September 15, 2016

Charles Deng Acupuncture, P.C. v Farmington Cas. Co. (2016 NY Slip Op 51326(U))

https://www.beynensonlaw.com/case-law/charles-deng-acupuncture-p-c-v-farmington-cas-co-2016-ny-slip-op-51326u/

Court: Appellate Term, Second Department
Decided: September 15, 2016
Citation: 2016 NY Slip Op 51326(U) · 53 Misc 3d 128(A)
Posture: Summary judgment
Outcome: Insurer prevailed
Issues: Fee schedule Timeliness and preclusion
Legal questions: Proof of mailing · Proving a fee schedule defense (see the maps)

Cite as

Charles Deng Acupuncture, P.C. v Farmington Cas. Co., 53 Misc 3d 128(A), 2016 NY Slip Op 51326(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2016)

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.

The insurer's summary judgment motion based on timely denials and full fee-schedule payment was granted and affirmed on appeal. The Appellate Term, Second Department, found that the insurer's proof established timely mailing of the denial forms and full payment under the workers' compensation fee schedule. It rejected the provider's contrary arguments without further explanation.

Reported in New York Official Reports at Charles Deng Acupuncture, P.C. v Farmington Cas. Co. (2016 NY Slip Op 51326(U))

[*1]

Charles Deng Acupuncture, P.C. v Farmington Cas. Co.

2016 NY Slip Op 51326(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This opinion is uncorrected and will not be published in the printed Official Reports.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.
2014-512 Q C

Charles Deng Acupuncture, P.C., as Assignee of Nina Amin, Appellant,

against

Farmington Casualty Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Jodi Orlow, J.), entered February 4, 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.

Contrary to plaintiff’s arguments on appeal, the proof submitted by defendant 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]), and that defendant had fully paid plaintiff for the services at issue in accordance with the workers’ compensation fee schedule.

Accordingly, the order is affirmed.

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

Decision Date: September 15, 2016

Legal questions (2)

Questions of no-fault law this decision rules on, from our Legal Questions pages. Bars count the decisions on the question by year and court, coloured by category; circles are this decision and the decisions on the question it cites or that cite it. Point at a bar or circle for details. The categories and summaries are Beynenson Law’s classification, made by a language model and checked by a second reading.

Proof of mailing

Open the full map

Did a party’s evidence establish that it mailed a no-fault claim, denial, verification request or examination notice?

This decision: The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice

Held, rejecting the provider's arguments, that the insurer's proof established that its denial of claim forms had been timely mailed.

Insurer proved mailingInsurer failed to proveProvider proved mailingProvider failed to proveTriable issue on mailingMixed rulingsThis decisionCites it or cited by itCited or followed

Of the 1,341 decisions on this question in the Second Department courts and the Court of Appeals, 798 (this one included) are in the same category.

Proving a fee schedule defense

Open the full map

Did the insurer prove that the amount billed exceeded the applicable workers’ compensation fee schedule?

This decision: Insurer proved the billed amount exceeded the applicable fee schedule

Held the insurer's proof established that it had fully paid the provider for the services at issue in accordance with the workers' compensation fee schedule, so dismissal was affirmed.

Excess shownNot established; openDefense rejectedSplit by chargeThis decision

Of the 284 decisions on this question in the Second Department courts and the Court of Appeals, 147 (this one included) are in the same category.

Cited in this decision

A label shows how this decision treated the case it cites.

St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co. (2008 NY Slip Op 04072) FollowedThe insurer raised factual issues concerning a proper timely denial and its entitlement to deny the hospital's claim.

Similar decisions

Charles Deng Acupuncture, P.C. v New S. Ins. Co. (2017 NY Slip Op 51189(U))The insurer's summary judgment dismissal was affirmed because the provider's challenges lacked merit or were first raised on appeal.
Charles Deng Acupuncture, P.C. v Allstate Ins. Co. (2017 NY Slip Op 51451(U))The insurer's affidavits failed to establish timely mailing, and the provider's affidavit failed to establish its prima facie case.
Charles Deng Acupuncture, P.C. v Unitrin Auto & Home Ins. Co. (2017 NY Slip Op 51834(U))The insurer's affidavit established timely mailing of the IME scheduling letters challenged by the provider.
Charles Deng Acupuncture, P.C. v Zurich Am. Ins. Co. (2018 NY Slip Op 51554(U))The insurer's cross motion for summary judgment was upheld because its proof established that it had issued no policy covering the loss.
Charles Deng Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51460(U))The insurer established full payment for CPT codes 97810 and 97811 under the workers' compensation fee schedule for chiropractors' acupuncture.