Alleviation Med. Servs., P.C. v 21st Century Ins. Co. (2016 NY Slip Op 51347(U))

Reported in New York Official Reports at Alleviation Med. Servs., P.C. v 21st Century Ins. Co. (2016 NY Slip Op 51347(U))

Alleviation Med. Servs., P.C. v 21st Century Ins. Co. (2016 NY Slip Op 51347(U)) [*1]
Alleviation Med. Servs., P.C. v 21st Century Ins. Co.
2016 NY Slip Op 51347(U) [53 Misc 3d 128(A)]
Decided on September 19, 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This opinion is uncorrected and will not be published in the printed Official Reports.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 September 19, 2016

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-2223 Q C
Alleviation Medical Services, P.C., as Assignee of DIONISIA RODRIGUEZ, Appellant,

against

21st Century Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Maureen A. Healy, J.), entered July 10, 2013. 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 modified by providing that defendant’s cross motion for summary judgment dismissing the complaint is 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 denied plaintiff’s motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint.

The affidavit by defendant’s claims representative was sufficient to establish that defendant did not receive the claim at issue. However, since the affidavit from plaintiff’s owner demonstrated that the claim form had been mailed to defendant, there is an issue of fact as to whether defendant’s time to pay or deny this claim ever began to run (see Compas Med., P.C. v 21st Century Ins. Co., 47 Misc 3d 128[A], 2015 NY Slip Op 50388[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]). Consequently, neither defendant nor plaintiff is entitled to summary judgment.

Accordingly, the order is modified by providing that defendant’s cross motion for summary judgment dismissing the complaint is denied.

Pesce, P.J., Aliotta and Solomon, JJ., concur.


Decision Date: September 19, 2016
Urban Well Acupuncture, P.C. v Erie Ins. Co. of N.Y. (2016 NY Slip Op 51302(U))

Reported in New York Official Reports at Urban Well Acupuncture, P.C. v Erie Ins. Co. of N.Y. (2016 NY Slip Op 51302(U))

Urban Well Acupuncture, P.C. v Erie Ins. Co. of N.Y. (2016 NY Slip Op 51302(U)) [*1]
Urban Well Acupuncture, P.C. v Erie Ins. Co. of N.Y.
2016 NY Slip Op 51302(U) [53 Misc 3d 126(A)]
Decided on September 19, 2016
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, 2016

SUPREME COURT, APPELLATE TERM, FIRST DEPARTMENT
PRESENT: Shulman, J.P., Ling-Cohan, Gonzalez, JJ.
570162/16
Urban Well Acupuncture, P.C., a/a/o Zunilda Perez, Plaintiff-Respondent,

against

Erie Insurance Company of New York, Defendant-Appellant.

Defendant appeals from an order of the Civil Court of the City of New York, New York County (Paul A. Goetz, J.), entered March 12, 2015, which denied its motion for summary judgment dismissing the complaint.

Per Curiam.

Order (Paul A. Goetz, J.), entered March 12, 2015, reversed, with $10 costs, motion granted and complaint dismissed. The Clerk is directed to enter judgment accordingly.

The affidavits and other documentary evidence submitted by defendant established, prima facie, that it timely denied (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]) plaintiff’s no-fault claims on the ground that the fees plaintiff charged for the acupuncture services it rendered to the assignor exceeded the amount permitted by the worker’s compensation fee schedule (see Akita Med. Acupuncture, P.C. v Clarendon Ins. Co., 41 Misc 3d 134[A], 2013 NY Slip Op 51860[U] [App Term, 1st Dept. 2013]; Great Wall Acupuncture, P.C. v Geico Ins. Co., 26 Misc 3d 23 [App Term, 2d Dept. 2009]). In opposition, plaintiff failed to raise a triable issue as to the efficacy of defendant’s mailing of the denial or the calculation of the fee pertaining to these claims. Therefore, defendant’s motion for summary judgment dismissing the claim — which sought the difference between the amount charged for the services and payments made to plaintiff pursuant to the fee schedule — should have been granted.

