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A.B. Med. Serv. v. N.Y. Cent. Mut. Fire Ins.

Appellate Term of the Supreme Court of New York, Second Department
May 26, 2004
2004 N.Y. Slip Op. 50507 (N.Y. App. Term 2004)

Opinion

2003-690 KC.

Decided May 26, 2004.

Appeal by defendant from so much of an order of the Civil Court, Kings County (P. Sweeney, J.), entered January 14, 2003, as granted plaintiffs' motion for summary judgment, deemed an appeal from the judgment, entered pursuant to said order on March 28, 2003, awarding plaintiff the sum of $6,732.10 (see Neuman v. Otto, 114 AD2d 791).

Judgment unanimously affirmed without costs.

PRESENT: PESCE, P.J., GOLIA and RIOS, JJ.


Plaintiffs commenced this action to recover $5,773.94 in first-party no-fault benefits, as well as statutory interest and attorney's fees, pursuant to Insurance Law § 5101 et seq. for medical services rendered to their assignor. Thereafter, plaintiffs moved for summary judgment. Defendant opposed the motion and by order entered January 14, 2003, the court below denied that part of the motion seeking summary judgment on the $1,440 claim and granted summary judgment on the $1,757.62 claim and claims amounting to $2,576.32. A judgment was subsequently entered on March 28, 2003.

A review of the record indicates that plaintiffs established their prima facie entitlement to summary judgment by showing that they submitted complete proofs of claims to defendant ( see Amaze Med. Supply Inc. v. Eagle Ins. Co., NYLJ, Dec. 29, 2003 [App Term, 2d 11th Jud Dists]). The denials attached to plaintiffs' moving papers which state when defendant received the claims, adequately establishes that plaintiffs sent the claims to defendant ( see A.B. Med. Servs. PLLC v. State Farm Mut. Auto. Ins. Co., NYLJ, Feb. 20, 2004 [App Term, 2d 11th Jud Dists]). This case squarely addresses the issue of timely denials which was raised, in dicta, in our prior holding in Amaze. Although the timely denial containing the unaffirmed, but factually-specific, medical reports defendant submitted in the claim stage constituted a sufficient denial thereof based on a defense of lack of medical necessity, in opposition to a motion for summary judgment, defendant must, nonetheless, submit proof in admissible form to rebut plaintiff's prima facie showing ( see Amaze Med. Supply Inc. v. Eagle Inc. Co., NYLJ, Dec. 29, 2003, supra). Herein, defendant failed to provide proof in admissible form, such as an affirmed medical report, to sufficiently raise a triable issue of fact as to the medical necessity of the services rendered so as to warrant the denial of plaintiffs' motion for summary judgment. As we noted in Amaze, where the plaintiff relies solely on its proof of claim to establish a prima facie showing, without any additional submission of proof of medical necessity in admissible form, and, in opposition, the defendant provides proof in admissible form of the lack of medical necessity, summary judgment may, in appropriate circumstances, be awarded to the defendant unless the plaintiff comes forward with admissible proof in reply to create a triable issue of fact ( see A.B.Med. Servs. PLLC v. Lubermens Mut. Cas. Co., No. 2003-1050 K C, decided herewith).

We find that defendant's remaining contentions lack merit. Accordingly, plaintiffs' motion was properly granted and the judgment is affirmed.


Summaries of

A.B. Med. Serv. v. N.Y. Cent. Mut. Fire Ins.

Appellate Term of the Supreme Court of New York, Second Department
May 26, 2004
2004 N.Y. Slip Op. 50507 (N.Y. App. Term 2004)
Case details for

A.B. Med. Serv. v. N.Y. Cent. Mut. Fire Ins.

Case Details

Full title:A.B. MEDICAL SERVICES, PLLC D.A.V. CHIROPRACTIC, P.C. DANIEL KIM…

Court:Appellate Term of the Supreme Court of New York, Second Department

Date published: May 26, 2004

Citations

2004 N.Y. Slip Op. 50507 (N.Y. App. Term 2004)

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