- Court
- New York Supreme Court, Appellate Division, Second Department
- Case
- Matter of Gur-Arie v. Zucker
- Docket
- 2022-01137
- Filed
- May 27, 2026
- Slip Op
- 2026 NY Slip Op 03306
- Citation
- 2026 NY Slip Op 03306 (N.Y. App. Div. 2d Dep’t 2026)
Background
David Gur-Arie is a 30-year-old man with disabilities including quadriplegic cerebral palsy. He is nonambulatory and nonverbal and uses a Solara tilt-in-space wheelchair as his primary device for sitting and movement. In 2013, he obtained a Convaid Cruiser stroller through his primary insurance as a secondary device, used for making weight-bearing transfers at home and for transportation to therapeutic services in a vehicle.
On July 15, 2020, Home Medical Equipment, LLC, made a prior approval request to the New York State Department of Health (DOH) on behalf of Gur-Arie for a new Convaid Cruiser stroller. On August 13, 2020, the DOH denied the request, finding the stroller was not medically necessary and not cost effective. Gur-Arie requested an administrative fair hearing to challenge the denial. After the hearing on March 2, 2021, the DOH’s Administrative Law Judge upheld the denial. Gur-Arie then commenced this CPLR article 78 proceeding, which was transferred to the Appellate Division for disposition.
Holding
The Appellate Division, Second Department granted the petition, annulled the DOH’s determination, and ordered the DOH to direct the Kings County Department of Social Services to provide the requested durable medical equipment to Gur-Arie. The court first dismissed the proceeding insofar as it was asserted against the Commissioner of the Office of Temporary and Disability Assistance (OTDA), as the OTDA commissioner was not a proper party because he did not render the final determination under review.
On the merits, the court applied the substantial evidence standard of review applicable to CPLR article 78 proceedings involving quasi-judicial hearings, under which the determination must be “supported by substantial evidence in the record and is not affected by an error of law.” The court found that the DOH’s determination upholding the denial of the Convaid Cruiser stroller was not supported by substantial evidence. The record demonstrated the medical necessity of the secondary mobility device for Gur-Arie’s daily functioning, transfers, and transportation needs, and the DOH’s conclusory findings of medical unnecessity and cost ineffectiveness were inadequately supported.
Takeaways
This decision is a significant victory for Medicaid recipients seeking durable medical equipment and highlights the court’s willingness to scrutinize DOH denials when the medical evidence in the record supports the request. The substantial evidence standard requires that the agency’s determination be supported by “such relevant proof as a reasonable mind may accept as adequate to support a conclusion.” Conclusory findings that equipment is “not medically necessary” or “not cost effective” may be insufficient when the record contains uncontroverted medical evidence demonstrating the patient’s need for the equipment.
The case also clarifies party identification in article 78 proceedings challenging DOH determinations. The Commissioner of the OTDA is not a proper respondent when the challenged determination was made by the DOH. Petitioners should name the DOH Commissioner and the DOH as respondents.
For advocates representing individuals with disabilities, the decision underscores the importance of building a strong record at the fair hearing level, including detailed medical documentation of the patient’s functional limitations and the medical necessity of the requested equipment.
Why It Matters
This case has important implications for individuals with severe disabilities who rely on Medicaid for durable medical equipment. The court’s willingness to annul the DOH’s denial and order provision of the equipment demonstrates that article 78 review provides a meaningful check on agency determinations that may not adequately account for a patient’s individualized medical needs. For a nonambulatory, nonverbal man with quadriplegic cerebral palsy, the denial of a secondary mobility device used for essential daily activities and medical transportation represented a significant barrier to functioning. The court’s intervention ensures that the agency’s gatekeeping function does not override clear medical necessity when the evidence supports the request.