been granted. Further, while defendant asserts that the action is premature since it never received the claims which are at issue, the affidavit of defendant’s claims examiner was insufficient to establish such assertion as a matter of law (Zuckerman v City of New York, 49 NY2d 557[*2][1980]; see generally Top Choice Med., P.C. v New York Cent. Mut. Fire Ins. Co., 22 Misc 3d 133[A], 2009 NY Slip Op 50230[U] [App Term, 2d Dept, 11th & 13th Jud Dists 2009]). Accordingly, defendant’s motion was properly denied and the order is modified to provide for nunc pro tunc relief.

Golia, J. (dissenting and voting to reverse the order and grant defendant’s motion to dismiss in the following memorandum). Here, plaintiff previously filed a motion for summary judgment, which included misrepresentations and questionable fraudulent billing, and which demonstrated an intentional failure to comply with requirements of the Civil Court Act, and refusal to affirmatively move to correct such failure. This motion for summary judgment was then withdrawn for reasons that are not contained in the record.{**24 Misc 3d at 70}

Those papers which are in this file contain an affirmation from plaintiff’s attorney, and certain documentary proof which the plaintiff’s attorney argued was sufficient to warrant summary judgment in favor of plaintiff.

The documentary proof that was annexed was not a doctor’s office records or a doctor’s affirmation relating to treatment. It was not even an NF-2 claim form. The submitted document was a “Health Insurance Claim Form” which set forth a list of dates representing an extensive series of more than 30 treatments performed by the claimant Dr. Dugo upon the alleged eligible injured insured Judy Nieves during the time period at issue in this no-fault case. A problem arises in that this “form” specifically asserts that the patient’s condition is not related to an auto accident or for that matter also not related to employment or any “other accident.” Clearly, this document is not sufficient to establish proof of treatment as a result of a covered automobile accident. Nevertheless, this document does raise the question as to whether or not these medical treatments were submitted for payment to both this no-fault carrier as well as to a different health insurance carrier with conflicting statements. To me, there appears to be grounds to question whether the provider submitted a claim to this “no-fault” carrier that the alleged injury was caused by an auto accident and another claim to a “health insurance” carrier that the injury was not caused by an auto accident.

Inasmuch as that motion was withdrawn, it is not part of this appeal and plays no part in my dissent.

What is part of this appeal is plaintiff’s failure to comply with the requirements of the Civil Court Act that were in effect at the time the underlying action was commenced.

The Civil Court action below was commenced on or about September 24, 2004, the defendant acknowledging that it was served and whereupon it served an answer upon plaintiff dated October 13, 2004.

Despite the fact that section 409 of the Civil Court Act, which was in effect at the time, required that a copy of the summons with proof of service be filed within 14 days of service, to wit: October 8, 2004, this plaintiff did not file those documents until March 12, 2007, nearly 2½ years later.

Indeed, it cannot even be argued that it was a mere oversight that was corrected as soon as [*3]the plaintiff became aware of the error. On May 3, 2005 the defendant served the plaintiff with a demand that it purchase an index number and file its papers in{**24 Misc 3d at 71} court. It then took the plaintiff another 22 months before it deigned to comply with either the court rule, or the defendant’s demand.

Furthermore, I disagree with the representation presented by the majority that “[i]n opposition, plaintiff asked for nunc pro tunc relief pursuant to CCA form 411.” In fact, what the plaintiff stated in its opposition papers was “[i]f this court deems it necessary, I would request the filing of the summons and complaint be accepted nunc pro tunc.” This inchoate statement was not even a precatory “request” but rather a conditional offer to make such request only “if this court deems it necessary.” This failure to file an application for relief is important because if plaintiff had made an affirmative request for nunc pro tunc relief, then it would have been required to argue why it was entitled to such relief. That would have necessitated an explanation of why it took more than 800 days to comply with a simple requirement that should have been done in 14 days, and why this plaintiff apparently ignored the defendant’s demand that plaintiff comply some two years before it did so.

