Learn About the Law
Get help with your legal needs
FindLaw’s Learn About the Law features thousands of informational articles to help you understand your options. And if you’re ready to hire an attorney, find one in your area who can help.
EXCEL SURGERY CENTER, L.L.C., as Assignee of Sylvester Leemow, Appellant, v. HERTZ CLAIM MANAGEMENT CORP., Respondent.
ORDERED that the order is reversed, without costs, and defendant's motion for summary judgment dismissing the complaint is denied.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the District Court which granted defendant's motion for summary judgment dismissing the complaint on the ground that the services at issue were not medically necessary.
In support of its motion, defendant submitted a sworn peer review report which set forth a factual basis and medical rationale for the reviewer's determination that there had been a lack of medical necessity for the services at issue (see American Chiropractic Care, P.C. v. Praetorian Ins. Co., 42 Misc 3d 145[A], 2014 NY Slip Op 50346[U] [App Term, 2d Dept, 9th & 10th Jud Dists 2014] ). However, in opposition to the motion, plaintiff submitted an affidavit by one of the chiropractors who had performed the services at issue, which, as plaintiff argues on appeal, “meaningfully referred to defendant's peer review report and sufficiently rebutted the conclusions set forth therein” (Vinings Spinal Diagnostic, P.C. v. Geico Gen. Ins. Co., 29 Misc 3d 132[A], 2010 NY Slip Op 51897[U], *1–2 [App Term, 2d Dept, 9th & 10th Jud Dists 2010]; see also Westcan Chiropractic, P.C. v. Hertz Claim Mgt., 48 Misc 3d 133[A], 2015 NY Slip Op 51066[U] [App Term, 2d Dept, 9th & 10th Jud Dists 2015] ) and, thus, was sufficient to raise a triable issue of fact as to medical necessity.
Accordingly, the order is reversed and defendant's motion for summary judgment dismissing the complaint is denied.
MARANO, P.J., GARGUILO and RUDERMAN, JJ., concur.
Thank you for your feedback!
A free source of state and federal court opinions, state laws, and the United States Code. For more information about the legal concepts addressed by these cases and statutes visit FindLaw's Learn About the Law.
Docket No: 2016–744 S C
Decided: December 28, 2017
Court: Supreme Court, Appellate Term, New York.
Search our directory by legal issue
Enter information in one or both fields (Required)
Harness the power of our directory with your own profile. Select the button below to sign up.
Learn more about FindLaw’s newsletters, including our terms of use and privacy policy.
Get help with your legal needs
FindLaw’s Learn About the Law features thousands of informational articles to help you understand your options. And if you’re ready to hire an attorney, find one in your area who can help.
Search our directory by legal issue
Enter information in one or both fields (Required)