AutoOne Ins./General Assur. v. Eastern Island Medical Care, P.C., 24 N.Y.S.3d 730
Insurer brought a DJ action against a medical provider alleging that it was not obligated to pay claims for services submitted by the provider since the services were not medically necessary. Although the insurer established prima facia that the services were not medically necessary and that the denials were mailed timely, the Court nevertheless denied summary judgment based upon the defendant/medical provider’s submission through affidavits and various medical records, which created a triable issue of fact as to the necessity of the treatment.
This was the reverse of what applicants do in Court by virtue of a Summary Judgment motion.