I do not deem it necessary or even advisable to grant plaintiff’s or its counsel’s unsupported request for nunc pro tunc relief for counsel’s failure to comply with well-established rules which were knowingly disregarded for approximately 2½ years. I would simply dismiss the action without prejudice.

Weston, J.P., and Steinhardt, J., concur; Golia, J. dissents in a separate memorandum.

Post Traumatic Med. Care, P.C. v Travelers Home & Mar. Ins. Co. (2009 NY Slip Op 51149(U))

Reported in New York Official Reports at Post Traumatic Med. Care, P.C. v Travelers Home & Mar. Ins. Co. (2009 NY Slip Op 51149(U))

Post Traumatic Med. Care, P.C. v Travelers Home & Mar. Ins. Co. (2009 NY Slip Op 51149(U)) [*1]
Post Traumatic Med. Care, P.C. v Travelers Home & Mar. Ins. Co.
2009 NY Slip Op 51149(U) [23 Misc 3d 147(A)]
Decided on June 8, 2009
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 June 8, 2009

SUPREME COURT OF THE STATE OF NEW YORK

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


PRESENT: : PESCE, P.J., GOLIA and RIOS, JJ
2008-1283 K C.
Post Traumatic Medical Care, P.C. a/a/o GEORGE FERRER, Appellant,

against

The Travelers Home and Marine Insurance Company a/k/a TRAVELERS PROPERTY CASUALTY CORPORATION, Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Kenneth P. Sherman, J.), entered July 11, 2007. The order denied plaintiff’s motion for summary judgment.

Order affirmed with $10 costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment. The Civil Court denied plaintiff’s motion on the ground that plaintiff’s affidavit was insufficient. This appeal by plaintiff ensued.

Inasmuch as the affidavit submitted by plaintiff’s medical billing manager was insufficient to establish that said person possessed personal knowledge of plaintiff’s practices and procedures so as to lay a foundation for the admission, as business records, of the documents annexed to plaintiff’s moving papers, plaintiff failed to make a prima facie showing of its entitlement to summary judgment (see Alvarez v Prospect Hosp., 68 NY2d 320 [1986]; Art of Healing Medicine, P.C. v Travelers Home & Mar. Ins. Co., 55 AD3d 644 [2008]; Dan Med., P.C. v New York Cent. Mut. Fire Ins. Co., 14 Misc 3d 44 [App Term, 2d & 11th Jud Dists 2006]). Consequently, plaintiff’s motion for summary judgment was properly denied.

Pesce, P.J., Golia and Rios, JJ., concur.
Decision Date: June 08, 2009

A.M. Med. Servs., P.C. v Travelers Ins. Co. (2009 NY Slip Op 51147(U))

Reported in New York Official Reports at A.M. Med. Servs., P.C. v Travelers Ins. Co. (2009 NY Slip Op 51147(U))

A.M. Med. Servs., P.C. v Travelers Ins. Co. (2009 NY Slip Op 51147(U)) [*1]
A.M. Med. Servs., P.C. v Travelers Ins. Co.
2009 NY Slip Op 51147(U) [23 Misc 3d 147(A)]
Decided on June 8, 2009
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 June 8, 2009

SUPREME COURT OF THE STATE OF NEW YORK

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


PRESENT: : PESCE, P.J., GOLIA and STEINHARDT, JJ
2008-1076 Q C.
A.M. Medical Services, P.C. as assignee of RAISA FASKHUTDINOVA, Appellant,

against

Travelers Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Diane A. Lebedeff, J.), entered July 18, 2007, deemed from a judgment of the same court entered May 20, 2008 (see CPLR 5501 [c]). The judgment, entered pursuant to the July 18, 2007 order granting defendant’s motion seeking, in effect, summary judgment, dismissed the complaint.

Judgment affirmed without costs.

