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Amaze Med. Supply Inc. v. Allstate Ins. Co.

Appellate Term of the Supreme Court of New York, Second Department
Jul 21, 2004
2004 N.Y. Slip Op. 50833 (N.Y. App. Term 2004)

Opinion

2003-1008 K C.

Decided July 21, 2004.

Appeal by plaintiff from so much of an order of the Civil Court, Kings County (R. Garson, J.), entered June 10, 2003, as denied its motion for partial summary judgment.

Order insofar as appealed from unanimously reversed without costs, plaintiff's motion for partial summary judgment granted in the principal sum of $2,365 and matter remanded to the court below for a calculation of statutory interest and an assessment of attorney's fees.

PRESENT: ARONIN, J.P., PATTERSON and GOLIA, JJ.


Plaintiff sues to recover first-party no-fault benefits for medical supplies furnished to its assignor. Plaintiff established a prima facie case by the submission of a properly completed claim ( see Amaze Med. Supply Inc. v. Eagle Ins. Co., 2 Misc 3d 128 [A], 2003 NY Slip Op 51701 [U] [App Term, 2d 11th Jud Dists]). The burden then shifted to defendant to show the existence of a triable issue of fact ( see Alvarez v. Prospect Hosp., 68 NY2d 320, 324).

Although defendant timely denied the claim for $765 within 30 days of its receipt (Insurance Law § 5106; 11 NYCRR 65.15 [g] [3]), the peer review report upon which the denial of benefits was predicated was not in admissible form and was therefore insufficient to defeat plaintiff's summary judgment motion. An affirmation of a chiropractor does not constitute competent evidence ( see CPLR 2106; see also Cubero v. DiMarco, 272 AD2d 430).

With respect to plaintiff's claims for $670 and $930, defendant failed to deny them within 30 days of their receipt. Thus, defendant is precluded from raising the defense of medical necessity as to those claims ( see Central Gen. Hosp. v. Chubb Group of Ins. Cos., 90 NY2d 195, 199).

Accordingly, inasmuch as defendant failed to raise a triable issue of fact, plaintiff's motion should have been granted, and the matter is remanded to the court below for a calculation of the statutory interest and an assessment of attorney's fees due on $2,365 (Insurance Law § 5106 [a]; 11 NYCRR 65.15 [h] [1]; 65.17 [b] [6]; see also St. Clare's Hosp. v. Allstate Ins. Co., 215 AD2d 641).


Summaries of

Amaze Med. Supply Inc. v. Allstate Ins. Co.

Appellate Term of the Supreme Court of New York, Second Department
Jul 21, 2004
2004 N.Y. Slip Op. 50833 (N.Y. App. Term 2004)
Case details for

Amaze Med. Supply Inc. v. Allstate Ins. Co.

Case Details

Full title:AMAZE MEDICAL SUPPLY INC. A/A/O HECTOR ALVAREZ, Appellant, v. ALLSTATE…

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

Date published: Jul 21, 2004

Citations

2004 N.Y. Slip Op. 50833 (N.Y. App. Term 2004)