| Countrywide Ins. Co. v 563 Grand Med., P.C. |
| 2008 NY Slip Op 03059 [50 AD3d 313] |
| April 3, 2008 |
| Appellate Division, First Department |
| Countrywide Insurance Company, Appellant, v 563 GrandMedical, P.C., as Assignee of Robert Alford, Respondent. |
—[*1] Gary Tsirelman, Brooklyn, for respondent.
Judgment, Supreme Court, New York County (Helen E. Freedman, J.), entered January 30,2007, awarding defendant the principal sum of $12,638.96, and bringing up for review an order,same court and Justice, entered May 25, 2006, which granted defendant's motion for summaryjudgment on its claim for first-party no-fault insurance benefits, and an order, same court andJustice, entered May 30, 2006, which in effect granted plaintiff's motion for reargument and,upon reargument, adhered to its prior determination, unanimously reversed, on the law, withoutcosts, the judgment vacated, and defendant's motion for summary judgment denied. Appeal fromthe order entered May 30, 2006 unanimously dismissed, without costs, as subsumed in the appealfrom the judgment.
Defendant medical provider established prima facie its entitlement to judgment as a matter oflaw by demonstrating that the necessary billing documents were mailed to and received byplaintiff insurer and that payment of the no-fault benefits was overdue (see InsuranceLaw § 5106 [a]; 11 NYCRR 65-3.8 [a] [1]; New York & Presbyt. Hosp. v Countrywide Ins. Co., 44 AD3d 729,730 [2007]). However, in opposition to the motion, plaintiff raised a triable issue of fact whetherthe claimed benefits were properly denied for lack of medical justification. Plaintiff was notrequired to set forth the medical rationale in the prescribed denial of claim form (see A.B. Med. Servs., PLLC v Liberty Mut.Ins. Co., 39 AD3d 779 [2007]). Nor is a nurse's review denying no-fault claims for lackof medical necessity per se invalid (seeChannel Chiropractic, P.C. v Country-Wide Ins. Co., 38 AD3d 294, 295 [2007]).[*2]
Plaintiff waived its objection to defendant's standing (see Hospital for Joint Diseases v TravelersProp. Cas. Ins. Co., 9 NY3d 312, 320 [2007]). Concur—Saxe, J.P., Sweeny,McGuire and Acosta, JJ.