In this action by a provider to recover assigned first-party no-fault benefits, defendant moved, in effect, for summary judgment dismissing the complaint. In support of its motion, defendant submitted the subject claim forms, which indicate that the billed-for services were rendered by independent contractors. Plaintiff’s opposition to the motion was based upon W-2 tax forms for the treating providers, which identified plaintiff as their employer. Plaintiff’s owner stated in an affidavit that the treating providers were employees, and that while the submitted claim forms identified them as independent contractors, it was a typographical error. The Civil Court granted defendant’s motion, finding that “the bills indicated that the services in question were performed by independent contractors.” Plaintiff appeals, arguing that it raised an issue of fact as to the employment status of its treating providers and that defendant failed to verify their employment status or to issue timely denials of the claims. A judgment was subsequently entered.

Where a billing provider seeks to recover no-fault benefits for services which were not rendered by it or its employees, but rather by a treating provider who is an independent contractor, it is not a “provider” of the medical services rendered within the meaning of Insurance Department Regulations (11 NYCRR) § 65-3.11 (a) (see Rockaway Blvd. Med. P.C. v Progressive Ins., 9 Misc 3d 52, 54 [App Term, 2d & 11th Jud Dists 2005]). Such a defense is [*2]nonprecludable (id.).

“[T]he claim forms at issue state that the treating professionals were independent contractors. Contrary to plaintiff’s contention, the allegation that said treating professionals were actually employees, and that the claim forms contain misinformation, is irrelevant” (A.M. Med. Servs., P.C. v Progressive Cas. Ins. Co., 22 Misc 3d 70, 72 [App Term, 2d & 11th Jud Dists 2008]). As plaintiff did not submit bills that entitled it to payment, correction of the defect involved herein is not permitted once litigation has been commenced (A.M. Med. Servs., P.C., 22 Misc 3d 70). Accordingly, the judgment is affirmed.

Pesce, P.J., Golia and Steinhardt, JJ., concur.
Decision Date: June 08, 2009

Bath Med. Supply, Inc. v Country Wide Ins. Co. (2009 NY Slip Op 51145(U))

Reported in New York Official Reports at Bath Med. Supply, Inc. v Country Wide Ins. Co. (2009 NY Slip Op 51145(U))

Bath Med. Supply, Inc. v Country Wide Ins. Co. (2009 NY Slip Op 51145(U)) [*1]
Bath Med. Supply, Inc. v Country Wide Ins. Co.
2009 NY Slip Op 51145(U) [23 Misc 3d 147(A)]
Decided on June 8, 2009
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 June 8, 2009

SUPREME COURT OF THE STATE OF NEW YORK

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


PRESENT: : PESCE, P.J., GOLIA and STEINHARDT, JJ
2008-686 Q C.
Bath Medical Supply, Inc. as assignee of CHARLES E. BODDY, Respondent,

against

Country Wide Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Queens County (Diane A. Lebedeff, J.), entered January 11, 2008, deemed from a judgment of the same court entered March 31, 2008 (see CPLR 5501 [c]). The judgment, entered pursuant to the January 11, 2008 order granting plaintiff’s motion for summary judgment, awarded plaintiff the principal sum of $2,101.

Judgment reversed without costs, order granting plaintiff’s motion for summary judgment vacated and plaintiff’s motion denied.

In this action to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment. Defendant opposed the motion, asserting that it had timely denied the claims on the ground that the supplies provided were not medically necessary. The Civil Court granted plaintiff’s motion, holding that defendant failed to establish that the verification requests which preceded defendant’s denials were properly issued, so that defendant’s denials were untimely. The instant appeal by defendant ensued. A judgment in favor of plaintiff was subsequently entered.

Contrary to defendant’s contention, the affidavit of plaintiff’s billing manager established the mailing of the claims in question since she stated that she had personally mailed the claims on February 10, 2005 (see Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [2001]; cf. New York and Presbyt. Hosp. v Allstate Ins. Co., 29 AD3d 547 [2006]). In addition, a review of the record indicates that plaintiff’s affidavit sufficed to establish that the annexed claim forms constituted evidence in admissible form (see CPLR 4518; Dan Med., P.C. v New York Cent. Mut. Fire Ins. Co., 14 Misc 3d 44 [App Term, 2d & 11th Jud Dists 2006]). Thus, plaintiff made out its prima facie entitlement to summary judgment. [*2]

However, the Civil Court erred in finding that defendant failed to properly toll the prescribed 30-day period, since the affidavit of defendant’s no-fault litigation supervisor sufficiently established the timely mailing of the verification requests by setting forth a detailed description of the standard office practice and procedure used to ensure that the verification requests were properly addressed and mailed (see Residential Holding Corp., 286 AD2d 679). For the same reason, the affidavit also established the timely mailing of defendant’s denial of claim forms (id.).

