Key Takeaway
Appellate Term First Department rules against durable medical equipment provider in no-fault case, finding insufficient evidence of medical necessity for summary judgment.
Triangle R Inc. v New York Cent. Mut. Fire Ins. Co., 2011 NY Slip Op 51663(U)(App. Term 1st Dept. 2011)
“In this action by plaintiff to recover assigned first-party no-fault benefits, defendant’s submissions sufficed to establish prima facie that the medical supplies provided by plaintiff to its assignor were not medically necessary (see Enko Enters. Intl., Inc. v Clarendon Natl. Ins. Co., 30 Misc 3d 127, 2010 NY Slip Op 52267 ; Innovative Chiropractic, P.C. v Travelers Ins. Co., 25 Misc 3d 140, 2009 NY Slip Op 52447 ). In opposition, plaintiff failed to raise a triable issue of fact. The undated medical report relied upon by plaintiff was not properly sworn (see CPLR 2106, 2109), and should not have been considered (see CPT Med. Servs., P.C. v New York Cent. Mut. Fire Ins. Co., 18 Misc 3d 87, 88 ). Moreover, even if considered, the report was insufficient to defeat summary judgment (id.).”
It looks to me like the Appellate Term, First Department, is not too fond of durable medical equipment. Enko v. Clarendon and Triangle v. NYCM (Defendant is entitled to summary judgment based upon submissions) and A-plus v. Mercury and Pomona v. Geico (Defendants submissions fail to conclusively establish its prima facie entitlement to summary judgment)
Related Articles
- Why Conclusory Affidavits Fail: Building Strong Opposition to Medical Necessity Summary Judgment Motions
- Medical Necessity in No-Fault Insurance: Understanding the First Department’s Victory for Insurance Carriers
- The CPLR 2106 Trap: Why Medical Practice Owners Must Avoid This Critical Procedural Error
- A prima facie case of medical necessity?
- New York No-Fault Insurance Law
Legal Update (February 2026): Since this 2011 post, New York’s no-fault regulations have undergone multiple amendments affecting medical necessity standards and evidentiary requirements for durable medical equipment claims. The fee schedules, prior authorization procedures, and documentation requirements for DME providers have been substantially revised, and practitioners should verify current provisions under the updated regulations and recent appellate decisions.
