July 11, 2006

Meridian Acupuncture Care v Geico Ins. Co. (2006 NY Slip Op 05599)

https://www.beynensonlaw.com/case-law/meridian-acupuncture-care-v-geico-ins-co-2006-ny-slip-op-05599/

Court: Appellate Division, Second Department
Decided: July 11, 2006
Citation: 2006 NY Slip Op 05599 · 31 AD3d 509
Posture: Motion to dismiss (CPLR 3211)
Outcome: Insurer prevailed
Issues: Medical necessity

Cite as

Meridian Acupuncture Care v Geico Ins. Co., 31 AD3d 509 (2d Dept 2006)

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.

A physician conducting an IME of an acupuncture patient need not hold an acupuncture license or certification. The Appellate Division, Second Department, affirmed dismissal under CPLR 3211 (a) (7) of a proposed class action seeking, among other relief, payment for acupuncture treatments. The provider's claims incorrectly assumed that 11 NYCRR part 65 required the insurer to use physicians licensed as acupuncturists for such IMEs. No such requirement appeared in 11 NYCRR 65-1.1, and conducting the examination was not practicing acupuncture under Education Law §§ 6521 and 8211 (1) (a). The court did not reach the remaining contentions.

Reported in New York Official Reports at Meridian Acupuncture Care v Geico Ins. Co. (2006 NY Slip Op 05599)

Meridian Acupuncture Care v Geico Ins. Co.

2006 NY Slip Op 05599 [31 AD3d 509]

July 11, 2006

Appellate Division, Second Department

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

As corrected through Wednesday, September 20, 2006

Meridian Acupuncture Care, Appellant,
v
Geico Insurance Company, Respondent.

—[*1]

In a proposed class action by individual insureds or their assignees, inter alia, in effect, to recover payments for acupuncture treatments, the plaintiff appeals from an order of the Supreme Court, Nassau County (Warshawsky, J.), entered January 12, 2005, which, among other things, granted that branch of the defendant’s motion which was to dismiss the complaint pursuant to CPLR 3211 (a) (7).

Ordered that the order is affirmed, with costs.

The Supreme Court properly dismissed the complaint for failure to state a cause of action (see CPLR 3211 [a] [7]). The plaintiff’s claims are based on the erroneous proposition that New York Insurance Department regulation 68 (11 NYCRR part 65) requires the defendant to use only physicians licensed as acupuncturists to conduct independent medical examinations of patients who have received acupuncture treatment. The regulation contains no such requirement (see 11 NYCRR 65-1.1). Furthermore, contrary to the plaintiff’s contentions, no license or certification is required for a physician conducting an independent medical examination of a patient who has received acupuncture treatment, and such a physician is not engaged in the practice of acupuncture (see Education Law §§ 6521, 8211 [1] [a]; Savarese v Allstate Ins. Co., 287 AD2d 492 [2001]). [*2]

In light of this determination, the parties’ remaining contentions need not be reached. Schmidt, J.P., Santucci, Luciano and Rivera, JJ., concur.

Cited by

Allstate Social Work & Psychological Servs., PLLC v Utica Mut. Ins. Co. (2011 NY Slip Op 21010)A psychologist may conduct IMEs of assignors who received psychological treatment under the mandatory no-fault endorsement.

Similar decisions

EMA Acupuncture, P.C. v Geico Ins. Co. (2015 NY Slip Op 51400(U))The provider's acupuncturist affidavit failed to meaningfully address or rebut the insurer's IME findings of no medical necessity.
MIA Acupuncture, P.C. v Geico Ins. Co. (2010 NY Slip Op 51899(U))The insurer established timely denials, proper fee schedule reductions, and lack of medical necessity for the remaining acupuncture services.
Great Wall Acupuncture, P.C. v Geico Ins. Co. (2009 NY Slip Op 29467)An insurer may use the chiropractic acupuncture fee schedule to reimburse acupuncture services performed by a licensed acupuncturist.
Gentle Care Acupuncture, P.C. v GEICO (2011 NY Slip Op 51121(U))An insurer may use the workers' compensation fee schedule for chiropractors' acupuncture services to reimburse a licensed acupuncturist.
Fine Healing Acupuncture, P.C., v Country-Wide Ins. Co. (2011 NY Slip Op 21361)An insurer's medical-necessity denial need not rest on an examination by a practitioner in the treating provider's specialty.