Key Takeaway
Court improperly searched record to grant defendant summary judgment on medical necessity when plaintiff never moved on that issue, violating procedural fairness.
No-fault insurance litigation requires strict adherence to procedural rules, particularly when courts consider summary judgment motions. A recent appellate decision highlights an important procedural misstep that can unfairly disadvantage healthcare providers seeking payment for services rendered to accident victims.
The Healing Art Acupuncture Decision
In healthcare provider litigation against insurance companies, the issue of medical necessity often becomes a central battleground. However, courts must follow proper procedures when addressing these claims, particularly regarding which party bears the burden of proof on specific issues.
Jason Tenenbaum’s Analysis:
Healing Art Acupuncture, P.C. v Allstate Ins. Co., 2015 NY Slip Op 51670(U)(App. Term 2d Dept. 2015)
“While the court has the power to award summary judgment to a nonmoving party predicated upon a motion for that relief by another party (see Dunham v Hilco Constr. Co., 89 NY2d 425 ), here the issue of medical necessity was not the subject of plaintiff’s motion for summary judgment (see Mary Immaculate Hosp. v Allstate Ins. Co., 5 AD3d 742 ). As a result, the court improvidently exercised its discretion when it searched the record and awarded defendant summary judgment dismissing the complaint insofar as it sought to recover for services rendered after November 20, 2009″
Search of the record was inappropriate. It makes sense in this case as Plaintiff has no reason to believe (s) he had to proffer sufficient evidence to show the services were medically necessary,
Key Takeaway
Courts cannot sua sponte search records to grant summary judgment on issues not raised in the motion. When medical necessity isn’t the subject of a plaintiff’s motion, the court acts improperly by independently examining evidence to dismiss claims on that ground. This protects healthcare providers from unexpected procedural disadvantages in no-fault litigation.
