In reading some of the entries in this blog, you might have noticed that a medical provider in a no-fault case, outside of New York, must show prima facie that the rendered services are reasonable and necessary. It is noteworthy that in cases not involving no-fault coverage, which are governed solely by statute, e.g., Fam Ct. Act Sec. 413, the courts have in certain cases forced providers of services to make a threshold showing that the said services are reasonable and necessary.
The Appellate Term, Second Term, lead this charge in Mason v. Sondermann, 12 Misc.3d(A)(App. Term 2d. Dept. 2006), when it held the following:
“Since it is unclear from the record whether defendant Stephanie Sondermann was emancipated at the time the treatment at issue in this case was rendered, and whether the services rendered to her were reasonable and necessary a new trial is required.”
Similarly, the Appellate Division in Mary Imogne Bassett Hosp. v. Dahlberg, 229 AD2d 78 (3d Dept. 2006) held: “In our view an absolute statutory obligation pursuant to Family Court Act Section 413 attaches to a parent of a child under the age of 21 for the child’s care, maintenance and education; the obligation also includes payment of reasonable medical expenses”
In another appellate case, the Appellate Term, First Department in Pediatric Urology Assoc. P.C. v. Becher, 22 Misc.3d 130(A)(App. Term 1st Dept. 2009), held the following: “Appellant was obligated to pay the reasonable value of the medical services undisputedly rendered to his nine-year-old daughter, and this even accepting that the services were rendered at the request of his former wife.”
Finally, in recently decided case entitled Mount Vernon Hosp. v Nasibu, 2009 NY Slip Op 08591 (2d Dept. 2009), which spurred the thought behind this post, the Appellate Division observed the following: “The parent of an unemancipated child under the age of 21 has an absolute duty to pay the reasonable expenses of medical care required by the child.”
I just find it anomalous that a medical provider litigating against a child’s parent for rendered services has more to prove (Fam Ct. Act Section 413) than the same medical provider who litigates against an insurance carrier seeking no fault benefits for similarly rendered services (Ins. Law 5106[a]).
