Reported in New York Official Reports at T & S Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51240(U))
| T & S Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. |
| 2017 NY Slip Op 51240(U) [57 Misc 3d 133(A)] |
| Decided on September 22, 2017 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports.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 September 22, 2017
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, MARTIN M. SOLOMON, JJ
2014-1714 K C
against
State Farm Mutual Automobile Ins. Co., Respondent.
The Rybak Firm, PLLC (Damin J. Toell, Esq.), for appellant. De Martini & Yi, LLP (Arthur J. DeMartini, Esq.), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Pamela L. Fisher, J.), entered June 9, 2014. The order granted defendant’s 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 appeals from an order of the Civil Court which granted defendant’s motion for summary judgment dismissing the complaint on the ground that plaintiff’s assignor had failed to appear for duly scheduled examinations under oath (EUOs).
Contrary to plaintiff’s sole argument on appeal, defendant properly tolled its time to pay or deny the claim at issue through its initial and follow-up EUO scheduling letters (see 11 NYCRR 65-3.5 [b]; 65-3.6 [b]).
Accordingly, the order is affirmed.
PESCE, P.J., ALIOTTA and SOLOMON, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: September 22, 2017
Reported in New York Official Reports at Compas Med., P.C. v American Tr. Ins. Co. (2017 NY Slip Op 51239(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
American Transit Ins. Co., Respondent.
The Rybak Firm, PLLC (Damin J. Toell, Esq.), for appellant. Law Office of Jason Tenenbaum, P.C. (Jason Tenenbaum, Esq.), for respondent.
Appeal from an order of the Civil Court of the City of New York, Queens County (Richard G. Latin, J.), entered June 13, 2014. The order, insofar as appealed from and as limited by the brief, denied the branches of plaintiff’s motion seeking summary judgment on the second through seventh causes of action and granted the branches of defendant’s cross motion seeking summary judgment dismissing the third through seventh causes of action.
ORDERED that the order, insofar as appealed from, is modified by providing that the branches of defendant’s cross motion seeking summary judgment dismissing the third through seventh causes of action are denied; as so modified, 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 moved for summary judgment and defendant cross-moved for summary judgment dismissing the complaint. Insofar as is relevant to this appeal, the Civil Court denied the branches of plaintiff’s motion seeking summary judgment on the second through seventh causes of action and granted the branches of defendant’s cross motion seeking summary judgment dismissing the third through seventh causes of action.
Contrary to plaintiff’s contention, the Civil Court correctly determined that there are triable issues of fact with respect to the second cause of action. With respect to the third through fifth causes of action, defendant made a prima facie showing that it had not received the [*2]requested verification, but plaintiff correctly argues that the affidavit it submitted in opposition to defendant’s motion was sufficient to give rise to a presumption that the requested verification had been mailed to, and received by, defendant (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). In light of the foregoing, there is a triable issue of fact as to whether these causes of action are premature (see Compas Med., P.C. v Praetorian Ins. Co., 49 Misc 3d 152[A], 2015 NY Slip Op 51776[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]).
With respect to the sixth and seventh causes of action, plaintiff correctly argues that defendant did not demonstrate, as a matter of law, that it had fully paid plaintiff for the services at issue in accordance with the workers’ compensation fee schedule. However, plaintiff failed to establish its prima facie entitlement to summary judgment on these causes of action, since the proof submitted by plaintiff failed to establish that the claims had not been timely denied (see Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 25 NY3d 498 [2015]), or that defendant had issued timely denial of claim forms with respect thereto that were conclusory, vague or without merit as a matter of law (see Westchester Med. Ctr. v Nationwide Mut. Ins. Co., 78 AD3d 1168 [2010]; Ave T MPC Corp. v Auto One Ins. Co., 32 Misc 3d 128[A], 2011 NY Slip Op 51292[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2011]).
Accordingly, the order, insofar as appealed from, is modified by providing that the branches of defendant’s cross motion seeking summary judgment dismissing the third through seventh causes of action are denied.
