Opinion
No. 2011–1238 K C.
2012-08-31
FIVE S & A REHAB PT, P.C. as Assignee of Ormella Thakoordial, Respondent, v. PRAETORIAN INS. CO., Appellant.
Appeal from an order of the Civil Court of the City of New York, Kings County (Robin Kelly Sheares, J.), entered March 8, 2011. The order denied defendant's motion for summary judgment dismissing the complaint.
Present: PESCE, P.J., RIOS and ALIOTTA, JJ.
ORDERED that the order is reversed, without costs, and defendant's motion for summary judgment dismissing the complaint is granted.
In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from an order of the Civil Court which denied defendant's motion for summary judgment dismissing the complaint.
In support of its motion, defendant established that it had timely mailed its denial of claim forms ( 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 claims were denied on the ground of lack of medical necessity based upon an annexed affirmed independent medical examination report which demonstrated a factual basis and a medical rationale for the conclusion that there was no medical necessity for the services at issue. As plaintiff failed to rebut defendant's prima facie showing, defendant was entitled to summary judgment dismissing the complaint ( see Delta Diagnostic Radiology, P.C. v. Integon Natl. Ins. Co., 24 Misc.3d 136[A], 2009 N.Y. 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 N.Y. Slip Op 52455[U] [App Term, 2d & 11th Jud Dists 2007]; A. Khodadadi Radiology, P.C. v. N.Y. Cent. Mut. Fire Ins. Co., 16 Misc.3d 131[A], 2007 N.Y. Slip Op 51342[U] [App Term, 2d & 11th Jud Dists 2007] ).
Accordingly, the order is reversed and defendant's motion for summary judgment dismissing the complaint is granted.