Plaintiff contends that defendant’s opposing papers did not establish that the claim determination period was tolled because, while the affidavit of defendant’s no-fault litigation supervisor sets forth the dates on which the verification requests were mailed, the denial of claim forms set forth different dates as the dates on which final verification was requested. However, the unsworn denial of claim forms do not purport to state the dates on which defendant first requested verification, whereas, in the sworn affidavit, defendant’s no-fault litigation supervisor states the dates on which verification was first requested, the dates on which the verification was received and the dates on which the denial of claim forms were mailed. To the extent the unsworn denial of claim forms suggest that defendant may have sent a further request for verification after receiving the verification it initially sought, they do not contradict the sworn statement by defendant’s no-fault litigation supervisor or otherwise nullify defendant’s position that the claim determination period was tolled. As a result, inasmuch as the affirmed peer review report was sufficient to demonstrate the existence of an issue of fact as to the medical necessity of the supplies plaintiff furnished, the judgment is reversed, the order granting plaintiff’s motion for summary judgment is vacated and plaintiff’s motion for summary judgment is denied (see Zuckerman v City of New York, 49 NY2d 557 [1980]).

Pesce, P.J., Golia and Steinhardt, JJ., concur.
Decision Date: June 08, 2009

Careplus Med. Supply, Inc. v Utica Mut. Ins. Co. (2009 NY Slip Op 51132(U))

Reported in New York Official Reports at Careplus Med. Supply, Inc. v Utica Mut. Ins. Co. (2009 NY Slip Op 51132(U))

Careplus Med. Supply, Inc. v Utica Mut. Ins. Co. (2009 NY Slip Op 51132(U)) [*1]
Careplus Med. Supply, Inc. v Utica Mut. Ins. Co.
2009 NY Slip Op 51132(U) [23 Misc 3d 145(A)]
Decided on June 2, 2009
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 June 2, 2009

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 9th and 10th JUDICIAL DISTRICTS


PRESENT: : RUDOLPH, P.J., TANENBAUM and MOLIA, JJ
2008-1445 N C.
Careplus Medical Supply, Inc. a/a/o PAUL ANDERSON and ALICIA PRINCE, Appellant,

against

Utica Mutual Insurance Company, Respondent.

Appeal from an order of the District Court of Nassau County, Third District (Bonnie P. Chaikin, J.), entered June 18, 2008. The order denied plaintiff’s motion for summary judgment.

Order affirmed without costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment. Defendant opposed the motion, arguing, inter
alia, that the affidavit by plaintiff’s president and medical biller failed to make a prima facie showing of plaintiff’s entitlement to judgment as a matter of law. The District Court denied plaintiff’s motion, holding, inter alia, that plaintiff failed to establish its prima facie case. This appeal by plaintiff ensued.

Plaintiff failed to make a prima facie showing of its entitlement to summary judgment since the affidavit submitted by plaintiff’s president and medical biller failed to establish that the documents annexed to plaintiff’s moving papers were admissible pursuant to CPLR 4518 (see Alvarez v Prospect Hosp., 68 NY2d 320 [1986]; Art of Healing Medicine, P.C. v Travelers Home & Mar. Ins. Co., 55 AD3d 644 [2008]; Fortune Med., P.C. v Allstate Ins. Co., 14 Misc 3d 136[A], 2007 NY Slip Op 50243[U] [App Term, 9th & 10th Jud Dists 2007]). Consequently, plaintiff’s motion for summary judgment was properly denied. We reach no other issue.

