August 24, 2012

Acupuncture Works, P.C. v State Farm Mut. Auto. Ins. Co. (2012 NY Slip Op 51654(U))

Headnote

The case involved a dispute over the payment of first-party no-fault benefits to Acupuncture Works, P.C. as the assignee of Luis Quizhpi. The trial court granted the defendant's motion for summary judgment and dismissed the complaint. The main issues considered were whether the denial of claim forms had been timely mailed, if the defendant had fully paid the plaintiff in accordance with the workers' compensation fee schedule, and if there was a lack of medical necessity for the services based on an independent medical examination. The appellate court affirmed the judgment, stating that the defendant's motion for summary judgment was properly granted and the plaintiff's cross motion for summary judgment was properly denied based on the evidence presented. The holding of the case was that the appellate court affirmed the judgment of the trial court, dismissing the complaint by Acupuncture Works, P.C. The court found that the defendant had established that the denial of claim forms had been timely mailed, had fully paid the plaintiff in accordance with the workers' compensation fee schedule, and that there was a lack of medical necessity for the services based on the independent medical examination. Therefore, the defendant's motion for summary judgment was deemed proper and the plaintiff's cross motion for summary judgment was properly denied.

Reported in New York Official Reports at Acupuncture Works, P.C. v State Farm Mut. Auto. Ins. Co. (2012 NY Slip Op 51654(U))

Acupuncture Works, P.C. v State Farm Mut. Auto. Ins. Co. (2012 NY Slip Op 51654(U)) [*1]

Acupuncture Works, P.C. v State Farm Mut. Auto. Ins. Co.

2012 NY Slip Op 51654(U) [36 Misc 3d 149(A)]

Decided on August 24, 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This opinion is uncorrected and will not be published in the printed Official Reports.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 24, 2012

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

PRESENT: : PESCE, P.J., WESTON and RIOS, JJ
2010-2053 K C.

Acupuncture Works, P.C. as Assignee of LUIS QUIZHPI, 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 (Peter Paul Sweeney, J.), entered December 24, 2009. The judgment, entered pursuant to an order of the same court granting defendant’s motion for summary judgment dismissing the complaint and denying plaintiff’s cross motion for summary judgment, dismissed the complaint.

ORDERED that the judgment is affirmed, without costs.

In this action by a provider to recover assigned first-party no-fault benefits, the Civil Court granted defendant’s motion for summary judgment and denied plaintiff’s cross motion for summary judgment. Plaintiff appeals from a judgment which was subsequently entered dismissing the complaint.

Contrary to plaintiff’s contentions, defendant’s moving papers established that the denial of claim forms had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]). With respect to the claims which were denied based upon the workers’ compensation fee schedule, defendant demonstrated that it had fully paid plaintiff the amount to which plaintiff was entitled in accordance with the workers’ compensation fee schedule for acupuncture services rendered by a chiropractor (see Great Wall [*2]Acupuncture, P.C. v GEICO Ins. Co., 26 Misc 3d 23 [App Term, 2d, 11th & 13th Jud Dists 2009]). With respect to the claims which were denied based upon an independent medical examination (IME) performed by defendant’s acupuncturist, the sworn IME report established a lack of medical necessity for the services, and the affidavit of plaintiff’s acupuncturist did not meaningfully refer to, let alone rebut, the conclusions of defendant’s acupuncturist (see Pan Chiropractic, P.C. v Mercury Ins. Co., 24 Misc 3d 136[A], 2009 NY Slip Op 51495[U] [App Term, 2d, 11th & 13th Jud Dists 2009]; see also Eastern Star Acupuncture, P.C. v Mercury Ins. Co., 26 Misc 3d 142[A], 2010 NY Slip Op 50380[U] [App Term, 2d, 11th & 13th Jud Dists 2010]). In light of the foregoing, defendant’s motion for summary judgment dismissing the complaint was properly granted and plaintiff’s cross motion for summary judgment was properly denied.

Accordingly, the judgment is affirmed.

Pesce, P.J., Weston and Rios, JJ., concur.
Decision Date: August 24, 2012