Triable issue of fact as to medical necessity

Five Boro Med. Equip., Inc. v A. Cent. Ins. Co., 2016 NY Slip Op 50412(U)(App. Term 1st Dept. 2016)

(1) The defendant-insurer’s motion for summary judgment dismissing this first-party no-fault action should have been denied. Initially, we note that Civil Court correctly determined that defendant’s documentary submissions were sufficient to establish, prima facie, that its denial of claim forms were timely and properly mailed (see Preferred Mut. Ins. Co. v Donnelly, 22 NY3d 1169 ; AutoOne Ins./General Assurance v Eastern Island Med. Care, P.C., ____ AD3d_____, 2016 NY Slip Op 00916 ), and that the peer review reports of defendant’s chiropractor were in admissible form”

(2)  However, the medical affidavit submitted by plaintiff, which specified the assignor’s medical conditions and described the intended benefits of each of the medical supplies at issue, was sufficient to raise a triable issue of fact as to medical necessity [*2](see AutoOne Ins./General Assurance v Eastern Island Med. Care, P.C., supra; Amherst Med. Supply, LLC v A. Cent. Ins. Co., 41 Misc 3d 133, 2013 NY Slip Op 51800).

I should have brought suit as “Autoone Ins Co. v. Eastern Island Med. Care, P.C”.  I think I let someone work here name Plaintiff as “Autoone Ins./General Assurance”.  That name is too long.

Substantively, the Court found issues of fact since the affidavit of merit related the supply to the injury.  I am sure it is boilerplate, but look at the industry.

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