PESCE, P.J., ALIOTTA and SOLOMON, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: September 22, 2017
Reported in New York Official Reports at TAM Med. Supply Corp. v 21st Century Ins. Co. (2017 NY Slip Op 51238(U))
| TAM Med. Supply Corp. v 21st Century Ins. Co. |
| 2017 NY Slip Op 51238(U) [57 Misc 3d 133(A)] |
| Decided on September 22, 2017 |
| 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 September 22, 2017
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, MARTIN M. SOLOMON, JJ
2014-1585 Q C
against
21st Century Insurance Company, Respondent.
The Rybak Firm, PLLC (Damin J. Toell, Esq.), for appellant. Law Offices of Bryan M. Rothenberg (Sharon A. Brennan, Esq.), for respondent.
Appeal from an order of the Civil Court of the City of New York, Queens County (Richard G. Latin, J.), entered June 9, 2014. The order, insofar as appealed from, granted the branch of defendant’s motion seeking summary judgment dismissing the second cause of action and, upon denying the branch of defendant’s motion seeking summary judgment dismissing the first cause of action, found, in effect pursuant to CPLR 3212 (g), that defendant had established proper mailing of the denial of the claim underlying that cause of action.
ORDERED that the order, insofar as appealed from, is affirmed, with $25 costs.
In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint on the ground of lack of medical necessity. Plaintiff appeals from so much of an order of the Civil Court as granted the branch of defendant’s motion seeking summary judgment dismissing the second cause of action and, upon denying the branch of defendant’s motion seeking summary judgment dismissing the first cause of action, found, in effect pursuant to CPLR 3212 (g), that defendant had established proper mailing of the denial of claim form underlying that cause of action.
Contrary to plaintiff’s sole argument on appeal, the proof submitted by defendant in support of its motion was sufficient to establish that the denial of claim forms at issue had been properly mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]).
Accordingly, the order, insofar as appealed from, is affirmed.
PESCE, P.J., ALIOTTA and SOLOMON, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: September 22, 2017
Reported in New York Official Reports at GBI Acupuncture, P.C. v GEICO Ins. Co. (2017 NY Slip Op 51237(U))
| GBI Acupuncture, P.C. v GEICO Ins. Co. |
| 2017 NY Slip Op 51237(U) [57 Misc 3d 132(A)] |
| Decided on September 22, 2017 |
| 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 September 22, 2017
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, MARTIN SOLOMON, JJ
2014-1535 Q C
against
GEICO Ins. Co., Respondent.
The Rybak Firm, PLLC (Damin J. Toell, Esq.), for appellant. The Law Office of Printz & Goldstein (Lawrence J. Chanice, Esq.), for respondent.
Appeal from an order of the Civil Court of the City of New York, Queens County (Richard G. Latin, J.), entered May 5, 2014. The order, insofar as appealed from, denied plaintiff’s motion for summary judgment, granted the branches of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims which had been denied based on the workers’ compensation fee schedule, and, upon denying the branches defendant’s cross motion seeking summary judgment dismissing the remainder of the complaint, found, in effect pursuant to CPLR 3212 (g), that defendant had established the timely denials of the claims underlying that portion of the complaint.
ORDERED that the order, insofar as appealed from, is affirmed, with $25 costs.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from so much of an order of the Civil Court as denied plaintiff’s motion for summary judgment, granted the branches of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims which had been denied based on the workers’ compensation fee schedule, and, upon denying the branches defendant’s cross motion seeking summary judgment dismissing the remainder of the complaint, found, in effect pursuant to CPLR 3212 (g), that defendant had established the timely denials of the claims underlying that portion of the complaint.
Contrary to plaintiff’s argument, defendant’s proof established proper mailing of the denial of claim forms at issue (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. [*2]Co., 50 AD3d 1123 [2008]). Plaintiff’s further argument regarding defendant’s application of the workers’ compensation fee schedule lacks merit (see Great Wall Acupuncture, P.C. v Geico Ins. Co., 26 Misc 3d 23 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2009]).
Accordingly, the order, insofar as appealed from, is affirmed.
