Your document has been successfully saved!

Search through millions of court cases, regulations, statutes and more...

Search for
Boolean Connector Use Result
AND Sleep AND Fall Records with both “Slip” and “Fall”
OR Lee OR Grant Records with either “Lee” or “Grant”
NOT Transaction NOT Fee Records that contain “Transaction” but exclude “Fee”
( ) (Tree OR Shrub) AND Fall Records containing “Tree” or “Shrub”, and the word “Fall”
" " "Capital Punishment" Records containing the exact phrase “Capital Punishment”
* Affirm* Records containing variations of the root word (such as “Affirmed”, “Affirming”, “Affirmation”, and etc…)
? Connect?r Records that contain single letter variations (such as “Connector” and “Connecter”)
Jurisdiction: Court of Appeals for the Second Circuit
Decision Date: 5/22/2014

STATES

                                                                                                                                                                                                                                                                                                                                                                                                                            FEDERAL

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Promed Durable Equip. Promed Durable Equip., Inc. v. Geico Ins., 2014 NY Slip Op 50872, 43 Misc. 3d 143, 993 N.Y.S.2d 645 (2nd Cir., 2014)

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ? 43 Misc. 3d 143993 N.Y. S. 2d 6452014 N.Y. Slip Op. 50872

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        PROMED DURABLE EQUIPMENT, INC. as Assignee of KEISHA DIAZ, Respondent,
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        v.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        GEICO INSURANCE, Appellant.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        No. 2012–95 K C.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Supreme Court, Appellate Term, Second Dept2, 11 and 13 Judicial Dist.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        May 22, 2014

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        ? 43 Misc. 3d 143993 N.Y. S. 2d 6452014 N.Y. Slip Op. 50872

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        PROMED DURABLE EQUIPMENT, INC. as Assignee of KEISHA DIAZ, Respondent, v. GEICO INSURANCE, Appellant.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        No. 2012–95 K C.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Supreme Court, Appellate Term, Second Dept2, 11 and 13 Judicial Dist.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        May 22, 2014

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 ORDERED that the order, insofar as appealed from, is affirmed, with $25 costs.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint on the ground that it had timely and properly denied the claim at issue based on a lack of medical necessity. Insofar as is relevant to this appeal, the Civil Court, upon denying plaintiff's motion, made, in effect, CPLR 3212(g) findings in plaintiff's favor, denied defendant's cross motion, and held that the only remaining issue for trial was medical necessity.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Defendant fails to articulate a sufficient basis to strike the Civil Court's implicit CPLR 3212(g) findings in plaintiff's favor ( see Viviane Etienne Med. Care, P. C. v. Country–Wide Ins. Co 114 A.D.3d 33 2013 ). In support of its cross motion, defendant submitted an affirmed report from a peer review doctor and an affidavit from a peer review chiropractor, both of which set forth a factual basis and medical rationale for the determinations that there was a lack of medical necessity for the medical supplies at issue. In opposition to defendant's cross motion, plaintiff submitted an affirmation by a doctor which was sufficient to raise a triable issue of fact as to whether these supplies were medically necessary ( see Zuckerman v. City of New York, 49 N.Y.2d 557 1980 ).

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Accordingly, the order, insofar as appealed from, is affirmed.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Cited By
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Cites
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Negative Treatment
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Notes

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Please, select a date range