TAM Med. Supply Corp. v American Tr. Ins. Co. (2016 NY Slip Op 51507(U))

Reported in New York Official Reports at TAM Med. Supply Corp. v American Tr. Ins. Co. (2016 NY Slip Op 51507(U))

[*1]
TAM Med. Supply Corp. v American Tr. Ins. Co.
2016 NY Slip Op 51507(U) [53 Misc 3d 139(A)]
Decided on October 11, 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This opinion is uncorrected and will not be published in the printed Official Reports.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 October 11, 2016

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2014-270 Q C
TAM Medical Supply Corp., as Assignee of Dorian Wood, Appellant,

against

American Transit Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Richard G. Latin, J.), entered December 19, 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, by order entered December 19, 2013, the Civil Court denied plaintiff’s motion for summary judgment, and granted defendant’s cross motion for summary judgment dismissing the complaint on the ground that the action was premature because plaintiff had failed to provide requested verification.

For the reasons stated in TAM Med. Supply Corp., as Assignee of Shameca Dudley v National Liab. & Fire Ins. Co. (___ Misc 3d ___, 2016 NY Slip Op ____ [appeal No. 2014-269 Q C], decided herewith), 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: October 11, 2016
TAM Med. Supply Corp. v National Liab. & Fire Ins. Co. (2016 NY Slip Op 51506(U))

Reported in New York Official Reports at TAM Med. Supply Corp. v National Liab. & Fire Ins. Co. (2016 NY Slip Op 51506(U))

[*1]
TAM Med. Supply Corp. v National Liab. & Fire Ins. Co.
2016 NY Slip Op 51506(U) [53 Misc 3d 139(A)]
Decided on October 11, 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 October 11, 2016

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2014-269 Q C
TAM Medical Supply Corp., as Assignee of Shameca Dudley, 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 December 18, 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, by order entered December 18, 2013, the Civil Court denied plaintiff’s motion for summary judgment, and granted defendant’s cross motion for summary judgment dismissing the complaint on the ground that the action was premature because plaintiff had failed to provide requested verification.

In support of its cross motion, defendant established that it had timely mailed its verification request and follow-up verification request (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). Defendant also demonstrated prima facie that it had not received the requested verification and, thus, that plaintiff’s action is premature (see Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492 [2005]). However, in opposition to the cross motion, plaintiff submitted an affidavit from plaintiff’s owner, which affidavit was sufficient to give rise to a presumption that the requested verification had been mailed to, and received by, defendant (see Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [2001]). In light of the foregoing, there is a triable issue of fact as to whether this action is premature (see Compas Med., P.C. v Praetorian Ins. Co., 49 Misc 3d 152[A], 2015 NY Slip Op 57776[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]).

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: October 11, 2016
TAM Med. Supply Corp. v American Tr. Ins. Co. (2016 NY Slip Op 51505(U))

Reported in New York Official Reports at TAM Med. Supply Corp. v American Tr. Ins. Co. (2016 NY Slip Op 51505(U))

[*1]
TAM Med. Supply Corp. v American Tr. Ins. Co.
2016 NY Slip Op 51505(U) [53 Misc 3d 139(A)]
Decided on October 11, 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 October 11, 2016

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


PRESENT:
2014-240 Q C October 11, 2016 SUPREME COURT OF THE STATE OF NEW YORK APPELLATE TERM : 2nd, 11th & 13th JUDICIAL DISTRICTS
TAM Medical Supply Corp., as Assignee of Luis Rojas, Appellant, DECIDED

against

American Transit Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Jodi Orlow, J.), entered December 17, 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, by order entered December 17, 2013, the Civil Court denied plaintiff’s motion for summary judgment, and granted defendant’s cross motion for summary judgment dismissing the complaint on the ground that the action was premature because plaintiff had failed to provide requested verification.

