SUPREME COURT OF THE STATE OF NEW YORK APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS
December 23, 2011
HIGH QUALITY MEDICAL, P.C. AS ASSIGNEE OF JOHNIE DANIELS,
GEICO INS. CO.,
Appeal from an order of the Civil Court of the City of New York, Kings County (Kathryn E. Freed, J.), entered December 3, 2009.
High Quality Med., P.C. v GEICO Ins. Co.
Decided on December 23, 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This opinion is uncorrected and will not be published in the printed Official Reports.
PRESENT: PESCE, P.J., GOLIA and STEINHARDT, JJ
The order, insofar as appealed from as limited by the brief, implicitly 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 implicitly denied the motion and cross motion, finding 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 defendant's defense of lack of medical necessity of the services provided to plaintiff's assignor. Defendant appeals, as limited by its brief, from so much of the order as implicitly denied its cross motion for summary judgment dismissing the complaint.
In support of its cross motion, defendant submitted, among other
things, an affirmed peer review report and an affirmed independent
medical examination (IME) report, each of which set forth a factual
basis and medical rationale for the doctor's determination that there
was a lack of medical necessity for the services rendered. In
opposition to the cross motion, plaintiff submitted an affidavit from
a doctor which failed to meaningfully refer to, let alone rebut, the
conclusions set forth in the peer review report or the IME report (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]). As plaintiff has
not challenged the Civil Court's finding, in effect, that defendant is otherwise
entitled to judgment, defendant's cross motion for summary judgment dismissing
the 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]).
Accordingly, the order, insofar as appealed from, is reversed and defendant's cross motion for summary judgment dismissing the complaint is granted.
Pesce, P.J., Golia and Steinhardt, JJ., concur.
Decision Date: December 23, 2011
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