B.Y., M.D., P.C. v Progressive Cas. Ins. Co. |
2010 NY Slip Op 50144(U) [26 Misc 3d 135(A)] |
Decided on January 28, 2010 |
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This opinion is uncorrected and will not be published in the printed Official Reports. |
Appeal from an order of the District Court of Nassau County, Third District (Michael A.
Ciaffa, J.), dated April 8, 2009. The order, insofar as appealed from as limited by the brief,
denied plaintiffs' motion for partial summary judgment and granted defendant's cross motion for
summary judgment dismissing various claims of plaintiffs on the ground of lack of medical
necessity.
ORDERED that the order, insofar as appealed from, is affirmed without costs.
In this action by providers to recover assigned first-party no-fault benefits, plaintiffs moved
for "partial summary judgment," asserting that, pursuant to CPLR 3212
(e) or, in the alternative, CPLR 3212 (g), the District Court should determine that
plaintiffs had established their prima facie case. Insofar as is relevant to this appeal,
defendant cross-moved for summary judgment dismissing various claims of plaintiffs on the
ground of lack of medical necessity. Plaintiffs appeal, as limited by their brief, from so much of
the order as denied their motion for partial summary judgment and granted defendant's cross
motion for summary judgment dismissing various claims of plaintiffs on the ground of lack of
medical necessity.
In support of defendant's cross motion for summary judgment, defendant annexed, among other things, an affirmed peer review report by a doctor, an affirmation by a doctor who had performed an independent medical examination and an affidavit by a chiropractor who had performed an independent medical examination. Since the foregoing documents set forth a factual basis and medical rationale for the doctors' and chiropractor's opinions that the services, [*2]which are the subject of the claims at issue, were not medically necessary, defendant established, prima facie, a lack of medical necessity for such services (see Exclusive Med. Supply, Inc. v Mercury Ins. Group, 25 Misc 3d 136[A], 2009 NY Slip Op 52273[U] [App Term, 2d, 11th & 13th Jud Dists 2009]; 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]).
In opposition to the cross motion, plaintiffs submitted an affirmation from the doctor who had treated plaintiffs' assignor, which affirmation was apparently missing at least one page. The portion of the affirmation which was contained in the record was insufficient to raise a triable issue of fact as it did not meaningfully refer to, or discuss, the determination of defendant's doctors and chiropractor (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 a result, defendant's cross motion, insofar as it sought to dismiss various claims of plaintiffs on the ground of lack of medical necessity, was properly granted (see Exclusive Med. Supply, Inc., 25 Misc 3d 136[A], 2009 NY Slip Op 52273[U]; Delta Diagnostic Radiology, P.C., 24 Misc 3d 136[A], 2009 NY Slip Op 51502[U]; Pan Chiropractic, P.C., 24 Misc 3d 136[A], 2009 NY Slip Op 51495[U]). Accordingly, the order, insofar as appealed from, is affirmed. We reach no other issue.
Nicolai, P.J., Tanenbaum and LaCava, JJ., concur.
Decision Date: January 28, 2010