September 23, 2004
CKC Chiropractic v Republic W. Ins. Co. (2004 NY Slip Op 24351)
https://www.beynensonlaw.com/case-law/ckc-chiropractic-v-republic-w-ins-co-2004-ny-slip-op-24351/
- Judge
- Eileen N. Nadelson, J.
- Decided
- September 23, 2004
- Citation
- 2004 NY Slip Op 24351 · 5 Misc 3d 492
- Posture
- Summary judgment
- Outcome
- Provider prevailed
- Later treatment
- Distinguished in 1 and followed in 1 later decisions (see Cited by)
- Legal questions
- Fraudulent incorporation (Mallela) (see the maps)
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.
Reported in New York Official Reports at CKC Chiropractic v Republic W. Ins. Co. (2004 NY Slip Op 24351)
| CKC Chiropractic v Republic W. Ins. Co. |
| 2004 NY Slip Op 24351 [5 Misc 3d 492] |
| September 23, 2004 |
| Civil Court Of The City Of New York, Kings County |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| As corrected through Wednesday, December 1, 2004 |
[*1]
| CKC Chiropractic, as Assignee of Sholanda Forbes and Others, Plaintiff, v Republic Western Insurance Co., Defendant. |
Civil Court of the City of New York, Kings County, September 23, 2004
APPEARANCES OF COUNSEL
Baker, Barshay & Neuwirth, P.C. (Robert J. Baker of counsel), for plaintiff. Meiselman, Denlea, Packman, Carton & Eberz, P.C. (Stephen L. Bauley of counsel), for defendant.
OPINION OF THE COURT
Eileen N. Nadelson, J.
This motion and cross motion for summary judgment raises a question of first impression under the regulations enacted pursuant to New York’s No-Fault Insurance Law.
Plaintiff sued defendant insurer to recover for first-party benefits under New York’s No-Fault Law. In support of its claim, plaintiff submitted proof of claim to defendant, including its proof of mailing. Plaintiff alleges that defendant failed to pay or deny its claim within 30 days as required by the No-Fault Law, nor has defendant requested additional verification. Under such circumstances, plaintiff asserts that defendant is precluded from raising a defense to its claim. (Presbyterian Hosp. v Maryland Cas. Co., 90 NY2d 274 [1997].) Therefore, plaintiff moved this court for summary judgment pursuant to CPLR 3211.
In opposition to plaintiff’s motion, defendant raised several issues, all of which have been dealt with during oral argument, leaving only one issue to be decided by the court. [*2]Defendant maintains that it does not have to pay the claim because plaintiff is not currently registered with the New York State Department of Education. This argument forms the basis of defendant’s cross motion for summary judgment. Plaintiff’s counsel has represented that plaintiff, although not currently registered, was registered at the time the services that form the basis of this claim were provided.
Therefore, the issue to be determined by the court is: Whether a health care provider who is registered with the New York State Department of Education at the time services are provided may recover the value of those services under New York’s No-Fault Insurance Law if the provider is no longer registered at the time payment for those services is sought?
11 NYCRR 65-3.16 (a) (12) states:
“A provider of health care services is not eligible for reimbursement under section 5102 (a) (1) of the Insurance Law if the provider fails to meet any applicable New York State or local licensing requirement necessary to perform such service in New York or meet any applicable licensing requirement necessary to perform such service in any other state in which such service is performed.”
To date, this section of the regulation has not been subject to judicial scrutiny.
The words of the statute would appear to be clear on its face: licensed to “perform such service.” However, without any other direct interpretation of this regulation, the court must look to other circumstances in which the judiciary has determined similar issues.
Section 691.10 (b) of title 22 of the Official Compilation of Codes, Rules and Regulations of the State of New York, dealing with the conduct of attorneys, states that “[a] disbarred, suspended or resigned attorney may be compensated . . . for legal services rendered and disbursements incurred by him prior to the effective date of the disbarment or suspension order or of his resignation.”
The rationale behind this regulation is that the services were provided by the attorney when he or she was licensed, and therefore the attorney is entitled to appropriate compensation for the work the attorney legally performed. (See generally, Casey v Ruffino, 306 AD2d 304 [2d Dept 2003]; Lee v Hayt, Percy & Mermelstein, 4 Misc 3d 1012[A], 2004 NY Slip Op 50853[U] [2004].)