For the reasons stated in TAM Med. Supply Corp., as Assignee of Shameca Dudley v National Liab. & Fire Ins. Co. (___ Misc 3d ___, 2016 NY Slip Op ___ [appeal No. 2014-269 Q C], decided herewith), 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: October 11, 2016
Performance Plus Med., P.C. v Nationwide Ins. (2016 NY Slip Op 51500(U))

Reported in New York Official Reports at Performance Plus Med., P.C. v Nationwide Ins. (2016 NY Slip Op 51500(U))

[*1]
Performance Plus Med., P.C. v Nationwide Ins.
2016 NY Slip Op 51500(U) [53 Misc 3d 139(A)]
Decided on October 11, 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 October 11, 2016

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-2766 Q C
Performance Plus Medical, P.C., as Assignee of Melanna Luckie, Appellant,

against

Nationwide Ins., Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Maureen A. Healy, J.), entered November 4, 2013. 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 on the ground that the action was premature because plaintiff had failed to provide requested verification.

Contrary to plaintiff’s contention, defendant demonstrated that it had not received the requested verification and, thus, that plaintiff’s action is premature (see Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492 [2005]). However, as plaintiff further argues, the affidavit by plaintiff’s owner, 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 this action is 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]).

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: October 11, 2016
Renelique v American Tr. Ins. Co. (2016 NY Slip Op 51495(U))

Reported in New York Official Reports at Renelique v American Tr. Ins. Co. (2016 NY Slip Op 51495(U))

[*1]
Renelique v American Tr. Ins. Co.
2016 NY Slip Op 51495(U) [53 Misc 3d 138(A)]
Decided on October 11, 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 October 11, 2016

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-2544 Q C
Pierre Jean Jacques Renelique, as Assignee of Stephanie Rouse, Appellant,

against

American Transit Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Cheree A. Buggs, J.), entered November 1, 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 on the ground that the action was premature because plaintiff had failed to provide requested verification.

For the reasons stated in Performance Plus Med., P.C., as Assignee of Melanna Luckie v Nationwide Ins. (____ Misc 3d ____, 2016 NY Slip Op ______ [appeal No. 2013-2766 Q C], decided herewith), 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: October 11, 2016
Mollo Chiropractic, PLLC v Farmington Cas. Co. (2016 NY Slip Op 51496(U))

Reported in New York Official Reports at Mollo Chiropractic, PLLC v Farmington Cas. Co. (2016 NY Slip Op 51496(U))

[*1]
Mollo Chiropractic, PLLC v Farmington Cas. Co.
2016 NY Slip Op 51496(U) [53 Misc 3d 138(A)]
Decided on October 11, 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 October 11, 2016
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-2574 Q C

Mollo Chiropractic, PLLC, as Assignee of Miguel Concepcion, Appellant,

against

Farmington Casualty Company, Respondent.


Appeal from an order of the Civil Court of the City of New York, Queens County (Barry A. Schwartz, J.), entered October 16, 2013. 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, defendant moved for summary judgment dismissing the complaint on the ground that the action was premature because plaintiff had failed to provide requested verification. By order entered October 16, 2013, the Civil Court granted defendant’s motion.

Contrary to plaintiff’s contentions, the proof submitted by defendant in support of its motion was sufficient to give rise to a presumption that the initial and follow-up verification requests had been properly mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]), and to demonstrate that defendant had not received the requested verification and, thus, that plaintiff’s action is premature (see Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492 [2005]). However, as plaintiff further argues, the affidavit by plaintiff’s owner, 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, 50 AD3d 1123). In light of the foregoing, there is a triable issue of fact as to whether this action is 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]).

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: October 11, 2016Compas Med., P.C. v ELRAC, Inc. (2016 NY Slip Op 51497(U))

Reported in New York Official Reports at Compas Med., P.C. v ELRAC, Inc. (2016 NY Slip Op 51497(U))

[*1]
Compas Med., P.C. v ELRAC, Inc.
2016 NY Slip Op 51497(U) [53 Misc 3d 138(A)]
Decided on October 11, 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 October 11, 2016
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-2705 Q C

Compas Medical, P.C., as Assignee of Daniel Joseph, Appellant,

against

ELRAC, Inc., Respondent.


Appeal from an order of the Civil Court of the City of New York, Queens County (William A. Viscovich, J.), entered November 19, 2013. 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, defendant moved for summary judgment dismissing the complaint on the ground that the claims at issue had been timely denied based upon the failure of plaintiff’s assignor and/or plaintiff to provide timely written notice of the accident at issue (see 11 NYCRR 65-2.4 [a], [b]). The Civil Court granted defendant’s motion.

