Sunday, June 8, 2008

No Opposition to Affirmed Peer Review Report Supports Summary Judgment to Insurer on Lack of Medical Necessity

Eden Med., P.C. a/a/o Shevonne Decamp v. Progressive Cas. Ins. Co.
(App. Term, 2nd Dept., decided 5/272008)

Kings Civil's grant of summary judgment to Progressive AFFIRMED.

"[Progressive] established that it paid $182.18 towards plaintiff's $3,247.19 claim and timely denied the balance on the ground that the services rendered were not medically necessary based on an affirmed peer review report. Since the peer review report submitted by defendant in support of its cross motion established prima facie that the services rendered by plaintiff were not medically necessary and plaintiff did not present any evidence refuting defendant's prima facie showing, the court below properly granted defendant's cross motion for summary judgment dismissing the complaint[.]"

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