PESCE, P.J., ALIOTTA and SOLOMON, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: September 22, 2017
Reported in New York Official Reports at Royal Med. Supply, Inc. v Nationwide Gen. Ins. Co. (2017 NY Slip Op 51235(U))
| Royal Med. Supply, Inc. v Nationwide Gen. Ins. Co. |
| 2017 NY Slip Op 51235(U) [57 Misc 3d 132(A)] |
| Decided on September 22, 2017 |
| 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 September 22, 2017
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, MARTIN SOLOMON, JJ
2014-1101 K C
against
Nationwide General Insurance Company, Respondent.
Gary Tsirelman, P.C. (Douglas Mace, Esq.), for appellant. Epstein, Gialleonardo, Harms & McDonald (Yael Ryzowy, Esq.), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Harriet L. Thompson, J.), entered February 14, 2014. The order granted defendant’s 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 appeals from an order of the Civil Court which granted defendant’s motion for summary judgment dismissing the complaint on the ground that plaintiff’s assignor had failed to appear for duly scheduled examinations under oath (EUOs).
Contrary to plaintiff’s argument on appeal, the proof submitted by defendant in support of its motion was sufficient to demonstrate that plaintiff’s assignor had failed to appear for the EUOs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]). Moreover, plaintiff’s arguments on appeal as to defendant’s proof of mailing of the EUO scheduling letters and the denial of claim forms lack merit.
Accordingly, the order is affirmed.
PESCE, P.J., ALIOTTA and SOLOMON, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: September 22, 2017
Reported in New York Official Reports at Citywide Acupuncture Servs., P.L.L.C. v Clarendon Natl. Ins. Co. (2017 NY Slip Op 51233(U))
| Citywide Acupuncture Servs., P.L.L.C. v Clarendon Natl. Ins. Co. |
| 2017 NY Slip Op 51233(U) [57 Misc 3d 132(A)] |
| Decided on September 22, 2017 |
| 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 September 22, 2017
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, MARTIN SOLOMON, JJ
2014-975 K C
against
Clarendon National Insurance Company, Appellant.
Law Offices of Moira Doherty, P.C. (Janice P. Rosen, Esq.), for appellant. Christopher S. Cardillo, P.C., for respondent (no brief filed).
Appeal from an order of the Civil Court of the City of New York, Kings County (Devin P. Cohen, J.), entered September 15, 2013. The order, insofar as appealed from and as limited by the brief, denied the branch of defendant’s cross motion seeking summary judgment dismissing the complaint based on plaintiff’s untimely submission of the claim.
ORDERED that the order, insofar as appealed from, is affirmed, with $25 costs.
In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals, as limited by its brief, from so much of an order as denied the branch of defendant’s cross motion seeking summary judgment dismissing the complaint based on plaintiff’s untimely submission of the claim at issue.
Contrary to defendant’s argument on appeal, the Civil Court properly found that, on this record, there is a triable issue of fact as to whether plaintiff had timely submitted the claim at issue (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]).
Accordingly, the order, insofar as appealed from, is affirmed.
PESCE, P.J., ALIOTTA and SOLOMON, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: September 22, 2017
Reported in New York Official Reports at Vladenn Med. Supply Corp. v American Tr. Ins. Co. (2017 NY Slip Op 51230(U))
| Vladenn Med. Supply Corp. v American Tr. Ins. Co. |
| 2017 NY Slip Op 51230(U) [57 Misc 3d 132(A)] |
| Decided on September 22, 2017 |
| 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 September 22, 2017
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, MARTIN SOLOMON, JJ
2014-917 Q C
against
American Transit Ins. Co., Respondent.
The Rybak Firm, PLLC (Damin J. Toell, Esq.), for appellant. Law Office of Jason Tenenbaum, P.C. (Jason Tenenbaum, Esq.), for respondent.
Appeal from an order of the Civil Court of the City of New York, Queens County (Ulysses Bernard Leverett, J.), entered March 19, 2014. The order, insofar as appealed from, denied the branch of plaintiff’s motion seeking summary judgment on so much of the complaint as sought to recover upon a claim for $1,885.58 and granted the branch of defendant’s cross motion seeking summary judgment dismissing that portion of the complaint.