Contrary to plaintiff’s argument, defendant conclusively established that the documents providing notice of the subject accident had not been mailed until July 7, 2010, by submitting a photocopy of the envelope in which defendant first received the documents, on which both the postage and the postmark are dated July 7, 2010, and that they therefore had not been submitted to defendant within the time frame required by 11 NYCRR 65-2.4 (b) (cf. CPLR 2103 [b] [2]; [f] [1]; Kresch v Saul, 29 AD3d 863 [2006]). Consequently, neither plaintiff nor plaintiff’s assignor complied with a condition precedent to coverage (see 11 NYCRR 65-2.4 [a], [b]).

Plaintiff also argues that defendant failed to prove that it had timely denied the claims. However, defendant submitted an affidavit by an employee of its third-party administrator, which affidavit sufficiently established the timely mailing of the denial of claim forms (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). Furthermore, the denial of claim forms advised plaintiff that the late notice of claim would “be excused should the applicant or the assignee provide reasonable justification for the failure to give timely notice” (see 11 NYCRR 65-3.3 [e]; Radiology Today, P.C. v Citiwide Auto Leasing Inc., 15 Misc 3d 92 [App Term, 2d Dept, 2d & 11th Jud Dists 2007]). Defendant established that no such justification was provided. Thus, defendant’s motion for summary judgment dismissing the complaint was properly granted (see Great Health Care Chiropractic, P.C. v Elrac, Inc., 48 Misc 3d 139[A], 2015 NY Slip Op 51223[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]).

Accordingly, the order is affirmed.

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


Decision Date: October 11, 2016Avicenna Med. Arts, P.L.L.C. v MVAIC (2016 NY Slip Op 51535(U))

Reported in New York Official Reports at Avicenna Med. Arts, P.L.L.C. v MVAIC (2016 NY Slip Op 51535(U))

[*1]
Avicenna Med. Arts, P.L.L.C. v MVAIC
2016 NY Slip Op 51535(U) [53 Misc 3d 142(A)]
Decided on October 11, 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 October 11, 2016
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2014-415 K C

Avicenna Medical Arts, P.L.L.C., as Assignee of Domingo Francisco Santana, Respondent,

against

MVAIC, Appellant.


Appeal from a judgment of the Civil Court of the City of New York, Kings County (Ingrid Joseph, J.), entered July 3, 2013. The judgment, after a nonjury trial, awarded plaintiff the principal sum of $1,326.74.

ORDERED that the judgment is reversed, with $30 costs, and the matter is remitted to the Civil Court for the entry of a judgment in favor of defendant dismissing the complaint.

At a nonjury trial in this action by a provider to recover assigned first-party no-fault benefits, plaintiff’s billing manager testified that the claims had been mailed to defendant Motor Vehicle Accident Indemnification Corporation (sued herein as MVAIC). Following the trial, the Civil Court awarded judgment to plaintiff in the principal sum of $1,326.74.

“The filing of a timely affidavit providing the MVAIC with notice of intention to file a claim is a condition precedent to the right to apply for payment from [MVAIC]’ (see Insurance Law § 5208 [a] [1], [3]). Compliance with the statutory requirement of timely filing a notice of claim must be established in order to demonstrate that the claimant is a covered person,’ within the meaning of the statute, entitled to recover no-fault benefits from the MVAIC (see Insurance Law § 5221 [b] [2]; Ocean Diagnostic Imaging v Motor Veh. Acc. Indem. Corp., 8 Misc 3d 137[A], 2005 NY Slip Op 51271[U] [App Term, (2d Dept,) 2d & 11th Jud Dists (2005)])” (A.B. Med. Servs. PLLC v Motor Veh. Acc. Indem. Corp., 10 Misc 3d 145[A], 2006 NY Slip Op 50139[U], *3 [App Term, 2d Dept, 2d & 11th Jud Dists 2006]; see also M.N.M. Med. Health Care, P.C. v MVAIC, 22 Misc 3d 128[A], 2009 NY Slip Op 50041[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2009]; Bell Air Med. Supply, LLC v MVAIC, 16 Misc 3d 135[A], 2007 NY Slip Op 51607[U] [App Term, 2d Dept, 2d & 11th Jud Dists 2007]). As plaintiff did not establish that such an affidavit had been submitted to MVAIC, plaintiff failed to establish its prima facie case (see Insurance Law §§ 5202 [b]; 5208, 5221 [b] [2]).