Plaintiff’s remaining arguments are either unpreserved or lacking in merit.

THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.


I concur I concur I concur

Decision Date: September 19, 2016

Urban Well Acupuncture, P.C. v Erie Ins. Co. of N.Y. (2016 NY Slip Op 51300(U))

Reported in New York Official Reports at Urban Well Acupuncture, P.C. v Erie Ins. Co. of N.Y. (2016 NY Slip Op 51300(U))

Urban Well Acupuncture, P.C. v Erie Ins. Co. of N.Y. (2016 NY Slip Op 51300(U)) [*1]
Urban Well Acupuncture, P.C. v Erie Ins. Co. of N.Y.
2016 NY Slip Op 51300(U) [53 Misc 3d 126(A)]
Decided on September 19, 2016
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, 2016

SUPREME COURT, APPELLATE TERM, FIRST DEPARTMENT
PRESENT: Shulman, J.P., Ling-Cohan, Gonzalez, JJ.
570163/16
Urban Well Acupuncture, P.C., a/a/o Zunilda Perez, Plaintiff-Respondent,

against

Erie Insurance Company of New York, Defendant-Appellant.

Defendant appeals from an order of the Civil Court of the City of New York, New York County (Paul A. Goetz, J.), entered March 12, 2015, which denied its motion for summary judgment dismissing the complaint.

Per Curiam.

Order (Paul A. Goetz, J.), entered March 12, 2015, modified by granting defendant partial summary judgment dismissing plaintiff’s claim for first-party no-fault benefits billed under CPT codes 97813 and 97814; as modified, order affirmed, without costs.

The affidavits and other documentary evidence submitted by defendant established, prima facie, that it timely denied (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]) plaintiff’s no-fault claims billed under CPT codes 97813 and 97814 on the ground that the amounts charged were in excess of the fees set forth in the applicable worker’s compensation fee schedule (see Akita Med. Acupuncture, P.C. v Clarendon Ins. Co., 41 Misc 3d 134[A], 2013 NY Slip Op 51860[U] [App Term, 1st Dept. 2013]; Great Wall Acupuncture, P.C. v Geico Ins. Co., 26 Misc 3d 23 [App Term, 2d Dept. 2009]). In opposition, plaintiff failed to raise a triable issue as to the efficacy of defendant’s mailing of the denial or the calculation of the fee pertaining to these claims.

However, triable issues remain as to whether defendant properly denied plaintiff’s claim for $70, billed under CPT code 99202 (initial evaluation), thus precluding summary judgment dismissing this claim (see Easy Care Acupuncture, P.C. v Nationwide Gen. Ins. Co., 50 Misc 3d 127[A], 2015 NY Slip Op 51849[U][App Term, 1st Dept. 2015]).

Plaintiff’s remaining arguments are either unpreserved or lacking in merit.

THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.


I concur I concur I concur

Decision Date: September 19, 2016

GL Acupuncture, P.C. v Allstate Ins. Co. (2016 NY Slip Op 51328(U))

Reported in New York Official Reports at GL Acupuncture, P.C. v Allstate Ins. Co. (2016 NY Slip Op 51328(U))

GL Acupuncture, P.C. v Allstate Ins. Co. (2016 NY Slip Op 51328(U)) [*1]
GL Acupuncture, P.C. v Allstate Ins. Co.
2016 NY Slip Op 51328(U) [53 Misc 3d 128(A)]
Decided on September 15, 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 September 15, 2016

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2014-529 Q C
GL Acupuncture, P.C., as Assignee of Richard Martinez, Appellant,

against

Allstate Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Cheree A. Buggs, J.), entered February 13, 2014. The order granted defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order is reversed, with $30 costs, and defendant’s motion for summary judgment dismissing the complaint is denied.

