June 11, 2026

Acupuncture Care, PC. v State Farm Mut. Auto. Ins. Co. (2026 NY Slip Op 50991(U))

Headnote

The insurer's alleged overpayments could not offset additional fee-schedule reimbursement because it had asserted no counterclaim. The Civil Court, Richmond County, granted the insurer's summary judgment motion in part and denied it in part, awarding the provider $65.60 and otherwise dismissing the complaint. The insurer's coder identified underpayments for three groups of services. The provider's billing specialist did not adequately rebut the coder's fee-schedule analysis. Although the coder also identified alleged overpayments for other services, the court declined to reduce the amount owed because the insurer had not counterclaimed for reimbursement.

Reported in New York Official Reports at Acupuncture Care, PC. v State Farm Mut. Auto. Ins. Co. (2026 NY Slip Op 50991(U))

Acupuncture Care, PC. v State Farm Mut. Auto. Ins. Co.
2026 NY Slip Op 50991(U) [89 Misc 3d 1218(A)]
Decided on June 11, 2026
Civil Court of the City of New York, Richmond County
Javier Ortiz, J.
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
This opinion is uncorrected and will not be published in the printed Official Reports.


Digest-Index Classification: Insurance�No-Fault Automobile Insurance�Overpayment

Acupuncture Care, PC. A/A/O ROSSI, ALBERT, Plaintiff,

v

State Farm Mutual Automobile Insurance Company, Defendant.

Civil Court of the City of New York, Richmond County

Decided on June 11, 2026

Index No. CV-769317-24/RI

For Plaintiff Acupuncture Care, PC:

Law Offices of Anna Goldman, PC

586 Midland Avenue Suite 2-B

Staten Island, New York 10306

718-307-5666

Appearing of counsel Marvin Ben Aaron mbaesqsiny@aol.com

For Defendant State Farm Mutual Auto Ins. Co.:

Nicole McErlean

Freiberg Peck & Kang LLP

200 Business Park Drive Suite 200

Armonk, New York 10504

212-252-9550

Nmcerlean@fplawfirm.com

Javier Ortiz, J.

[*1]

Recitation, as required by CPLR �2219(a), of the papers considered in the review of this Motion:

D’s Motion & Supporting Docs 8-16

P’s Affirmation in Opposition 18

D’s Affirmation in Reply 19

Upon the foregoing cited papers, the Decision/Order on Defendant’s motion for summary judgment is GRANTED IN PART and DENIED IN PART for the reasons discussed as follows:

The coder affirmation of Mercy Acuna, RN, BSN, CPC (NYSCEF No. 14) indicates that an additional $65.60 is owed to Plaintiff as follows: (1) $26.24 for dates of service 03/18/24-03/27/24 ($186.18 found to be owing pursuant to coder affirmation, but only $159.94 paid per the denial); (2) $26.24 for dates of service 04/01/24-04/11/24 ($81.30 found to be owing pursuant to coder affirmation, but only $55.06 paid per the denial); and (3) $13.12 for dates of [*2]service 05/08/24-05/16/24 ($40.65 found to be owing pursuant to coder affirmation, but only $27.53 paid per the denial).FN1

While Plaintiff submitted a rebuttal affirmation of its billing and collections specialist (see NYSCEF No. 18), the Court finds that affirmation does not adequately rebut the relevant points made in Ms. Acuna’s thorough 27-page discussion of the application of the fee schedule to the bills at issue here.

As such, Plaintiff is granted judgment for $65.60 plus interest, attorney’s fees, and filing fees. The Complaint is otherwise dismissed. All trial dates are hereby vacated.

This constitutes the Decision and Order of the Court.

DATED: June 11, 2026

Hon. Javier Ortiz, J.C.C.

Kings County Civil Court

Footnotes

Footnote 1

Ms. Acuna also found that Defendant only should have paid $152.26 for dates of service March 1-13, 2024, even though Defendant’s denial indicated that it would pay Plaintiff $175.66. Additionally, for dates of service April 16-May 1, 2024, Ms. Acuna found that Defendant only should have paid $73.36 even though the denial indicated a payment of $103.75. The Court nonetheless finds that the total $53.79 of alleged overpayments for March 1-13, 2024 (equaling $23.40) and April 16-May 1, 2024 (equaling $30.39) cannot be used to reduce the overall amounts owed by Defendant here because Defendant did not assert a counterclaim in its answer seeking reimbursement for any alleged overpayments. (Cf Nova Acupuncture, P.C. v Mercury Cas. Co., 48 Misc 3d 127(A), 2015 NY Slip Op 50914(U) [App Term, 2d Dept 2015] [defendant asserted counterclaim to seek reimbursement of overpayments]; Cornell Med., P.C. v Mercury Cas. Co., 24 Misc 3d 58, 2009 NY Slip Op 29228) [App Term, 2d Dept 2009] [defendant sought to amend its answer to include counterclaim to seek reimbursement of overpayments].)

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