Accordingly, the judgment is reversed and the matter is remitted to the Civil Court for the entry of a judgment in favor of defendant dismissing the complaint.

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


Decision Date: October 11, 2016Kings County Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 51446(U))

Reported in New York Official Reports at Kings County Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 51446(U))

[*1]
Kings County Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co.
2016 NY Slip Op 51446(U) [53 Misc 3d 136(A)]
Decided on October 5, 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 October 5, 2016

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2014-1123 K C
Kings County Chiropractic, P.C., as Assignee of HEMRAJ BALKRAN, Appellant,

against

State Farm Mutual Automobile Ins. Co., Respondent.

Appeal from a judgment of the Civil Court of the City of New York, Kings County (Devin P. Cohen, J.), entered July 2, 2013. The judgment, entered pursuant to a February 28, 2013 order of the same court granting defendant’s motion for summary judgment, dismissed the complaint.

ORDERED that the judgment is reversed, with $30 costs, the order entered February 28, 2013 is vacated, 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 a judgment of the Civil Court entered pursuant to an order of the same court which granted defendant’s motion for summary judgment dismissing the complaint.

Plaintiff correctly argues on appeal that defendant’s motion, which sought summary judgment on the ground that plaintiff had failed to appear for examinations under oath, should have been denied, as defendant failed to submit proof by someone with personal knowledge of plaintiff’s nonappearance (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]; Bright Med. Supply Co. v IDS Prop. & Cas. Ins. Co., 40 Misc 3d 130[A], 2013 NY Slip Op 51123[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2013]; Alrof, Inc. v Safeco Natl. Ins. Co., 39 Misc 3d 130[A], 2013 NY Slip Op 50458[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2013]).

Accordingly, the judgment is reversed, the order entered February 28, 2013 is vacated, and defendant’s motion for summary judgment dismissing the complaint is denied.

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


Decision Date: October 05, 2016
High Quality Med. Supplies, Inc. v Mercury Ins. Group (2016 NY Slip Op 51444(U))

Reported in New York Official Reports at High Quality Med. Supplies, Inc. v Mercury Ins. Group (2016 NY Slip Op 51444(U))

[*1]
High Quality Med. Supplies, Inc. v Mercury Ins. Group
2016 NY Slip Op 51444(U) [53 Misc 3d 136(A)]
Decided on October 5, 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 October 5, 2016

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2014-1081 K C
High Quality Medical Supplies, Inc., as Assignee of CHARLES BOTWEE, Respondent,

against

Mercury Ins. Group, Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Robin Kelly Sheares, J.), entered July 31, 2013. The order denied 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, defendant appeals from an order of the Civil Court which denied defendant’s motion for summary judgment dismissing the complaint.

In SK Prime Med. Supply, Inc. v State Farm Mut. Auto. Ins. Co. (43 Misc 3d 133[A], 2014 NY Slip Op 50630[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2014]), this court noted that the “NYS Medicaid DME Services Fee Schedule” has been adopted as the Durable Medical Goods Fee Schedule for Workers’ Compensation (12 NYCRR 442.2 [a]). However, contrary to defendant’s argument on appeal, that is not a basis to hold that “the billing for durable medical equipment that is not included within the fee schedule is not compensable.” Indeed, 11 NYCRR 68.5 specifically addresses reimbursement for healthcare services not set forth in fee schedules.[FN1]

Accordingly, the order is affirmed.

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

Decision Date: October 05, 2016

Footnotes

Footnote 1:11 NYCRR 65-3.16 (a) provides for payment of “medical expenses,” which shall be in accordance with fee schedules contained in 11 NYCRR 68, entitled “Charges for Professional Health Services.” Reimbursement for durable medical equipment is regularly treated as interchangeable with reimbursement for healthcare services under the No-Fault Regulations (see e.g. Fair Price Med. Supply Corp. v Travelers Indem. Co., 10 NY3d 556 [2008]; see generally Amaze Med. Supply v Allstate Ins. Co., 3 Misc 3d 43, 44 [App Term, 2d Dept, 2d & 11th Jud Dists 2004]).