Rudolph, P.J., Tanenbaum and Molia, JJ., concur.
Decision Date: June 02, 2009

RLC Med., P.C. v Allstate Ins. Co. (2009 NY Slip Op 51131(U))

Reported in New York Official Reports at RLC Med., P.C. v Allstate Ins. Co. (2009 NY Slip Op 51131(U))

RLC Med., P.C. v Allstate Ins. Co. (2009 NY Slip Op 51131(U)) [*1]
RLC Med., P.C. v Allstate Ins. Co.
2009 NY Slip Op 51131(U) [23 Misc 3d 145(A)]
Decided on June 2, 2009
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 June 2, 2009

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 9th and 10th JUDICIAL DISTRICTS


PRESENT: : RUDOLPH, P.J., TANENBAUM and MOLIA, JJ
2008-1443 N C.
RLC Medical, P.C. a/a/o DENISE DeANGELIS, Appellant,

against

Allstate Insurance Company, Respondent.

Appeal from an order of the District Court of Nassau County, Third District (Bonnie P. Chaikin, J.), entered June 4, 2008. The order denied plaintiff’s motion for summary judgment.

Order affirmed without costs.

In this action by a provider to recover assigned first-party no-fault benefits, defendant served plaintiff with various discovery demands. Thereafter, plaintiff moved
for summary judgment. In opposition to the motion, defendant argued that plaintiff did not make a prima facie showing of its entitlement to judgment as a matter of law. In addition, defendant asserted that plaintiff’s motion should be denied because plaintiff’s owner failed to appear for examinations under oath (EUOs) and because plaintiff failed to respond to defendant’s discovery demands, which sought information as to whether plaintiff was a fraudulently incorporated medical provider, and, thus, ineligible for reimbursement of no-fault benefits. The District Court denied plaintiff’s motion, holding that the affidavit by plaintiff’s billing manager failed to establish a prima facie case because it did not demonstrate that the documents annexed to plaintiff’s motion were admissible as business records. This appeal by plaintiff ensued.

Plaintiff failed to make a prima facie showing of its entitlement to summary judgment since the affidavit submitted by plaintiff’s billing manager failed to establish that the documents annexed to plaintiff’s moving papers were admissible pursuant to CPLR 4518 (see Art of Healing Medicine, P.C. v Travelers Home & Mar. Ins. Co., 55 AD3d 644 [2008]; Fortune Med., P.C. v Allstate Ins. Co., 14 Misc 3d 136[A], 2007 NY Slip Op 50243[U] [App Term, 9th & 10th Jud Dists 2007]). Consequently, plaintiff’s motion for summary judgment was properly denied.

We reach no other issue.

In light of the foregoing, the order is affirmed. [*2]

Rudolph, P.J., Tanenbaum and Molia, JJ., concur.
Decision Date: June 02, 2009

A.B. Med. Servs., PLLC v Country-Wide Ins. Co. (2009 NY Slip Op 51130(U))

Reported in New York Official Reports at A.B. Med. Servs., PLLC v Country-Wide Ins. Co. (2009 NY Slip Op 51130(U))

A.B. Med. Servs., PLLC v Country-Wide Ins. Co. (2009 NY Slip Op 51130(U)) [*1]
A.B. Med. Servs., PLLC v Country-Wide Ins. Co.
2009 NY Slip Op 51130(U) [23 Misc 3d 145(A)]
Decided on June 2, 2009
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 June 2, 2009

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 9th and 10th JUDICIAL DISTRICTS


PRESENT: : MOLIA, J.P., SCHEINKMAN and LaCAVA, JJ
2008-1440 N C.
A.B. Medical Services, PLLC, D.A.V. CHIROPRACTIC, P.C. and LVOV ACUPUNCTURE, P.C. a/a/o JOSHUA JACOBS, Appellants,

against

Country-Wide Insurance Company, Respondent.

Appeal from an order of the District Court of Nassau County, Third District (Rhonda E. Fischer, J.), entered June 11, 2008. The order, insofar as appealed from, denied plaintiffs’ motion for summary judgment.

