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Alfa Medical Supplies As Assignee of Julio C. Diaz v. Geico General Ins. Co

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS New York Supreme and/or Appellate Courts


December 21, 2012

ALFA MEDICAL SUPPLIES AS ASSIGNEE OF JULIO C. DIAZ,
APPELLANT,
v.
GEICO GENERAL INS. CO.,
RESPONDENT.

Appeal from an order of the Civil Court of the City of New York, Kings County (Katherine A. Levine, J.), entered May 24, 2010.

Alfa Med. Supplies v GEICO Gen. Ins. Co.

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This opinion is uncorrected and will not be published in the printed Official Reports.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

PRESENT: RIOS, J.P., ALIOTTA and SOLOMON, JJ

The order denied plaintiff's motion for summary judgment and granted defendant's cross motion for summary judgment dismissing the complaint.

ORDERED that the order is modified by providing that the branch of plaintiff's motion seeking summary judgment upon so much of the complaint as sought to recover upon a $70 claim for a thermophore is granted and the branch of defendant's cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon that claim is denied; as so modified, 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 Civil Court which denied its motion for summary judgment and granted defendant's cross motion for summary judgment dismissing the complaint.

The affidavit submitted by defendant in support of its cross motion for summary judgment established that defendant had timely denied (see St. Vincent's Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]) the claim at issue on the ground of lack of medical necessity. Moreover, defendant annexed to its motion papers an affirmed peer review report which set forth a factual basis and medical rationale for the peer reviewer's determination that there was a lack of medical necessity for the supplies provided, with the exception of a thermophore, which the peer reviewer found to be medically necessary (see e.g. 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]). On appeal, defendant concedes that plaintiff is entitled to recover upon so much of plaintiff's complaint as sought $70 for the thermophore.

In opposition to defendant's cross motion for summary judgment, plaintiff failed to raise a triable issue of fact, since it did not submit an affirmation from a doctor rebutting the conclusions set forth in the peer review report (see Innovative Chiropractic, P.C. v Mercury Ins. Co., 25 Misc 3d 137[A], 2009 NY Slip Op 52321[U] [App Term, 2d, 11th & 13th Jud Dists 2009]; 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]). Thus, the Civil Court properly granted the branches of defendant's cross motion seeking summary judgment dismissing the remainder of the complaint.

Accordingly, the order is modified by providing that the branch of plaintiff's motion seeking summary judgment upon so much of the complaint as sought to recover upon the $70 claim for a thermophore is granted and the branch of defendant's cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon that claim is denied.

Rios, J.P., Aliotta and Solomon, JJ., concur.

Decision Date: December 21, 2012

20121221

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