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. Defendant’s motion was based on the defense that it had fully paid plaintiff for the services at issue in accordance with the workers’ compensation fee schedule.

Plaintiff correctly argues on appeal that the affidavits submitted by defendant did not sufficiently set forth a standard office practice or procedure that would ensure that defendant’s denial of claim forms had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). Thus, defendant did not demonstrate its entitlement to summary judgment.

Accordingly, the order is reversed and defendant’s motion for summary judgment dismissing the complaint is denied.

Pesce, P.J., Aliotta and Solomon, JJ., concur.


Decision Date: September 15, 2016
TAM Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 51327(U))

Reported in New York Official Reports at TAM Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 51327(U))

TAM Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 51327(U)) [*1]
TAM Med. Supply Corp. v State Farm Mut. Auto. Ins. Co.
2016 NY Slip Op 51327(U) [53 Misc 3d 128(A)]
Decided on September 15, 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 September 15, 2016

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2014-515 Q C
TAM Medical Supply Corp., as Assignee of Clifton Carr, Appellant,

against

State Farm Mutual Automobile Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Larry Love, J.), entered February 25, 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.

For the reasons stated in Metro Health Prods., Inc. v State Farm Mut. Auto. Ins. Co. (49 Misc 3d 130[A], 2015 NY Slip Op 51419[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]), the order is affirmed.

Pesce, P.J., Aliotta and Solomon, JJ., concur.


Decision Date: September 15, 2016
Restoration Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 51325(U))

Reported in New York Official Reports at Restoration Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 51325(U))

Restoration Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 51325(U)) [*1]
Restoration Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co.
2016 NY Slip Op 51325(U) [53 Misc 3d 128(A)]
Decided on September 15, 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 September 15, 2016

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2014-510 Q C
Restoration Chiropractic, P.C., as Assignee of Fabio Gutierrez, Appellant,

against

New York Central Mutual Fire Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Jodi Orlow, J.), entered February 7, 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. The motion was based upon the defense that plaintiff’s claims were timely denied on the ground that plaintiff’s assignor had failed to appear for duly scheduled independent medical examinations (IMEs).

Contrary to plaintiff’s argument, the proof submitted by defendant in support of its motion was sufficient to give rise to a presumption that the IME scheduling letters and denial of claim forms had been properly mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). Contrary to plaintiff’s further argument, defendant established that plaintiff’s assignor had failed to appear for the duly scheduled IMEs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]). Plaintiff’s remaining contention is without merit.

Accordingly, the order is affirmed.

Pesce, P.J., Aliotta and Solomon, JJ., concur.


Decision Date: September 15, 2016
Dr. Ronda M. Bachenheimer/Meadowbrook Chiropractic v Allstate Ins. Co. (2016 NY Slip Op 51324(U))

Reported in New York Official Reports at Dr. Ronda M. Bachenheimer/Meadowbrook Chiropractic v Allstate Ins. Co. (2016 NY Slip Op 51324(U))

Dr. Ronda M. Bachenheimer/Meadowbrook Chiropractic v Allstate Ins. Co. (2016 NY Slip Op 51324(U)) [*1]
Dr. Ronda M. Bachenheimer/Meadowbrook Chiropractic v Allstate Ins. Co.
2016 NY Slip Op 51324(U) [53 Misc 3d 128(A)]
Decided on September 15, 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 September 15, 2016

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2014-508 Q C
Dr. Ronda M. Bachenheimer/Meadowbrook Chiropractic, as Assignee of Brian Ficeto, Appellant,

against

Allstate Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Carmen R. Velasquez, J.), entered February 19, 2014. The order, insofar as appealed from, denied plaintiff’s motion for summary judgment.

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.

Upon a review of the record, we agree with the Civil Court’s determination that there is a triable issue of fact regarding the medical necessity of the services at issue (see Zuckerman v City of New York, 49 NY2d 557 [1980]).

Accordingly, the order, insofar as appealed from, is affirmed.

