August 31, 2012

Raz Acupuncture, P.C. v Geico Gen. Ins. Co. (2012 NY Slip Op 51716(U))

https://www.beynensonlaw.com/case-law/raz-acupuncture-p-c-v-geico-gen-ins-co-2012-ny-slip-op51716u/

Court: Appellate Term, Second Department
Decided: August 31, 2012
Citation: 2012 NY Slip Op 51716(U) · 36 Misc 3d 153(A)
Posture: Summary judgment
Outcome: Insurer prevailed
Issues: Fee schedule
Legal questions: Proving a fee schedule defense (see the maps)

Cite as

Raz Acupuncture, P.C. v Geico Gen. Ins. Co., 36 Misc 3d 153(A), 2012 NY Slip Op 51716(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2012)

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.

The insurer's summary judgment dismissing the disputed acupuncture claims on fee-schedule grounds was affirmed. The Appellate Term, Second Department, affirmed the order insofar as appealed from, rejecting the provider's argument that the insurer had not demonstrated full payment under the workers' compensation fee schedule. The provider conceded that its remaining contention rested on material outside the record.

Reported in New York Official Reports at Raz Acupuncture, P.C. v Geico Gen. Ins. Co. (2012 NY Slip Op 51716(U))

[*1]

Raz Acupuncture, P.C. v Geico Gen. Ins. Co.

2012 NY Slip Op 51716(U) [36 Misc 3d 153(A)]

Decided on August 31, 2012

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This opinion is uncorrected and will not be published in the printed Official Reports.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 August 31, 2012

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : PESCE, P.J., RIOS and ALIOTTA, JJ
2011-384 K C.

Raz Acupuncture, P.C. as Assignee of HECTOR CORDOVA, Appellant, —
against
GEICO General Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Katherine A. Levine, J.), entered March 23, 2010. The order, insofar as appealed from as limited by the brief, granted the branches of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover for services rendered from February 23, 2005 to May 4, 2005.

ORDERED that the order, insofar as appealed from, is affirmed, without costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals, as limited by its brief, from so much of an order of the Civil Court as granted the branches of defendant’s motion seeking summary judgment dismissing the complaint insofar as it sought to recover for services rendered from February 23, 2005 to May 4, 2005, finding that defendant had timely denied those claims based upon the workers’ compensation fee schedule.

We find plaintiff’s argument on appeal—that defendant failed to demonstrate that it had fully paid plaintiff for the acupuncture services at issue in accordance with the workers’ compensation fee schedule—to be without merit. Plaintiff’s remaining contention is, as plaintiff concedes, based upon material that is dehors the record.

Accordingly, the order, insofar as appealed from, is affirmed. [*2]

Pesce, P.J., Rios and Aliotta, JJ., concur.
Decision Date: August 31, 2012

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.

Proving a fee schedule defense

Open the full map

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

Rejected the provider's argument that the insurer failed to show full payment under the fee schedule and affirmed dismissal of the acupuncture claims timely denied on fee schedule grounds.

Excess shownNot established; openDefense rejectedSplit by chargeThis decision

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.

Similar decisions

Raz Acupuncture, P.C. v New S. Ins. Co. (2012 NY Slip Op 50865(U))The insurer established full payment under the workers' compensation fee schedule for the four challenged causes of action.
Raz Acupuncture, P.C. v Nationwide Mut. Ins. Co. (2012 NY Slip Op 50871(U))The provider's fee-schedule payment challenge failed, and its remaining contention relied on material outside the record.
Raz Acupuncture, P.C. v AIG Indem. Ins. Co. (2010 NY Slip Op 51177(U))An insurer may use the workers' compensation acupuncture fee schedule for chiropractors to reimburse a licensed acupuncturist.
Health Needles Acupuncture, P.C. v GEICO Ins. Co. (2014 NY Slip Op 51864(U))The insurer established full payment for the disputed acupuncture services under the workers' compensation fee schedule for chiropractors.
Acupuncture Now, P.C. v GEICO Ins. Co. (2017 NY Slip Op 51809(U))The insurer's summary judgment cross motion on fee schedule claims was granted after its mailing and fee schedule proof were upheld.