Elmont Open MRI & Diagnostic Radiology, P.C. v State Farm Ins. Co. |
2007 NY Slip Op 50988(U) [15 Misc 3d 139(A)] |
Decided on March 16, 2007 |
Appellate Term, Second Department |
Published by New York State Law Reporting Bureau pursuant to Judiciary Law ยง 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This opinion is uncorrected and will not be published in the printed Official Reports.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, First District (Sharon Commissiong, J.), entered April 19, 2005. The order, insofar as appealed from, denied plaintiff's motion for summary judgment.
Order, insofar as appealed from, affirmed without costs.
In this action by a provider to recover assigned first-party no-fault benefits for an MRI provided its assignor, the court denied plaintiff's motion for summary judgment and denied defendant's cross motion for summary judgment on the ground that defendant's peer review report created a triable issue of the MRI's medical necessity. After receiving plaintiff's claim, defendant informed plaintiff by letter that the claim's "processing" would be delayed pending receipt of "confirmation of medical necessity
from the referring physician." Defendant received the verification 13 days later and issued its denial 30 days thereafter on the basis of the peer review report which was compiled, in part, on information received from the physician.
Plaintiff objects only to defendant's failure to seek the verification directly from plaintiff as, plaintiff insists, the regulations require. The court below rejected the argument and we affirm for the reasons set forth in Doshi Diagnostic Imaging Servs. v State Farm Insurance (___ Misc 3d ___, 2007 NY Slip Op _______, decided herewith). [*2]
Rudolph, P.J., Tanenbaum and LaCava, JJ., concur.
Decision Date: March 16, 2007