ORDERED that the order, insofar as appealed from, 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. Plaintiff appeals from so much of an order of the Civil Court as denied the branch of plaintiff’s motion seeking summary judgment on so much of the complaint as sought to recover upon a claim for $1,885.58 and granted the branch of defendant’s cross motion seeking summary judgment dismissing that portion of the complaint.
Contrary to plaintiff’s arguments, the record establishes that defendant had not received timely notice of the accident (see 11 NYCRR § 65-1.1); that the claim at issue had been untimely submitted(see id.); and that defendant had timely denied the claim at issue on those grounds (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]).
Accordingly, the order, insofar as appealed from, is affirmed.
PESCE, P.J., ALIOTTA and SOLOMON, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: September 22, 2017
Reported in New York Official Reports at LMS Acupuncture, P.C. v Titan Ins. Co. (2017 NY Slip Op 51229(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
Titan Insurance Co., Respondent.
The Rybak Firm, PLLC (Damien J. Toell, Esq.), for appellant. Epstien, Gialleonardo, Harms & McDonald (Athena T. Buchanan, Esq.), for respondent.
Appeal from an order of the Civil Court of the City of New York, Queens County (Ulysses Bernard Leverett, J.), entered March 21, 2014. The order granted defendant’s motion for summary judgment dismissing the complaint.
ORDERED that the order is modified by providing that the branches of defendant’s motion seeking summary judgment dismissing the first through third causes of action are denied; as so modified, the order is affirmed, without costs.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court which granted defendant’s motion for summary judgment dismissing the complaint on the ground that plaintiff’s assignor had failed to appear for duly scheduled examinations under oath (EUOs).
Plaintiff correctly argues on appeal that defendant failed to demonstrate that it was entitled to summary judgment dismissing the first through third causes of action, as the EUO requests at issue had been sent more than 30 days after defendant had received the claims underlying those causes of action, and, therefore, the requests were nullities with respect to those claims (see Neptune Med. Care, P.C. v Ameriprise Auto & Home Ins., 48 Misc 3d 139[A], 2015 NY Slip Op 51220[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]; O & M Med., P.C. v Travelers Indem. Co., 47 Misc 3d 134[A], 2015 NY Slip Op 50476[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]). Consequently, the branches of defendant’s motion seeking summary judgment dismissing those causes of action should have been denied.
However, contrary to plaintiff’s arguments, defendant did establish that it had timely mailed the initial and follow-up EUO scheduling letters and denials of the claims underlying the [*2]fourth through sixth causes of action (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; see also 11 NYCRR 65-3.8 [l]). Consequently, we leave undisturbed so much of the order as granted the branches of defendant’s motion seeking summary judgment dismissing those causes of action.
Plaintiff’s remaining arguments lack merit.
Accordingly, the order is modified by providing that the branches of defendant’s motion seeking summary judgment dismissing the first through third causes of action are denied.
PESCE, P.J., ALIOTTA and SOLOMON, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: September 22, 2017
Reported in New York Official Reports at Compas Med., P.C. v 21st Century Ins. Co. (2017 NY Slip Op 51228(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
21st Century Insurance Company, Respondent.
The Rybak Firm, PLLC (Damin J. Toell, Esq.), for appellant. Law Offices of Bryan M. Rothenberg (Maryana Feigen, Esq.), for respondent.
Appeal from an order of the Civil Court of the City of New York, Queens County (Cheree A. Buggs, J.), entered April 2, 2014. The order, insofar as appealed from, denied plaintiff’s motion for summary judgment and granted the branches of defendant’s cross motion seeking summary judgment dismissing the first, fourth and fifth causes of action.
ORDERED that the order, insofar as appealed from, is modified by providing that the branch of defendant’s cross motion seeking summary judgment dismissing the fourth cause of action is denied; as so modified, 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 moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint on the ground that defendant had fully paid plaintiff for the services underlying the first, fourth and fifth causes of action in accordance with the workers’ compensation fee schedule, and that it had not received the claims underlying the remaining causes of action. Plaintiff appeals from so much of an order of the Civil Court as denied plaintiff’s motion and granted the branches of defendant’s cross motion seeking summary judgment dismissing the first, fourth and fifth causes of action.
