XVV, Inc. v. Farmington Cas. Co.

• Court: Appellate Terms of the Supreme Court of New York
• Decided: September 22, 2017
• Docket: 2017 NYSlipOp 51231(U)
• Status: Published

Opinion

XVV, Inc., as Assignee of Wilby Lyndor, Appellant,

against

Farmington Casualty Company, Respondent.

Law Offices of Ilona Finkelshteyn, P.C. (Marina Josovich, Esq.), for appellant. Law Offices of Aloy O. Ibuzor (Medgine Bernadotte, Esq.), for respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Cheree A. Buggs, J.), entered April 3, 2014. The order denied plaintiff's motion for summary judgment and granted defendant's cross motion for summary judgment dismissing the complaint.

ORDERED that the order is modified by providing that defendant's cross motion for summary judgment dismissing the complaint is denied; as so modified, the order is affirmed, without costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court which denied plaintiff's motion for summary judgment, and granted defendant's cross motion for summary judgment dismissing the complaint on the ground of a lack of medical necessity.

Contrary to plaintiff's argument on appeal, the peer review report submitted by defendant sufficiently set forth a factual basis and medical rationale for the peer reviewer's determination that there was a lack of medical necessity for the supplies at issue. However, as plaintiff further argues, the medical affidavit that plaintiff submitted in opposition was sufficient to raise a triable issue of fact as to medical necessity.

Accordingly, the order is modified by providing that defendant's cross motion for summary judgment dismissing the complaint is denied.

PESCE, P.J., ALIOTTA and SOLOMON, JJ., concur.

ENTER:
Paul Kenny
Chief Clerk
Decision Date: September 22, 2017