Pesce, P.J., Aliotta and Solomon, JJ., concur.


Decision Date: September 15, 2016
Daily Med. Equip. Distrib. Ctr., Inc. v National Liab. & Fire Ins. Co. (2016 NY Slip Op 51323(U))

Reported in New York Official Reports at Daily Med. Equip. Distrib. Ctr., Inc. v National Liab. & Fire Ins. Co. (2016 NY Slip Op 51323(U))

Daily Med. Equip. Distrib. Ctr., Inc. v National Liab. & Fire Ins. Co. (2016 NY Slip Op 51323(U)) [*1]
Daily Med. Equip. Distrib. Ctr., Inc. v National Liab. & Fire Ins. Co.
2016 NY Slip Op 51323(U) [53 Misc 3d 127(A)]
Decided on September 15, 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 September 15, 2016

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2014-494 Q C
Daily Medical Equipment Distribution Center, Inc., as Assignee of Evelyn Rivas, Appellant,

against

National Liability & Fire Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Jodi Orlow, J.), entered February 5, 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 plaintiff’s assignor had failed to appear for duly scheduled independent medical examinations (IMEs). By order entered February 5, 2014, the Civil Court denied plaintiff’s motion and granted defendant’s cross motion.

Contrary to plaintiff’s contention, the affidavits submitted by defendant in support of its cross motion established the timely and proper mailing of the IME scheduling letters and the denial of claim forms (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). In light of the foregoing, plaintiff has shown no basis to disturb the order from which it has appealed.

Accordingly, the order is affirmed.

Pesce, P.J., Aliotta and Solomon, JJ., concur.


Decision Date: September 15, 2016
DAC Medical, P.C./Timothy Mosomillo, D.O. v Allstate Ins. Co. (2016 NY Slip Op 51322(U))

Reported in New York Official Reports at DAC Medical, P.C./Timothy Mosomillo, D.O. v Allstate Ins. Co. (2016 NY Slip Op 51322(U))

DAC Medical, P.C./Timothy Mosomillo, D.O. v Allstate Ins. Co. (2016 NY Slip Op 51322(U)) [*1]
DAC Medical, P.C./Timothy Mosomillo, D.O. v Allstate Ins. Co.
2016 NY Slip Op 51322(U) [53 Misc 3d 127(A)]
Decided on September 15, 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 September 15, 2016

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2014-421 Q C
DAC Medical, P.C./Timothy Mosomillo, D.O., as Assignee of Nancy Cirillo, Appellant,

against

Allstate Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (William A. Viscovich, J.), entered January 24, 2014. The order, insofar as appealed from, denied plaintiff’s motion for summary judgment.

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.

Upon a review of the record, we agree with the Civil Court’s determination that there is a triable issue of fact regarding the medical necessity of the services at issue (see Zuckerman v City of New York, 49 NY2d 557 [1980]).

Accordingly, the order, insofar as appealed from, is affirmed.

Pesce, P.J., Aliotta and Solomon, JJ., concur.


Decision Date: September 15, 2016
New Way Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 51321(U))

Reported in New York Official Reports at New Way Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 51321(U))

New Way Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 51321(U)) [*1]
New Way Med. Supply Corp. v State Farm Mut. Auto. Ins. Co.
2016 NY Slip Op 51321(U) [53 Misc 3d 127(A)]
Decided on September 15, 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 September 15, 2016

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2014-409 Q C
New Way Medical Supply Corp., as Assignee of Kathleem Long, Appellant,

against

State Farm Mutual Automobile Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Ulysses Bernard Leverett, J.), entered January 28, 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.

For the reasons stated in Metro Health Prods., Inc. v State Farm Mut. Auto. Ins. Co. (49 Misc 3d 130[A], 2015 NY Slip Op 51419[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]), the order is affirmed.

Pesce, P.J., Aliotta and Solomon, JJ., concur.


Decision Date: September 15, 2016