Plaintiff correctly argues that defendant failed to establish that its denial of the claim underlying the fourth cause of action was timely (see 11 NYCRR 65-3.8 [a] [1]) and that, therefore, its fee schedule defense as to that claim is not precluded (see Great Wall Acupuncture, [*2]P.C. v GEICO Ins. Co., 25 Misc 3d 137[A], 2009 NY Slip Op 52308[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2009]). Consequently, the branch of defendant’s cross motion seeking summary judgment dismissing this cause of action is denied. However, plaintiff failed to demonstrate its entitlement to summary judgment on this claim, as the proof submitted by plaintiff did not establish that the claim at issue had not been timely denied (see Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 25 NY3d 498 [2015]), or that defendant had issued a timely denial of claim form that was conclusory, vague or without merit as a matter of law (see Westchester Med. Ctr. v Nationwide Mut. Ins. Co., 78 AD3d 1168 [2010]; Ave T MPC Corp. v Auto One Ins. Co., 32 Misc 3d 128[A], 2011 NY Slip Op 51292[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2011]).
Contrary to plaintiff’s further argument, defendant’s proof was sufficient to demonstrate, prima facie, that defendant had fully paid for the services charged under code 64550 of the workers’ compensation fee schedule (see Rogy Med., P.C. v Mercury Cas. Co., 23 Misc 3d 132[A], 2009 NY Slip Op 50732[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2009]). Plaintiff failed to rebut that showing. Consequently, we do not disturb so much of the order as granted the branches of defendant’s cross motion seeking summary judgment dismissing the first and fifth causes of action.
As to the remaining causes of action, we find, contrary to plaintiff’s argument, that there is a triable issue of fact as to whether defendant received the claims underlying those causes of action.
We note that plaintiff’s claim that one of defendant’s affidavits was not signed or notarized is contradicted by the record.
Accordingly, the order, insofar as appealed from, is modified by providing that the branch of defendant’s cross motion seeking summary judgment dismissing the fourth cause of action is denied.
PESCE, P.J., ALIOTTA and SOLOMON, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: September 22, 2017
Reported in New York Official Reports at Acupuncture Approach, P.C. v Tri State Consumer Ins. Co. (2017 NY Slip Op 51170(U))
| Acupuncture Approach, P.C. v Tri State Consumer Ins. Co. |
| 2017 NY Slip Op 51170(U) [57 Misc 3d 129(A)] |
| Decided on September 19, 2017 |
| Appellate Term, First 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 September 19, 2017
PRESENT: Shulman, J.P., Ling-Cohan, Gonzalez, JJ.
570145/17
against
Tri State Consumer Ins. Co., Defendant-Respondent.
Plaintiff appeals from an order of the Civil Court of the City of New York, New York County (Andrea Masley, J.), entered June 27, 2013, which granted defendant’s motion for summary judgment dismissing the complaint.
Per Curiam.
Order (Andrea Masley, J.), entered June 27, 2013, modified by reinstating plaintiff’s claim for first-party no-fault benefits billed under CPT code 97039; as modified, order affirmed, with $10 costs.
Triable issues of fact are raised as to whether defendant-insurer properly denied plaintiff’s no-fault claim billed under CPT code 97039, thus precluding summary judgment dismissing this claim. Defendant’s submissions failed to establish prima facie its contention that the service is not reimbursable because it is a “physical medicine modality” and “outside the provider’s specialty” (see TC Acupuncture, P.C. v Tri-State Consumer Ins. Co., 52 Misc 3d 131[A], 2016 NY Slip Op 50978[U] [App Term, 1st Dept 2016]; VS Care Acupuncture v State Farm Mut. Auto. Ins. Co., 46 Misc 3d 141[A], 2015 NY Slip Op 50164[U][App Term, 1st Dept 2015]; see also Forrest Chen Acupuncture Servs., P.C. v GEICO Ins. Co., 54 AD3d 996 [2008]). The remaining claims at issue on appeal were properly dismissed as premature, since it is undisputed that plaintiff failed to respond to the duly issued verification requests (see St. Vincent Med. Care, P.C. v Country Wide Ins. Co., 80 AD3d 599, 600 [2011]).
THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.
I concur I concur I concur
Decision Date: September 19, 2017