Further, under general principles of contract law, it is well settled that contracts made by private parties must necessarily be construed in the light of the applicable law at the time of their execution. (10 NY Jur 2d, Contracts § 204, at 112; see City of Troy Unit of Rensselaer County Ch. of Civ. Serv. Empls. Assn. v City of Troy, 36 AD2d 145 [3d Dept 1971].) Generally, therefore, the validity of a contract will depend upon the law as it existed at [*3]the time it was made. (Goldfarb v Goldfarb, 86 AD2d 459 [2d Dept 1982].) The only exception to this rule occurs if there is a variation in the law that is made due to changes in public policy. Otherwise, the contract will be interpreted according to the law in effect at the time of its execution. (Bloomfield v Bloomfield, 97 NY2d 188 [2001].)
The court does not find any legislative intent that indicates it is against public policy to reimburse a medical provider for services rendered that were lawfully performed, regardless of the subsequent status of the medical provider.
Based on the foregoing, the court holds that a medical provider may be reimbursed for services rendered while he or she was registered and licensed to perform such services under section 65-3.16 (a) (12) of 11 NYCRR, even if the provider subsequently becomes unregistered.
Plaintiff’s motion for summary judgment is granted. Defendant’s cross motion for summary judgment is denied.
Legal questions
A question 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.
On the merits, when may a no-fault insurer withhold payment because unlicensed persons own or control the provider (Mallela)?
This decision: Alleged conduct legally cannot support the ineligibility defense
Held that a provider registered and licensed when it rendered the services remains eligible for reimbursement under 65-3.16 (a) (12) even though its registration later lapsed, so the insurer's ineligibility defense failed as a matter of law.
Of the 61 decisions on this question in the Second Department courts and the Court of Appeals, 9 (this one included) are in the same category. One decision in other departments that cites or is cited by this one is on the full map.
Cited by
A label shows how the later decision treated this one.
- A.B. Med. Servs. PLLC v Travelers Indem. Co. (2008 NY Slip Op 28185) DistinguishedA provider PLLC's summary judgment motion was denied because its sole member's suspension left it without authority to prosecute.
- Devonshire Surgical Facility v AIU Ins. Co. (2007 NY Slip Op 51034(U)) FollowedThe insurer failed to establish grounds to disturb summary judgment or obtain discovery concerning alleged fraudulent incorporation.
- Devonshire Surgical Facility v GEICO (2006 NY Slip Op 52450(U))The insurer's untimely denial precluded its fee-schedule, unbundling and provider-fraud defenses.
- 563 Grand Med., P.C. v Allstate Ins. Co. (2005 NY Slip Op 50127(U))A professional corporation lacking authorization to practice acupuncture cannot recover no-fault benefits for acupuncture services.
- Metro Med. Diagnostics, P.C. v Allstate Ins. Co. (2005 NY Slip Op 50327(U))A denial based on a pending investigation does not preserve defenses outside the regulatory verification procedures.
Similar decisions
- Citywide Social Work & Psychological Servs., P.L.L.C. v State Farm Mut. Auto. Ins. Co. (2006 NY Slip Op 51831(U))An untimely denial does not preclude a defense that a provider is fraudulently licensed and ineligible for no-fault reimbursement.
- Multiquest PLLC v Allstate Ins. Co. (2005 NY Slip Op 52209(U))A billing provider cannot recover assigned no-fault benefits for services rendered by an independent contractor rather than the provider or its employees.
- Multiquest, PLLC v Allstate Ins. Co. (2005 NY Slip Op 25512)The licensing bar in 11 NYCRR 65-3.16 (a) (12) does not apply retroactively to treatment provided before April 4, 2002.
- Health & Endurance Med., P.C. v Liberty Mut. Ins. Co. (2008 NY Slip Op 50864(U))A billing provider cannot recover direct payment of assigned no-fault benefits for services rendered by an independent contractor.
- Surgicare Surgical v National Interstate Ins. Co. (2014 NY Slip Op 24362)An insurer complies with 11 NYCRR 68.6 by paying the applicable local fee-schedule amount for services rendered outside New York. The Civil Court, Bronx County, granted the insurer's motion to dismiss and denied the provider's summary judgment cross motion concerning surgery performed in New Jersey.