March 18, 2016
Natural Therapy Acupuncture, P.C. v American Tr. Ins. Co. (2016 NY Slip Op 50389(U))
https://www.beynensonlaw.com/case-law/natural-therapy-acupuncture-p-c-v-american-tr-ins-co-2016-ny-slip-op50389u/
- Decided
- March 18, 2016
- Citation
- 2016 NY Slip Op 50389(U) · 51 Misc 3d 129(A)
- Posture
- Summary judgment
- Outcome
- Insurer prevailed
- Later treatment
- Followed in 1 later decision (see Cited by)
- Issues
- Fee schedule
- Legal questions
- Proving a fee schedule defense (see the maps)
Posture, outcome, issues and treatment by other decisions are Beynenson Law’s classification. Treatment labels are assigned by a language model reading the citing decision; negative and appeal-history labels are checked by a second reader.
Summary
Editorial summary by Beynenson Law, not part of the court’s decision.
Reported in New York Official Reports at Natural Therapy Acupuncture, P.C. v American Tr. Ins. Co. (2016 NY Slip Op 50389(U))
| Natural Therapy Acupuncture, P.C. v American Tr. Ins. Co. |
| 2016 NY Slip Op 50389(U) [51 Misc 3d 129(A)] |
| Decided on March 18, 2016 |
| Appellate Term, Second Department |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports. |
Decided on March 18, 2016
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : WESTON, J.P., PESCE and ALIOTTA, JJ.
2014-769 Q C
against
American Transit Ins. Co., Respondent.
Appeal from an order of the Civil Court of the City of New York, Queens County (William A. Viscovich, J.), entered March 14, 2014. The order denied plaintiff’s motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint.
ORDERED that the order is affirmed, with $25 costs.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint on the ground that defendant had timely and properly paid plaintiff’s claims in accordance with the workers’ compensation fee schedule. Plaintiff appeals from an order of the Civil Court denying plaintiff’s motion and granting defendant’s cross motion.
Contrary to plaintiff’s arguments on appeal, the affidavit of defendant’s no-fault examiner, and the exhibits annexed in support of defendant’s cross motion, established that defendant had fully paid plaintiff for the services at issue in accordance with the workers’ compensation fee schedule (see Great Wall Acupuncture, P.C. v Geico Ins. Co., 26 Misc 3d 23 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2009]). Plaintiff failed to raise a triable issue of fact in opposition to defendant’s cross motion. Consequently, the Civil Court properly granted defendant’s cross motion and denied plaintiff’s motion.
Accordingly, the order is affirmed.
Weston, J.P., Pesce and Aliotta, JJ., concur.
Decision Date: March 18, 2016
Legal questions
A question of no-fault law this decision rules on, from our Legal Questions pages. Bars count the decisions on the question by year and court, coloured by category; circles are this decision and the decisions on the question it cites or that cite it. Point at a bar or circle for details. The categories and summaries are Beynenson Law’s classification, made by a language model and checked by a second reading.
Did the insurer prove that the amount billed exceeded the applicable workers’ compensation fee schedule?
This decision: Insurer proved the billed amount exceeded the applicable fee schedule
Held the no-fault examiner's affidavit and exhibits established the insurer fully paid the acupuncture provider under the workers' compensation fee schedule, and the provider raised no triable issue.
Of the 285 decisions on this question in the Second Department courts and the Court of Appeals, 147 (this one included) are in the same category.
Cited in this decision
A label shows how this decision treated the case it cites.
- Great Wall Acupuncture, P.C. v Geico Ins. Co. (2009 NY Slip Op 29467) FollowedAn insurer may use the chiropractic acupuncture fee schedule to reimburse acupuncture services performed by a licensed acupuncturist.
Cited by
A label shows how the later decision treated this one.
- Tandingan PT PC v State Farm Fire & Cas. Co. (2021 NY Slip Op 50869(U)) FollowedThree provider claims were barred by a declaratory judgment, and the insurer proved fee schedule payment of the fourth.
- NY Wellness Med. P.C. v Ameriprise Ins. Co. (2021 NY Slip Op 50382(U))The insurer's delay notices referring only to the assignor's EUO failed to toll the payment period for three provider bills.
Similar decisions
- Natural Therapy Acupuncture, P.C. v Travelers Ins. Co. (2015 NY Slip Op 51713(U))The insurer established timely denial and full payment under the fee schedule for acupuncture services performed by chiropractors.
- Natural Therapy Acupuncture, P.C. v GEICO Ins. Co. (2019 NY Slip Op 51254(U))The insurer established that its payments complied with the workers' compensation fee schedule, and the provider failed to rebut that showing.
- Natural Therapy Acupuncture, P.C. v Nationwide Ins. (2017 NY Slip Op 50943(U))The insurer established full payment for acupuncture services under the workers' compensation fee schedule applicable to chiropractors.
- Natural Therapy Acupuncture, P.C. v Interboro Ins. Co. (2012 NY Slip Op 51350(U))The insurer established deductible and fee schedule defenses to three claims and nonreceipt of the claim underlying the second cause of action.
- Acupuncture Healthcare Plaza I, P.C. v Truck Ins. Exch. (2016 NY Slip Op 50309(U))The insurer established timely mailing of its denial and full payment under the fee schedule for acupuncture performed by chiropractors.