SUPREME COURT OF THE STATE OF NEW YORK APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS Appellate Term, Second Department
January 13, 2012
SKY MEDICAL SUPPLY, INC. AS ASSIGNEE OF WENDY FISHER,
NEW YORK CENTRAL MUTUAL FIRE INSURANCE COMPANY, APPELLANT.
Appeal from an order of the Civil Court of the City of New York, Kings County (Robin S. Garson, J.), entered June 8, 2009.
Sky Med. Supply, Inc. v New York Cent. Mut. Fire Ins. Co.
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This opinion is uncorrected and will not be published in the printed Official Reports.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 January 13, 2012
PRESENT: GOLIA, J.P., WESTON and RIOS, JJ
The order denied defendant's motion for summary judgment dismissing the complaint.
ORDERED that the order is reversed, without costs, and defendant's motion for summary judgment dismissing the complaint is granted.
In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from an order denying its motion for summary judgment dismissing the complaint.
The affidavit submitted by defendant in support of its motion for
summary judgment was sufficient to establish that defendant's denial
of claim form, which denied the claim at issue on the ground of lack
of medical necessity, had been timely mailed in accordance with
defendant's standard office practices and procedures (see St.
Vincent's Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123
; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17
Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]). Defendant also submitted, among other
things, an affidavit by its chiropractor/acupuncturist, together with her peer review report, which set forth a
factual basis and medical rationale for her determination that there was a lack of medical necessity for the medical
supplies at issue. Defendant's showing that the supplies were not medically necessary was not rebutted by plaintiff. In light of the
foregoing, defendant's 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 Cent. Mut. Fire Ins. Co., 16
Misc 3d 131[A], 2007 NY Slip Op 51342[U] [App Term, 2d
& 11th Jud Dists 2007]).
Golia, J.P., Weston and Rios, JJ., concur.
Decision Date: January 13, 2012
© 1992-2012 VersusLaw Inc.