Opinion
No. 2013–2049 N C.
05-01-2015
LENOX HILL RADIOLOGY and MIA, P.C. as Assignee of Samir Gemayel, Respondent, v. GREAT NORTHERN INSURANCE COMPANY Doing Business as Chubb Group Of Insurance Companies, Appellant.
Opinion
ORDERED that the order is affirmed, without costs.
In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from an order of the District Court which denied defendant's motion for summary judgment dismissing the complaint.
Defendant established that the denial of claim forms, which denied the claims on the ground of lack of medical necessity, had been timely and properly mailed (see St. Vincent's Hosp. of Richmond v. Government Empls. Ins. Co., 50 AD3d 1123 [2008] ). While the affirmed peer review report by defendant's doctor set forth a factual basis and medical rationale for the doctor's opinion that there was a lack of medical necessity for the services at issue, plaintiff proffered a doctor's affirmation in opposition, which affirmation was sufficient to raise a triable issue of fact as to whether the services were medically necessary (see Zuckerman v. City of New York, 49 N.Y.2d 557 [1980] ). Consequently, defendant's motion for summary judgment dismissing the complaint was properly denied.
Accordingly, the order is affirmed.
GARGUILO, J.P., MARANO and CONNOLLY, JJ., concur.