Order, insofar as appealed from, affirmed without costs.

In this action by providers to recover assigned first-party no-fault benefits, plaintiffs moved for summary judgment and defendant cross-moved for summary judgment dismissing the complaint. Defendant argued, inter alia, that plaintiffs did not make a prima facie showing of their entitlement to judgment as a matter of law. The District Court denied plaintiffs’ motion and defendant’s cross motion, finding that defendant had failed to submit sufficient proof to support its defense that plaintiffs are fraudulently incorporated, but that discovery was outstanding. The court directed plaintiffs to provide the discovery demanded by defendant. Plaintiffs appeal from so much of the order as denied their motion for summary judgment.

Plaintiffs failed to make a prima facie showing of their entitlement to summary judgment since the affidavit submitted by plaintiffs’ medical biller failed to establish that the documents annexed to plaintiffs’ moving papers were admissible pursuant to CPLR 4518 (see Art of Healing Medicine, P.C. v Travelers Home & Mar. Ins. Co., 55 AD3d 644 [2008]; Fortune Med., P.C. v Allstate Ins. Co., 14 Misc 3d 136[A], 2007 NY Slip Op 50243[U] [App Term, 9th & 10th Jud Dists 2007]). Consequently, plaintiffs’ motion for summary judgment was properly denied, albeit on other grounds.

In light of the foregoing, the order, insofar as appealed from, is affirmed. [*2]

Molia, J.P., Scheinkman and LaCava, JJ., concur.
Decision Date: June 02, 2009

Inwood Hill Med., P.C. v Utica Mut. Ins. Co. (2009 NY Slip Op 51129(U))

Reported in New York Official Reports at Inwood Hill Med., P.C. v Utica Mut. Ins. Co. (2009 NY Slip Op 51129(U))

Inwood Hill Med., P.C. v Utica Mut. Ins. Co. (2009 NY Slip Op 51129(U)) [*1]
Inwood Hill Med., P.C. v Utica Mut. Ins. Co.
2009 NY Slip Op 51129(U) [23 Misc 3d 145(A)]
Decided on June 2, 2009
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 June 2, 2009

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 9th and 10th JUDICIAL DISTRICTS


PRESENT: : RUDOLPH, P.J., TANENBAUM and MOLIA, JJ
2008-1439 N C.
Inwood Hill Medical, P.C. and WESTCHESTER NEURODIAGNOSTIC, P.C. a/a/o LENNY MUNOZ, Appellants,

against

Utica Mutual Insurance Company, Respondent.

Appeal from an order of the District Court of Nassau County, Third District (Rhonda E. Fischer, J.), entered May 19, 2008. The order, insofar as appealed from, denied plaintiffs’ motion for summary judgment.

Order, insofar as appealed from, affirmed without costs.

In this action by providers to recover assigned first-party no-fault benefits, plaintiffs moved for summary judgment and defendant cross-moved for summary judgment. Insofar as is relevant to this appeal, the court denied plaintiffs’ motion on the ground that the affidavit submitted by plaintiffs’ medical biller was legally insufficient. This appeal by plaintiffs ensued.

Plaintiffs failed to make a prima facie showing of their entitlement to summary judgment since the affidavit submitted by plaintiffs’ medical biller failed to establish that the documents annexed to plaintiffs’ moving papers were admissible pursuant to CPLR 4518 (see Alvarez v Prospect Hosp., 68 NY2d 320 [1986]; Art of Healing Medicine, P.C. v Travelers Home & Mar. Ins. Co., 55 AD3d 644 [2008]; Fortune Med., P.C. v Allstate Ins. Co., 14 Misc 3d 136[A], 2007 NY Slip Op 50243[U] [App Term, 9th & 10th Jud Dists 2007]). Consequently, plaintiffs’ motion for summary judgment was properly denied.

Rudolph, P.J., Tanenbaum and Molia, JJ., concur. [*2]
Decision Date: June 02, 2009