Hillcrest Radiology Assoc. v State Farm Mut. Auto. Ins. Co.

[*1] Hillcrest Radiology Assoc. v State Farm Mut. Auto. Ins. Co. 2010 NY Slip Op 51467(U) [28 Misc 3d 138(A)] Decided on August 13, 2010 Appellate Term, Second Department Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on August 13, 2010
SUPREME COURT OF THE STATE OF NEW YORK
APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., WESTON and GOLIA, JJ
2009-711 K C. NO. 2009-711 K C

Hillcrest Radiology Associates a/a/o DENNYS BARCCO, Respondent,

against

State Farm Mutual Automobile Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Johnny Lee Baynes, J.), entered December 4, 2008. The order denied defendant's motion for summary judgment dismissing the complaint.

ORDERED that the order is affirmed without costs.

In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint on the ground that the services billed for were not medically necessary. In opposition to the motion, plaintiff's attorney argued that defendant had failed to make a prima facie showing of its entitlement to judgment as a matter of law. The Civil Court denied the motion and defendant appeals.

In support of its motion for summary judgment, defendant annexed to its papers an affirmed peer review report, which found the MRIs in question to be medically unnecessary. However, also annexed to the moving papers were defendant's independent medical examination report, which found one of the MRIs to be medically necessary, and other reports that contradicted facts set forth in the peer review report. Since defendant's moving papers are contradictory as to whether there was a lack of medical necessity for the services at issue, defendant failed to establish its prima facie entitlement to summary judgment as a matter of law (see Zuckerman v City of New York, 49 NY2d 557 [1980]). Accordingly, defendant's motion was properly denied (see Alvarez v Prospect Hosp., 68 NY2d 320 [1986]).

Pesce, P.J., and Weston, J., concur.

Golia, J., concurs in part and dissents in part in a separate memorandum.
SUPREME COURT OF THE STATE OF NEW YORK
APPELLATE TERM : 2nd, 11th and 13th JUDICIAL DISTRICTS
PRESENT : PESCE, P.J., WESTON and GOLIA, JJ.
HILLCREST RADIOLOGY ASSOCIATES [*2]
a/a/o DENNYS BARCCO,

Respondent,

-against-
STATE FARM MUTUAL AUTOMOBILE
INSURANCE COMPANY,

Appellant.

Golia, J., concurs in part and dissents in part and votes to modify the order to provide that so much of defendant's motion as sought summary judgment dismissing the complaint insofar as it sought to recover for the MRIs of plaintiff's assignor's shoulder and knee is granted, in the following memorandum:

I concur with the majority in affirming that part of the Civil Court order which denied defendant's motion for summary judgment as it relates to the MRI of plaintiff's assignor's cervical spine. As stated in the majority's decision, "defendant's independent medical examination report . . . found . . . the MRI to be medically necessary." Inasmuch as this directly contradicted defendant's peer review report, I agree that defendant is not entitled to summary judgment as regards this MRI study.

My review of the file does not reflect any "other reports that contradicted facts set forth in the peer review report."

In addition, it should be noted that plaintiff has failed to submit an affidavit by a doctor, nurse or trained medical personnel of any kind to contradict or rebut the finding set forth in the peer review report. Indeed, the only medical opinion of any kind that contradicts the peer review report is that of defendant's doctor who conducted the independent medical examination (IME) regarding the cervical MRI. As stated earlier, I concur with the majority in finding that defendant's own IME doctor has properly raised an issue of fact preventing the court from granting summary judgment but only as to that MRI study.

However, there is no such issue of fact raised by any competent medical affiants as regards the remaining two MRIs of the left shoulder and left knee. It is beyond the ken of plaintiff's counsel to reach "contrary" medical conclusions when not presented with "contrary" medical evidence.

Accordingly, I would modify the order to provide that so much of defendant's motion as sought summary judgment dismissing the complaint insofar as it sought to recover for the MRIs of plaintiff's assignor's shoulder and knee is granted.
Decision Date: August 13, 2010