I am waiting for Mitch Lustig’s comment about how these courts refuse to learn their lesson…
Ortho-Med Surgical Supply, Inc. v Progressive Cas. Ins. Co., 2012 NY Slip Op 50149(U)(App. Term 2d Dept. 2012)
“Contrary to the determination of the Civil Court, defendant was not required to annex to its motion papers copies of the medical records which were reviewed by defendant’s peer reviewer (see Elmont Open MRI & Diagnostic Radiology, P.C. v New York Cent. Mut. Fire Ins. Co., 30 Misc 3d 126[A], 2010 NY Slip Op 52222[U] [App Term, 9th & 10th Jud Dists 2010]; Urban Radiology, P.C. v Tri-State Consumer Ins. Co., 27 Misc 3d 140[A], 2010 NY Slip Op 50987[U] [App Term, 2d, 11th & 13th Jud Dists 2010]). Consequently, defendant established its prima facie entitlement to summary judgment (see Delta Diagnostic Radiology, P.C. v Integon Natl. Ins. Co., 24 Misc 3d 136[A], 2009 NY Slip Op 51502[U] [App Term, 2d, 11th & 13th Jud Dists 2009]; Delta Diagnostic Radiology, P.C. v American Tr. Ins. Co., 18 Misc 3d 128[A], 2007 NY Slip Op 52455[U] [App Term, 2d & 11th Jud Dists 2007]; [*2]A. Khodadadi Radiology, P.C. v NY Cent. Mut. Fire Ins. Co., 16 Misc 3d 131[A], 2007 NY Slip Op 51342[U] [App Term, 2d & 11th Jud Dists 2007]).
…”plaintiff “failed to demonstrate that discovery was needed in order to show the existence of a triable issue of fact” (Delta Diagnostic Radiology, P.C. v Interboro Ins. Co., 25 Misc 3d 134[A], 2009 NY Slip Op 52222[U] [App Term, 2d, 11th & 13th Jud Dists 2009]; see also Corwin v Heart Share Human Servs. of NY, 66 AD3d 814 [2009]; GZ Med. & Diagnostic, P.C. v Mercury Ins. Co., 26 Misc 3d 146[A], 2010 NY Slip Op 50491[U] [App Term, 2d, 11th & 13th Jud Dists 2010]).”
New Life Med., P.C. v Geico Ins. Co.,2012 NY Slip Op 50150(U)(App. Term 2d Dept. 2012)(run of the mill medical necessity case)
Total Equip., LLC v Praetorian Ins. Co., 2012 NY Slip Op 50155(U)(App. Term 2d Dept. 2012)(District Nassau County reversed)
Elmont Open MRI & Diagnostic Radiology, P.C. v Tri-State Ins. Co., 2012 NY Slip Op 50170(U)(App. Term 2d Dept. 2012)(District Nassau County reversed).
One Response
Here it is. How many freaking times does the Appellate Term have to say the same thing. I am a pretty fair minded defense guy and some think I am a secret plaintiff. HOWEVER, WHEN WILL THE LOWER COURTS AND THE PLAINTIFF’S BAR LEARN THAT IN ORDER TO DEFEAT A MEDICAL NECESSITY MOTION BASED UPON A PEER OR IME, THE DOCTOR MUST SUBMIT A MEANINGFUL AFFIDAVIT. HOW MANY TIMES DOES THE COURT HAVE TO SAY THAT A DEFENDANT’S MOTION IS NOT DEFICIENT IF IT DOES NOT INCLUDE THE DOCUMENTS RELIED UPON BY THE PEERR. ALSO, HOW MANY TIMES DOES THE APPELLATE TERM HAVE TO CITE DELTA DIAGNOSTIC RADIOLOGY AND ST VINCENTS HOSPITAL TO PROVE THAT THE INSURER’S DENIAL WAS MAILED IN ACCORDANCE WITH ITS STANDARD BUSINESS PRACTICES AND PROCEDURES. WHY ARE PLAINITFF’S MAKING THE SAME STUPID ARGUMENTS AND MORE IMPORTANTLY AND SHOCKINGLY WHY ARE THE LOWER COURT JUDGES ACCEPTING THESE ARGUMENTS. THE CASE LAW FROM THE APPELLATE DEPARTMENTS, BOTH FIRST AND SECOND, COULD NOT BE ANY CLEARER.